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Measuring Access and Performance (MAP):

A tool for measuring social marketing product and service delivery coverage, quality of coverage,

access and equity of access in developing countries

Kim Longfield, PhDSenior Researcher

Population Services InternationalSocial Marketing and Communications for Health

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Population Services International

Non-profit organization founded in 1970Social marketing and communications interventions in more than 60 countries, many that promote use of products and services• HIV

Largest distributor of condoms in the developing world• Malaria

Largest distributor of mosquito nets in the developing world• Reproductive Health

Among the largest distributor of family planning products in thedeveloping world

• Maternal and Child HealthLarge scale programs in diarrhea disease control

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The Challenge: Monitoring Accessibility of Products and Services

AngolaBelizeBeninBoliviaBosnia/HerzegovinaBotswanaBulgariaBurkina FasoBurundiCambodiaCameroonCentral African RepublicChinaCongo-Brazzaville (RC)Congo-Kinshasa (DRC)Costa RicaCote d’IvoireCroatiaDominican RepublicEl SalvadorEthiopiaGhanaGuatemalaGuineaHaitiHondurasIndiaKazakhstanKenyaKyrgyzstanLaosLesothoMadagascarMalawiMaliMexicoMozambiqueMyanmar

NamibiaNepalNicaraguaNigeriaPakistanPanamaPapua New GuineaParaguayRomaniaRussiaRwandaSão Tomé/PríncipeSomalilandSouth AfricaSudanSwazilandTajikistanTanzaniaThailandTogoTrinidad/Tobago, CaribbeanUgandaUzbekistanVietnamZambiaZimbabwe 4

Case Study: Burkina Faso

AngolaBelizeBeninBoliviaBosnia/HerzegovinaBotswanaBulgariaBurkina FasoBurundiCambodiaCameroonCentral African RepublicChinaCongo-Brazzaville (RC)Congo-Kinshasa (DRC)Costa RicaCote d’IvoireCroatiaDominican RepublicEl SalvadorEthiopiaGhanaGuatemalaGuineaHaitiHondurasIndiaKazakhstanKenyaKyrgyzstanLaosLesothoMadagascarMalawiMaliMexicoMozambiqueMyanmar

NamibiaNepalNicaraguaNigeriaPakistanPanamaPapua New GuineaParaguayRomaniaRussiaRwandaSão Tomé/PríncipeSomalilandSouth AfricaSudanSwazilandTajikistanTanzaniaThailandTogoTrinidad/Tobago, CaribbeanUgandaUzbekistanVietnamZambiaZimbabwe

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Study Design for Burkina Faso

Randomly sample, with probability of selection proportional to population size19 Geographic Areas• In Burkina Faso, villages

Audit the village to determine if product is• Available

• If so, sold at recommended price

• Not past expiration date

• Meets other standards

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Understanding Penetration vs. Coverage

• Penetration was the standard measurement: product available in X outlets/ total number of outlets.

• Penetration is not the same as coverage: 7 out of 19 villages = 37% of villages with product available

• Coverage is the new standard: 7 out of 19 villages = 50%. Half of the country is covered, half is not.

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MAP: Penetration vs. Coverage: Product Availability

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MAP: Penetration vs. Coverage: Product Availability (cont.)

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Where is the product available at a minimum standard?

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Lot Quality Assurance Sampling

Uses Hypothesis Testing• e.g. how likely is it that the product is available in

more than 50 percent of villages? How likely is it that it available in less than 20%?

• Each numerator (1-19) out of 19, corresponds with a likelihood. For example, if the product is available in 7/19, then it is 92% likely that the product is available in more than 50% of villages.

• If an intervention area (for example, all of Burkina Faso) is stratified into multiple geographic areas, then the N/19 results can be combined to produce estimates of coverage (e.g. 50% +/- x%) across the entire intervention area.

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LQAS Table

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MAP: Four Indicators Correlated with Behavior

Coverage• The presence or absence of a product or service, relative to a

minimum standard such as “at least one outlet”, in a geographic area.

• Crude measure of proximity.• The closer you are to something, the more likely you are to

use itQuality of Coverage• The extent to which, in areas with coverage, other minimum

standards are met, such as price adherence.• The quality of available services is associated with

maintaining behaviorsAccess and Equity of Access

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Access and Equity of Access

Country X

◄Residential Area or Hot Zone A ►

●◄PSI Outlet A ●◄PSI Outlet B

●◄PSI Outlet C

•Numerator is 300 (Area A) + 300 (Area B) + 300 (Area C) = 900. Denominator is 1000 x 4 = 4000. 900/4000 = 22.5%

Access = 22.5%

◄Residential Area or Hot Zone B ►

◄Residential Area or Hot Zone D ►◄Residential Area or Hot Zone C ►

◄500m ►

◄500m ► ◄500m ►

30%

30% 30% 70% 70%

100%

70%

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Examples of How You Might Apply MAP in the US

Coverage of:• Outpatient clinics for PLWHA in high prevalence

areas• Vaccinations for children < 6 years by school district• # or type of trainings received by physicians by

census enumeration area• Prenatal care services available in low income

areas• Youth-friendly clinics in areas served by public

transportation• Hurricane evacuation plans for neighborhoods at

high risk for flooding24

Learn More About MAP

www.psi.org/researchLessons Learned paperSocial Marketing Research Series examples from five countries (more forthcoming)Kim Longfield klongfield@psi.org