World Development Report 1984

measuring social acceptability, or easy formula for the amount spent by its formal layers of governensuring
it. ment-central, provincial, prefectural, and
county-on providing contraceptive supplies free
Financing family planning to users; reimbursing service fees for sterilization,
abortion, and IUD insertion; and providing train-
Public family planning programs, like programs in ing and information on family planning. These
education and health, are heavily subsidized, and costs amount to $213 million annually, about $0.21
services are often offered free of charge. Although per capita. In addition, the rural collective system
the private sector makes a significant contribution finances the family planning staff at the commune
to providing services in some countries, public or brigade level (at an estimated cost of $0.34 per
finance will continue to be critical, especially in capita) and pays incentives, in the form of food
low-income countries and in backward regions, supplements and reimbursement of travel costs, to
where contraceptive demand is limited and health holders of one-child certificates ($0.25 per capita)
services are weak. and to individuals undergoing sterilization ($0.15
per capita). Finally, additional time is spent by
Ptiblic spending barefoot doctors on family planning work (though
not much: in Shandong Province they allocate an
China and India-the two most populous coun- average of 1.5 percent of their time to family plantries
in the developing world, with approximately ning, valued at approximately $3 million). Health
half its population-spent roughly $1.00 and $0.30 workers and midwives probably spend more time
per capita, respectively, on population programs in on family planning. Adding all these contributions
1980. In most of three dozen developing countries together produces a figure for family planning
for which rough estimates are available, spending expenditure in China of nearly $1 per capita.
fell within this range (see Table 7.4). If other devel- Although governments finance a large share of
oping countries with programs were spending their population programs, the amounts spent are
equivalent amounts, the total spent on population still trivial-both in absolute terms and in relation
activities in all developing countries in 1980 must to other government outlays (see Box 7.7). In
have been about $2 billion. China the state budget for the family planning pro-
Practically all spending on population in China, gram absorbs only 0.4 percent of total current
and close to 80 percent of the total in India, is spending, compared with 5.2 percent for health
financed from domestic resources. For all other and 13.1 percent for education. In India and
developing countries combined, government and Mauritius spending on family planning in 1981
foreign donors each contribute about 50 percent. accounted for only 0.5 percent of total government
The government share tends to rise the longer a expenditure. The figures are even lower in Korea
program has been in existence. Three out of four (0.2 percent) and in Malaysia (less than 0.1
countries with programs less than five years old percent).
were contributing less than 10 percent of the costs Foreign donors spent an estimated $491 million
of their programs, in contrast to an average of 54 for population programs in developing countries
percent among twenty-seven countries with pro- in 1981; about two-thirds of this amount was for
grams at least ten years old. Nepal is one of the family planning and related programs. In realrare
exceptions: the share of domestic government terms, population assistance grew at almost 6 perfinancing
fell from 80 percent of its spending on cent a year during the 1970s but fell 3 percent inpopulation
in 1975 to 40 percent in 1980. 1980 and 6 percent in 1981. The prospects for
Even among well-established programs there is increased assistance are not good: UNFPA, a major
wide variation in government spending. Domestic channel for population assistance, expects its,
budgetary outlays in 1980 are estimated to have spending to rise by barely 1 percent over the next
been $0.42 per capita in Sri Lanka, about $0.71 per four years. Population assistance from donors is
capita in Korea, and $1.45 per capita in Costa Rica. discussed further in the next chapter.
But these estimates probably understate the true
government contribution. The cost of health work- Private spending
ers, whose functions often include family planning,
is not always imputed to the population pro- Important constraints limit the growth of private
gram-nor are contributions by local government. suppliers of family planning, especially in rural
The estimate for China of $1 per capita includes areas. The most severe constraint is the need for
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