One of the priorities of the Bangladesh Health and Family Planning Programme is to
focus on a cost recovery policy by the introduction of user fees to improve quality and financial
sustainability. To assist the policy we propose an operations research-based cost
recovery model to find the best ‘service mix’ from outdoor, indoor, emergency and diagnostic
services for sub-district-level health facilities. The model considers budget, patient flow
patterns, resource availability, service demand and equity principal constraints. The study
offers proposals to assist the decision-making process for the introduction of a user fee and
considers how much to charge, which services to start with, and which to include later.