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Costa Rican Demographic Association (Asociacion Demografica Costarricense (ADC): the coupon system controversy.
Managua, Nicaragua, Instituto Centroamericano de Administracion de Empresas, 1973. 43 p. (INCAE Management Case No. 9-575-601)This case study was developed as a teaching tool for administrative family planning personnel. The Costa Rican Demographic Association (ADC) assumed responsibility for the distribution of oral contraceptives (OCs) through commerical outlets in a program started by Alberto Gonzalez. Gonzalez had organized a rural distribution system of OCs by recruiting local women to sell OCs to friends and relatives at reduced prices. The number of women involved grew so rapidly, Gonzalez, who was a founder of ADC and its first Executive Director, expanded the distribution system to urban areas. In 1964, however, stiff opposition to the distribution system was made by the College of Pharmacists, for OCs were being sold at greatly reduced prices through noncommerical outlets. After difficult negotiation, the College agreed, in 1967, to allow the ADC to import and distribute contraceptives providing a pharmacist supervised the distribution, a doctor's prescription was obtained, and the ADC disburse OCs in pharmacies. The latter provision forced ADC to abandon its highly successful system of individual distributors. Instead, a woman had to go to a clinic, obtain a doctor's prescription as well as a blue (minimal charge) or green (no charge) coupon and then find an authorized outlet to purchase the OCs at a reduced price. The pharmacist had to keep special inventories and maintain a coupon system in order to obtain credit from ADC. ADC had to make sure inventories were maintained and that proper controls were placed on the distribution process. By 1971, 233,309 cycles of OCs were distributed through the coupon system. Nonetheless, questions were raised by USAID and other organizations about control procedures and pricing. It was suggested that it might be more convenient for the patient if the clinics themselves could assume the responsibility of supplying OCs to patients.