What could better cost-effectiveness measurement look like, if it accounted for equity too?
A commitment to being cost-effective helps programme teams, funders and governments decide how to use limited resources to achieve the greatest possible impact. It shows the relationship between programme costs and results, helping teams understand what is working, where delivery can become more efficient and how performance can improve over time.
In family planning, the most widely used measure is cost per couple-year of protection (CYP): the cost of providing one year of contraceptive protection. Other measures capture outcomes such as the cost of averting an unintended pregnancy, an unsafe abortion, a maternal death or a disability-adjusted life year (DALY).
These measures are important, but no single ratio captures the full value of family planning. Access to contraception can help people avoid or delay pregnancy, reducing associated health risks while supporting wider opportunities such as education, employment, financial security and the ability to plan for the future. These benefits are difficult to reflect fully in a conventional cost-effectiveness calculation. The lasting impact is bigger than the sum of its parts.
For MSI, value for money is about more than achieving the lowest cost per CYP or DALY averted. It means delivering impact efficiently while ensuring that services protect quality, choice and autonomy, and reach people facing the greatest barriers to accessing reproductive healthcare.
This brief sets out MSI’s evolving approach to equity-adjusted value for money. It does not replace conventional cost-effectiveness measures but provides a fuller account of value by considering who was reached, whether care protected quality, choice and autonomy, and whether investment generated impact where access gaps were greatest.
