Abstract
Background
Task-sharing, the expansion of health service provision to a broader range of health workers, where the number of providers is expanded through training and support of additional cadres, offers a strategy to alleviate some of the human resource and financial challenges that limit low- and middle-income countries’ (LMICs) ability to deliver essential health services, including family planning (FP). In this study, we apply the World Health Organization’s (WHO) recommendations to estimate the potential cost-savings from task-sharing FP services.
Methods
We use the Adding It Up (AIU) 2024 model estimates on contraceptive services for 128 LMICs to estimate the direct costs of providing contraceptive care for six methods – condoms (male and female), oral contraceptive pills, emergency contraceptive pills (ECP), injectables, implants and intrauterine devices. We compare the costs of two scenarios – a status quo (under current provider guidelines for FP service delivery) and a task-sharing scenario (implementing WHO task-sharing guidelines for FP service delivery).
Results
Implementing WHO task-sharing recommendations within the next year would save an estimated $1.6 billion USD across all LMICs. Task-sharing reduces the direct cost of service delivery for all six methods, saving 34% for male condoms, 31% for injectables, 30% for pills and IUDs, 22% for ECPs, 12% for implants and 9% for female condoms. These cost savings were largely consistent at the global, regional, and sub-regional levels.
Conclusions
WHO recommendations for task-sharing service delivery offer a critical cost-saving policy mechanism that leverages limited human and financial resources to better meet contraceptive needs while at the same time reducing health system costs. Cost estimates generated from the AIU model show that implementing WHO recommendations for task-sharing family planning services is a promising strategy for expanding access to contraceptive care across LMICs. Amidst increasing cuts to family planning financing, strategies for delivering quality services at lower costs are critical to ensuring continued access to care.
Trial registration
Not applicable.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s12913-026-14839-x.
Keywords: Task sharing, Family planning services, Contraceptive service delivery, Health system costs, Human resources for health, Cost modeling, Low- and middle-income countries
Background
Human resources remain a critical component of any health system’s goal of providing full access to essential services [1], including family planning (FP). Countries classified by the World Bank as Lower- and Middle-Income (LMICs) are confronted with significant constraints on meeting demand for health services. Over the last decade, healthcare delivery systems, and healthcare workers in particular, were expected to do more with the same or less funding – deliver services to a growing population with complex demography-based health needs, with flat-lined or reduced funding and patient-to-provider ratios [2–4]. The withdrawal of the United States Agency for International Development, the largest donor of family planning assistance, transformed a difficult situation into a dire reality [5]. One strategy that evidence increasingly indicates could alleviate some of this pressure is task-sharing. In its foundational guidance the World Health Organization (WHO) defines task-sharing as expanding health service tasks from providers with specialized training is expanded to a broader set of providers to improve efficiency and coverage while maintaining quality standards: a concept first formalized in WHO’s 2008 guidance on task-shifting with a focus on HIV/AIDS [6], and subsequently extended to family planning [7]. Under a task-sharing model, mid-level and lay health providers, such as clinical officers, midwives, nurses and community health workers (CHWs), receive training that expands their ability to deliver all or some components of service provision.
The WHO developed recommendations specific to task-sharing for FP services to guide and spur adoption across member countries [7]. These recommendations outline which cadre of providers can provide what FP method and how to maintain quality and safety of services through training, supportive supervision, and adequate supply of contraceptive commodities.
Through training, supportive supervision and strategic implementation, task-sharing FP service delivery can expand the number of FP providers and increase access, while ensuring that quality of care and patient outcomes are comparable regardless of health provider cadre [8]. Systematic reviews of task-sharing initiatives across several countries and a broad set of services such as tuberculosis care, HIV/AIDS testing and treatment, mental health services, and maternal and newborn health (MNH), have demonstrated positive return-on-investment [9–14].
Despite this growing body of evidence supporting task-sharing FP services [14–17], there remains limited data about the implications of and associated cost-savings from scaling-up implementation at the national level. This paper models the cost implications to the health system of adopting the WHO recommendations across 128 LMICs, providing global, regional and sub-regional estimates of the cost-savings that can be achieved from task-sharing FP services.
Methods
This study estimates the cost savings associated with task sharing in the provision of contraceptive care and pregnancy related and newborn care in LMICs, from a health-system perspective with provider-mediated delivery of contraceptives. The analysis utilizes the Adding It Up (AIU) 2024 model [18, 19], which estimates the need, impact and costs associated with providing sexual and reproductive health (SRH) services across 128 LMICs. The results from the AIU model are presented in reports generated every 3–4 years which inform global, regional and national policy advocacy discussions on the resources required to fulfill contraceptive, abortion as well as maternal and newborn health needs.
The AIU model generates estimates through incorporating the following categories and sources of data:
Demographic data on population, from the Department of Economic and Social Affairs, Population Division (UNPD) World Population Prospects 2024 [20, 21];
Contraceptive method mix from each country’s most recent method use survey, as well as overall levels of contraceptive use for the UNPD World Contraceptive Use model-based estimates are combined with estimated population data to generate estimated number of users for each contraceptive method;
Treatment based on globally standardized protocols for providing contraceptive services;
Ingredient-based or bottom-up costing approach.
The treatment assumptions for each service intervention are based on information from the WHO One Health Tool (OHT) [22], refined to adhere to WHO protocols, and updated based on scientific literature and expert review. These inputs consist of three direct cost categories – personnel, contraceptive commodities and consumable supplies – which combine to generate the unit cost (per person or user per year) of providing direct FP services. For each contraceptive service, treatment protocols are outlined that quantify the types and quantities of commodities and medical supplies needed to provide contraceptive services as well as personnel levels, number of minutes and cost-per-minute (based on estimated salary data) for each service.
Personnel costs data come from WHO- CHOosing Interventions that are Cost-Effective (CHOICE) salary estimates (inflated to 2024 US dollars) [23, 24]; while the inputs for commodities and medical supplies come from the Reproductive Health Supplies Coalition FP Visibility Analytics Network (RHSC-VAN) [25], United Nations Population Fund (UNFPA) [26], Management Sciences for Health supplies [27], and UNICEF procurement databases [28]. Table 1 below outlines the detailed descriptions for the three direct cost categories. The AIU 2024 Methodology Report [19] provides detailed documentation of the AIU 2024 model methodology.
Table 1.
Direct cost category descriptions
| Cost Category | Description |
|---|---|
| Personnel | Personnel costs represent compensation for health workers providing contraceptive care. These are calculated using time-based assumptions multiplied by country specific personnel salaries from the 2010 WHO-CHOosing Interventions that are Cost-Effective (CHOICE) estimates [23] which were adjusted to 2024 levels based on International Monetary Fund (IMF) World Economic Outlook’s country-specific GDP deflator data [24]. |
| Contraceptive commodities | Contraceptive commodity costs are calculated by multiplying the average prices per unit of each method multiplied by the number of units needed per person/couple per year of protection (CYP). The average price per commodity unit is taken from the Reproductive Health Supplies Coalition FP Visibility Analytics Network for 2017–2023 [25], weighted by the distributed volume of each method’s presentation and factoring in an additional 45% for supply chain wastage – (30%) and last mile distribution (15%) costs. Wastage rate includes expiration, damage, and other losses prior to dispensing, applied to all drug and supply prices, in line with AIU 2024 methodology (19, p.101). The number of units per person per year are based on the estimated quantity needed to provide one CYP based on supplemented scientific literature and expert review. |
| Consumable supplies | Supply costs include drugs and single-use medical products (e.g., syringes, bandages) required for FP service provision. This is calculated by multiplying the average price per unit of each item by the quantity required per person per year. Nearly all supplies cost data are drawn from the United Nations Population Fund (UNFPA) procurement [26], Management Sciences for Health supplies procurement [27], UNICEF product supply [28] and the International Development Association (IDA) Foundation’s product price indicators [29]. |
The estimates of all three categories are annualized by dividing the cost per person per method by the quantity needed to provide one couple-years of protection (CYP), which is based on each method’s average length of use and drawn from AIU methodology: 14 for pills and ECP, 77 for condoms, average of 7.7 for injectables, average of 3 for implants and 4.7 for IUDs [19]. The CYP factor for condoms reflects AIU’s assumption of a monthly coital frequency of 5.6 over 12 months, with an adjustment for user wastage, rather than a simple 12-month-of-use conversion. The AIU model incorporates CYP factors for each method based on the average length of use in generating annual costs, however, it accounts for method failure rates in generating estimated demographic impact, in terms of pregnancies averted.
Table 2 maps the provider cadres recommended in the WHO FP task-sharing guidelines [7], to the staff categories used in the AIU model for each contraceptive method and scenario. Provider salary data by cadre are drawn from the WHO-CHOICE database [23] and then linked to AIU staff groupings.
Table 2.
Personnel provider by cadre for each contraceptive method selected for analysis
| Method | Personnel | |
|---|---|---|
| Status quo scenario | Task-sharing scenario | |
| Informed Choice Counselling | Nurse or Midwife | Community Health Worker or Assistant Nurse |
|
Oral and Emergency Contraceptive Pills (OCPs and ECPs) |
Nurse or Midwife (contraceptive service provision) |
Community Health Worker or Assistant Nurse (contraceptive service provision) |
|
Condoms (female and male) |
Nurse or Midwife (contraceptive service provision) |
Community Health Worker or Assistant Nurse (contraceptive service provision) |
| Injectables | Nurse or Midwife (contraceptive service provision) |
Community Health Worker or Assistant Nurse (contraceptive service provision) |
| Implants | Nurse or Midwife (contraceptive service provision) |
Community Health Worker or Assistant Nurse (contraceptive insertion and removal) |
| IUD | Physician or obstetrician (contraceptive insertion and removal) | Nurse/Midwife (contraceptive insertion and removal) |
As outlined in Table 2, delivery of all contraceptive services for this analysis includes informed choice counselling as an integral task. Salary data for tasks that are performed by nurses or midwives applies to the average salary for both cadres. Salary data for tasks performed by CHWs or assistant nurses, applies to the average salaries for all cadres (pharmacy worker/technician, pharmacist and auxiliary nurse) between the two cadres.
Our analysis focuses exclusively on the direct service delivery costs of implementing FP task-sharing. As such, we assume that the necessary concomitant investments in an enabling environment and supporting health system infrastructure have already been made to ensure quality of care and patient outcomes are equivalent, regardless of the provider’s cadres.
Analysis
The task-sharing scenario modifies personnel cadres only, as outlined in the WHO’s FP task-sharing guidelines [7]. The core of the analysis compares personnel and direct service delivery costs between two scenarios – status quo and task-sharing. The status quo scenario uses the estimated amount of time spent by health provider cadre per visit taken from WHO OHT - a global model for estimating health systems costs, which assumes service delivery at current or pre-task sharing levels. We assume that the total estimated number of users is the same for both scenarios; however, the key difference between the two scenarios is the annualized personnel cost by method. We model the annual personnel cost and resulting direct service cost for both scenarios at the country level, then produce average annual personnel and direct cost (per person) as well as the total estimates for all LMICs at subregion, region and global levels [20].
Therefore, task sharing is expected to reduce personnel costs, which in turn lowers total direct costs, as personnel expenditure constitutes a component of direct costs. We estimate personnel costs and direct costs in status quo and task sharing scenarios, in 2024 US dollars (USD), for six family planning (FP) methods. These include four short-acting reversible contraceptives (SARCs): condoms (male and female), oral contraceptive pills (OCP/pills), emergency contraceptive pills (ECPs), and injectables; and, two that are long-acting reversible contraceptives (LARCs): implants and intrauterine devices (IUDs).We assume FP method provision includes informed choice counselling as well as screening for STI/HIV and GBV as important components of quality and rights-based service delivery.
We calculate annual absolute total direct cost savings (in USD) by subtracting the annual total direct cost under the task-sharing scenario from that under the status quo scenario. Relative total cost savings (in %) are calculated by dividing absolute total direct cost savings by the annual total direct cost under the status quo scenario. Annual cost per person is defined as the total annual direct cost of a contraceptive method in a given scenario divided by the number of users of that method. Absolute and relative cost savings per user are calculated using the same approach as for total cost savings.
We assess regional and sub-regional cost savings by two classification types. Using the absolute cost savings results, we first assess which region and subregions account for the largest share of global and regional cost savings, respectively. Next, we use relative cost savings results to compare the costs in status quo scenario relative to its task-sharing scenario and assess cost savings for each region and subregion.
Results
Average personnel costs
First, we compared the annualized personnel cost per person for each method for both scenarios, to identify the immediate cost implications of task-sharing. As shown in Table 3, annualized personnel costs are highest for short-acting reversible contraceptives (SARCs) with a range of $10.84 per user for pills to $7.29 per ECP. The annualized personnel cost for delivering long-acting reversible contraceptive (LARC) methods was an average of $3.18 for IUDs and $4.18 for implants. When services are reconfigured to task-sharing recommendations, personnel cost savings are 44% for condoms (male and female), pills, and injectables, 39% for ECP, 33% for IUDs and 22% for implants.
Table 3.
Annual average personnel costs per person (USD) under status quo and task-sharing scenarios, including absolute (USD) and relative (%) cost savings by contraceptive method, in 128 LMICs
| Cost | Pills | ECP | Condom (male) | Condom (female) | Injectables | Implants | IUD |
|---|---|---|---|---|---|---|---|
| Status quo | $10.84 | $7.29 | $9.07 | $9.91 | $10.54 | $4.18 | $3.18 |
| Task-sharing | $6.10 | $4.46 | $5.10 | $5.58 | $5.93 | $3.27 | $2.12 |
| Cost Savings (USD) | $4.74 | $2.83 | $3.97 | $4.33 | $4.61 | $0.91 | $1.06 |
| Cost Savings (%) | 44% | 39% | 44% | 44% | 44% | 22% | 33% |
Although personnel salaries and costs vary across regions and sub-regions, the standardized approach to estimating these costs generates the same levels of cost savings as the global average. Regional cost comparisons and cost savings are detailed in the table S1 in additional file.
Average annual direct costs
Comparison between the average annual direct cost per user for both scenarios shows a similar pattern in cost savings in all but one method (female condom). The average savings in annual direct costs per person by method for all LMICs are 34% for male condoms, 31% for injectables, 30% for pills and IUDs, 21% for ECP, 12% for implants and 9% for female condoms (see Table 4). Regional comparisons of direct costs and cost savings are detailed in table S2 in additional file.
Table 4.
Annual direct costs per person (USD) under status quo and task-sharing scenarios, including absolute (USD) and relative (%) cost savings by contraceptive method, in 128 LMICs
| Cost | Pills | ECP | Condom (male) | Condom (female) | Injectables | Implants | IUD |
|---|---|---|---|---|---|---|---|
| Status quo | $15.59 | $13.26 | $11.57 | $46.96 | $15.10 | $7.50 | $3.60 |
| Task-sharing | $10.85 | $10.42 | $7.60 | $42.63 | $10.49 | $6.59 | $2.54 |
| Cost Savings (USD) | $4.74 | $2.83 | $3.97 | $4.33 | $4.61 | $0.91 | $1.06 |
| Cost Savings (%) | 30% | 21% | 34% | 9% | 31% | 12% | 30% |
Number of users by method
The number of users per method varies considerably by region, which in turn influences the distribution of total cost savings (Table 5). Across all 128 LMICs, there are an estimated 481 million users of the six methods included in this analysis. Asia region accounts for the largest share with 325 million users, followed by 90 million users in the Africa region, 61 million users in the Latin America and the Caribbean (LAC), 5 million users in the European region, and 552 thousand in the Oceania region (the sub-regional disaggregated number of users are detailed in Table S3 in additional file).
Table 5.
Estimated number of modern contraceptive method users (in thousands) and method mix by UNPD region
| Pills | ECP | Condom (male) | Condom (female) | Injectables | Implants | IUD | Region Total | |
|---|---|---|---|---|---|---|---|---|
| Africa | 20,873 (23%) | 604 (1%) | 12,209 (14%) | 415 (> 1%) | 28,332 (32%) | 17,768 (20%) | 9,654 (11%) | 89,855 (100%) |
| Asia | 60,716 (19%) | 496 (> 1%) | 119,200 (37%) | 370 (> 1%) | 30,849 (10%) | 5,840 (2%) | 107,119 (33%) | 324,590 (100%) |
| Europe | 735 (14%) | 1 (> 1%) | 3,282 (61%) | 37 (1%) | 10 (> 1%) | 12 (> 1%) | 1,339 (25%) | 5,417 (100%) |
| Latin America & the Caribbean | 22,603 (37%) | 84 (> 1%) | 16,163 (27%) | 171 (> 1%) | 11,375 (19%) | 3,324 (5%) | 7,085 (12%) | 60,805 (100%) |
| Oceania | 64 (12%) | N/A* (N/A*) | 26 (5%) | 6 (1%) | 223 (40%) | 208 (38%) | 24 (4%) | 552 (100%) |
| All LMICs | 104,991 (31%) | 1,186 (0%) | 150,881 (0%) | 1,000 (6%) | 70,789 (15%) | 27,152 (26%) | 125,220 (22%) | 481,219 (100%) |
*No data available on use of emergency contraceptive pills (ECPs) for LMICs in Oceania
Total direct costs
Task-sharing would reduce total direct costs by US $1.6 billion (31%) across all 128 LMICs. This reduction is based on the difference between the estimated $5.17 billion in service delivery costs for the status quo scenario and $3.58 billion for the task-sharing scenario. While our health systems perspective assumes provider-mediated delivery for all methods, we acknowledge that in practice all contraceptives could be accessed via self-service channels, and condoms are most commonly acquired in this way. Excluding male and female condoms, task-sharing would still yield estimated savings of US $985 million. The largest savings accrued from task-sharing SARCs - condoms (34%), injectables (31%), pills (30%), ECP (21%), with similar savings in LARCs - IUD (30%) and implants (12%). Table 6 below shows the costs of the two scenarios as well as the cost difference and cost savings by method. In our second level analysis, we assess regional cost savings by two classification types, and Table S4 in additional file shows the same results by regions. We first assess which region(s) account for the largest share of global cost savings. Next, we compare each region’s status quo scenario relative to its task-sharing scenario to assess cost savings (see Table 7; also see supplementary table S5 in the additional file for the same table excluding male and female condoms, and tables S6 and S7 for absolute and relative costs by subregions).
Table 6.
Comparison of total direct costs (USD, in million) under status quo and task-sharing scenarios, including absolute (USD) and relative (%) cost savings by contraceptive method across 128 LMICs
| Cost | Pills | ECP | Condom (male) | Condom (female) | Injectables | Implants | IUD | Total |
|---|---|---|---|---|---|---|---|---|
| Status quo | $1,637 | $16 | $1,746 | $47 | $1,069 | $204 | $451 | $5,169 |
| Task-sharing | $1,139 | $12 | $1,147 | $43 | $742 | $179 | $318 | $3,581 |
| Cost Savings (USD | $498 | $3.4 | $598 | $4.3 | $326 | $25 | $133 | $1,588 |
| Cost Savings (%) | 30% | 21% | 34% | 9% | 31% | 12% | 30% | 31% |
Table 7.
Total direct absolute cost savings (USD, millions,) regional share of global savings, and method distribution of absolute savings within region (%)
| Total absolute cost savings | Regional share of global cost savings | Method distribution of regional cost savings | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Pills | ECP | Condom (male) | Condom (female) | Injectables | Implants | IUD | |||
| Africa | $371 | 23% | 37% | 0.3% | 14% | 0.4% | 39% | 4% | 6% |
| Asia | $804 | 51% | 23% | 0.2% | 53% | 0.1% | 11% | 1% | 12% |
| Europe | $25 | 1.6% | 18% | 0.01% | 73% | 0.8% | 0.2% | 0.1% | 7% |
| Latin America & the Caribbean | $386 | 24% | 45% | 0.1% | 27% | 0.4% | 24% | 2% | 2.8% |
| Oceania | $1.3 | 0.1% | 17% | N/A* | 6% | 1.5% | 63% | 11% | 1.4% |
*No data available on use of emergency contraceptive pills (ECPs) for LMICs in the Oceania
Our assessment of the regional results presented in Table 7 shows the combined impact of two key factors that drive cost savings – the total number of users in the region and having a larger proportion of SARC users. The Asia, LAC and Africa regions account for 98% of global savings (51%, 24% and 23%, respectively). Within the Asia region, the largest cost savings were from condoms (53%), pills (22%), IUD (12%) and injectables (11%). A slightly different pattern emerges for the LAC region where task-sharing saved 45% in cost of pills, 27% for condoms and 24% for injectables. In the Africa region, injectables account for the largest share of cost savings at 39%, while savings for pills and condoms account for 37% and 14%, respectively.
The results in Table 7 show aggregate savings across all regions with savings ranging from 34% for LMICs in the European region to 24% for LMICs in the Oceania region, with the LAC (32%), Africa (30%), and Asia (30%) regions falling between that range.
Cost savings by method type for the Asia and European regions follow a similar pattern with condoms accounting for the largest share of cost savings, followed by pills and IUDs. For LMICs in the Africa and Oceania regions, injectables represent the largest share of cost savings followed by pills and condoms. For LMICs in the LAC region, pills account for the largest share of cost savings, followed by condoms and injectables.
Discussion
Implications
The primary premise of task-sharing is to address the shortage of highly skilled health workers by redistributing responsibilities among different health worker cadres, thereby expanding access to services and lowering health system costs. The results show that task-sharing achieves the greatest direct cost savings for condoms, followed by injectables, pills, and IUDs, suggesting that the more tasks associated with a method’s provision can be shifted, the greater the potential cost savings. This shows task-sharing achieves cost savings across all regions, providing a strong case for implementing WHO recommendations [7]. While this analysis presents the perspective of the health system provider and assumes services are delivered by a trained health worker, it is important to note that provision of certain contraceptive care services, such as condoms and injectables, are shifting towards individual self-care. This shift towards self-care has the potential to result in further health system cost savings and expanded access, and further work could incorporate demand for self-care data where available to understand additional cost savings.
Although significant, direct cost savings are not the same magnitude as personnel cost savings because of the moderating effect of contraceptive commodities and consumable supplies costs. The higher the cost-share of those latter categories, the lower savings from personnel cost translate to direct cost. This limiting effect was most prominent for female condoms where direct cost savings were lower relative to personnel cost savings because the average cost of female condoms account for 80% ($36.23 of $45.55) of direct service cost for the status quo scenario.
While the results of this analysis focus on costs, it is important to consider the overall impact of task-sharing FP service delivery and its impact on expanding method access and choice. Country assessments of task-sharing have shown increasing impact in terms of method availability and use. A rapid program review of pilot projects in Burkina Faso, Côte d’Ivoire, Ethiopia, Ghana and Nigeria, showed that increases in LARCs and contraceptive prevalence as well as reduction in total fertility followed implementation of task-sharing strategies [30]. In-depth evaluations of Pakistan’s Lady Health Worker (LHW) program, described an 11% increase in contraceptive use in relative to areas with no LHWs (all other provider levels remaining equal) [31]. Similarly, assessments of Ethiopia’s health extension worker (HEW) program showed that areas with access to services delivered by HEWs correlated with increased contraceptive prevalence [32].
Nevertheless, there remains a critical gap in evidence of the cost-effectiveness of implementing task-sharing at the national level. A 2023 analysis of national health systems policies and treatment protocols for LARCs in seven sub-Saharan countries - Democratic Republic of Congo, India, Mali, Mozambique, Nigeria, Rwanda and Senegal - found a need to increase availability and awareness of task-sharing of FP services as well as greater clarity of scopes of practice for providers [33]. The analysis recommended strengthening health systems’ enabling environment (such as improved training, supportive supervision, increased and reliable supply of commodities), as well as better compensation mechanisms for providers [34].
Data on implant insertion and removal by CHWs have shown promising outcomes at sub-national levels in Ethiopia and Nigeria, as have data on IUD insertion and removal by nurses and midwives [32, 35, 36]. However, those successes have yet to be implemented across all regions/states in these countries. Above all, these data would provide robust evidence that decision-makers need to scale-up task-sharing initiatives, reap cost savings, lower access barriers to and deliver quality FP services.
Limitations
A primary limitation of this analysis is its reliance on global average data for personnel costs, commodity prices, and supply costs, due to the lack of comprehensive and conclusive country-level data on these specific inputs for contraceptive service delivery. Furthermore, data on the current, national-level implementation of task-sharing for FP are limited. Our review indicates that while FP task-sharing policies are described for many LMICs, evidence of their implementation is often limited to sub-national pilot studies and programs. As such, we assume that current service delivery across all LMICs remains at pre-task-sharing modalities. We also assume that initial investments have been made to foster an enabling policy and implementation environment as well as a supporting health system infrastructure to ensure quality of care and patient outcomes are the same regardless of provider cadre. Due to the wide variation in program support and health system costs associated with task-sharing [14, 16], this analysis could not account for these additional costs which may affect the cost estimates presented here. Relatedly, our health systems perspective treats all contraceptive methods as provider-mediated, in line with WHO task-sharing guidance, which is normative rather than descriptive of current practice. This assumption is a stronger simplification for condoms than for other methods, as condoms are widely accessed through over-the-counter, pharmacy, and community-based channels in many LMICs; we therefore present additional results excluding male and female condoms in the “Total direct costs” sub-section under "Results" and in Supplemental Table S5 to support transparent interpretation of the headline savings. Our review of the available literature does not show conclusive correlation between task-sharing FP service delivery and changes in method use, as such this analysis does not account for potential changes to the distribution of users across the different methods.
Conclusion
The results presented here add to the growing evidence that task-sharing can significantly reduce the cost of delivering FP services at global, regional, and sub-regional levels. Scaling task-sharing may offer substantial, sustained reductions in FP service delivery costs, particularly in settings with high SARC reliance and limited human resources. As policymakers and program managers work to strengthen health systems and service delivery following the drastic funding cuts in global health funding limited domestic government fiscal space for health and strained human resources, task-sharing offers a promising strategy for maneuvering resource constraints to meet their population’s contraceptive needs.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
This report was made possible by UNFPA, Ayman Abdelmohsen and Olanike Adedeji. Any opinions stated within this document reflect those of the authors and not necessarily of the United Nations Population Fund. The authors also acknowledge the World Health Organization (WHO) and HRP, whose 2025 guidance, Guidance on planning, implementing and scaling up task sharing for contraceptive services [7] presents early findings from the modelling work reported in this paper.
Author contributions
AA developed the research methodology, analyzed the data, and prepared the manuscript. MO developed and executed the analyses code, exported analysis results, number checked and edited the manuscript. HQ conceptualized the study, reviewed and edited the draft of the manuscript. MA conceptualized the study, validated the content, reviewed and edited the manuscript. ES conceptualized the study, developed the research methodology, validated the content, reviewed and edited the manuscript. All authors read and approved the final manuscript before submission.
Funding
This report was made possible by UNFPA. Any opinions stated within this document reflect those of the authors and not necessarily of the United Nations Population Fund.
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethical approval and consent
This study used secondary, anonymized data from globally available survey datasets. The datasets do not contain personally identifiable information (PII). In accordance with institutional and national guidelines, ethics approval and informed consent were not required for secondary analysis of anonymized data.
Consent for publication
Not applicable.
Disclaimer
This report contains the collective views of an international group of experts and does not necessarily represent the decisions or the stated policy of the World Health Organization or the United Nations Population Fund.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.World Health Organization. Global Strategy on Human Resources for Health: Workforce 2030. Geneva: World Health Organization; 2016. [Google Scholar]
- 2.World Bank. World Bank country and lending groups (2024/25 fiscal year) [Internet]. 2024 [cited 2024 Jul 10]. Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/378832-what-is-the-world-bank-atlas-method
- 3.de Silva S, Jadhav A, Fabic MS, Munthali L, Oyedokun-Adebagbo F, Kebede Z. Family planning reproductive health, and progress toward the sustainable development goals: reflections and directions on the 30th anniversary of the international conference on population and development. Glob Health Sci Pract. 2024;12(5):e2400127. 10.9745/GHSP-D-24-00127 [DOI] [PMC free article] [PubMed]
- 4.World Health Organization. WHO Health workforce support and safeguards list 2023. Geneva: World Health Organization; 2023. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Damavandi S, Sully E, Friedrich-Karnick A, Tignor M. Just the numbers: the impact of US international family planning assistance, 2024 [Internet]. New York: guttmacher institute; 2025 Feb [cited 2024 Jun 4]. Available from: https://www.guttmacher.org/2025/02/just-numbers-impact-us-international-family-planning-assistance-2024
- 6.World Health Organization, US President’s Emergency Plan for AIDS Relief, Joint United Nations Programme on HIV/AIDS. Task Shifting: Rational Redistribution of Tasks Among Health Workforce Teams: Global Recommendations and Guidelines. Geneva: World Health Organization; 2008.
- 7.World Health Organization. Guidance on planning, implementing and scaling up task sharing for contraceptive services. Geneva: World Health Organization; 2025. [Google Scholar]
- 8.Bhadra B, Burman S, Purandare C, Divakar H, Sequeira T, Bhardwaj A. The impact of using nurses to perform postpartum intrauterine device insertions in Kalyani Hospital, India. Int J Gynaecol Obstet. 2018;143(Suppl 1):33–7. 10.1002/ijgo.12602. [DOI] [PubMed] [Google Scholar]
- 9.World Health Organization. WHO Recommendations: Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting. Geneva: World Health Organization; 2012. [PubMed] [Google Scholar]
- 10.Yanguela J, Pence B, Udedi M, Banda J, Kulisewa K, Zimba C. Implementation strategies to build mental health-care capacity in Malawi: a health-economic evaluation. Lancet Glob Health. 2024;12(4):e662–71. 10.1016/S2214-109X(23)00597-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Schaefer L. Task-sharing implant insertion by community health workers: Not just can it work, but how might it work practically and with impact in the real world. Glob Health Sci Pract. 2015;3(3):327–9. 10.9745/GHSP-D-15-00230. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Dadirai Mdege N, Chindove S, Ali S. The effectiveness and cost implications of task-sharing in the delivery of antiretroviral therapy to HIV-infected patients: A systematic review. Health Policy Plan. 2013;28(3):223–36. 10.1093/heapol/czs058. [DOI] [PubMed] [Google Scholar]
- 13.Bollinger L, Adesina A. Using the national optimized treatment costing (OTC) tool to estimate ART costs for differentiated care. In. San Francisco; 2020.
- 14.Dawson A, Buchan J, Duffield C, Homer C, Wijewardena K. Task shifting and sharing in maternal and reproductive health in low-income countries: a narrative synthesis of current evidence. Health Policy Plan. 2014;29(3):396–408. 10.1093/heapol/czt026. [DOI] [PubMed] [Google Scholar]
- 15.Seidman G, Atun R. Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries. Hum Resour Health. 2017;15(1):29. 10.1186/s12960-017-0200-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.MacLachlan E, Atuyambe L, Millogo T, Guiella G, Yaro S, Kasasa S. Continuation of subcutaneous or intramuscular injectable contraception when administered by facility-based and community health workers. Contraception. 2018;98(5):423–9. 10.1016/j.contraception. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Ayuk B, Yankam B, Saah F, Bain L. Provision of injectable contraceptives by community health workers in sub-Saharan Africa. Hum Resour Health. 2022;20(1):66. 10.1186/s12960-022-00763-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Sully EA, Rosenberg JD, Tignor M, Geddes, Christina E, Dilaverakis Fernandez A, Polis C. Adding It Up 2024: Investing in sexual and reproductive health in low- and middle-income countries [Internet]. New York: Guttmacher Institute; 2025 [cited 2026 Feb 10]. Available from: https://www.guttmacher.org/report/adding-it-up-2024-investing-sexual-and-reproductive-health-low-and-middle-income-countries
- 19.Rosenberg JD, Sully EA, Murulidhar A, Audam S, Schwab C. Adding It Up 2024: investing in sexual and reproductive health in low- and middle-income countries—methodology report [Internet]. New York: Guttmacher Institute; 2025 [cited 2026 Feb 10]. Available from: https://osf.io/hrw6f
- 20.United Nations Department of Economic and Social Affairs PD. World Population Prospects 2024 [Internet]. Available from: https://population.un.org/wpp/
- 21.United Nations Department of Economic and Social Affairs SD. Standard country or area codes for statistical use (M49) [Internet]. 2024. Available from: https://unstats.un.org/unsd/methodology/m49/
- 22.UN Inter-Agency Working Group on Costing. OneHealth Tool [Internet]. Available from: https://www.avenirhealth.org/softwareonehealth.php
- 23.Serje J, Bertram M, Brindley C, Lauer J. Global Health Worker Salary Estimates: An econometric analysis of global earnings data. Cost Eff Resour Alloc. 2018;16:10. 10.1186/s12962-018-0093-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.International Monetary Fund. World Economic Outlook, April 2024: Steady but Slow: Resilience amid Divergence. International Monetary Fund; 2024.
- 25.Reproductive Health Supplies Coalition. Global Family Planning Visibility and Analytics Network [Internet]. Available from: https://www.rhsupplies.org/gfpvan/about.html
- 26.UNFPA Procurement Services. UNFPA Product Catalog [Internet]. 2019. Available from: https://www.unfpaprocurement.org/products
- 27.Management Sciences for Health. International Medical Products Price Guide [Internet]. 2015. Available from: http://mshpriceguide.org/en/home/
- 28.United Nations Children’s Fund. UNICEF Supply Catalogue [Internet]. 2018. Available from: https://supply.unicef.org/
- 29.IDA Foundation. Product Indicator 2023 [Internet]. Available from: https://web.archive.org/web/20230204005337/https://idafoundation.org/media/wysiwyg/products/2023_Product_Indicator_IDA.pdf
- 30.Ouedraogo L, Habonimana D, Nkurunziza T, Chilanga A, Hayfa E, Fatim T. Towards achieving the family planning targets in the African region: A rapid review of task-sharing policies. Reprod Health. 2021;18:22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Oxford Policy Management. Lady Health Worker Programme: External Evaluation of the National Programme for Family Planning and Primary Health Care. 2009 Aug.
- 32.Ministry of Health Ethiopia. Implanon and other family planning methods uptake in a sample of focus Woredas (June 2009 – Dec 2010). Washington: PROGRESS; 2012. [Google Scholar]
- 33.Malakoff S. In: Agarwal A, Platz M, editors. Implementation of task-sharing guidelines for long-acting and permanent methods. Washington: USAID MOMENTUM; 2023.
- 34.Achola OJ, Stafford R, Tripathi V, Levin L, Mimno K, Agarwal A. Implementation of the world health organization’s task-sharing guidelines for long-acting reversible contraceptives and permanent methods across momentum safe surgery in family planning and obstetrics countries: desk review. Washington: USAID MOMENTUM.
- 35.Tilahun Y, Lew C, Belayihun B, Hagos KL, Asnake M. Improving contraceptive access, use, and method mix by task-sharing Implanon insertion to frontline health workers. Glob Health Sci Pract. 2017;5(4):592–602. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Charyeva Z, Oguntunde O, Orobaton N, Otolorin E, Inuwa F, Alalade O. Task Shifting Provision of Contraceptive Implants to Community Health Extension Workers. Glob Health Sci Pract. 2015;3(3):382–94. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.