planning for lapm programs: the science and art of reality √
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Planning for LAPM Programs: The Science and Art of Reality √. ACQUIRE End-of-Project Event September 17, 2008. Outline of Presentation. The Science of Reality √: Generating data for decision-making What is Reality √? What can Reality √ do for you? - PowerPoint PPT PresentationTRANSCRIPT
Planning for LAPM Planning for LAPM Programs: Programs:
The Science and Art of The Science and Art of Reality √Reality √
ACQUIRE End-of-Project EventSeptember 17, 2008
Outline of Presentation
The Science of Reality √: Generating data for decision-making
– What is Reality √?
– What can Reality √ do for you?
The Art of Reality √: Setting assumptions, interpreting data and planning
– Tanzania experience
– Bangladesh experience
Q&A
What is Reality √ ?
Excel-based family planning forecasting tool for evidence-based planning and advocacy
Methodology: Based on Spectrum System of Policy Models—DemProj and FamPlan
Reality √ CD-ROM and User’s
Guide
What Can Reality √ Do For You?
Enables assessment of:– Past FP trends
– Feasibility of future FP goals
Projects data on:– CPR
– Number of users
– Number of adopters
– Impact of discontinuation
– Commodity needs and costs
– Estimated service delivery caseload
– CYP
Past trendsPast trends
Future goalsFuture goals
What Data Does Reality √ Require?
To input– Population projections of women of reproductive age
• UN Population Projections (on Reality √ CD-ROM)
• Projected census data
– Contraceptive prevalence data
• Demographic and health surveys
– Service provision—number of sites that can provide method
Standard values that can be changed– Discontinuation rates
– Commodity costs
– CYP conversion
Reality √ Strengths
Flexible level of analyses: national, regional, district, site, urban/rural
Helps users plan realistically based on informed estimates of need
Allows a user to test multiple scenarios in minutes → “What if…”
User-friendly—only basic Excel skills required
Empowering districts to use data for decision making (Reality √) for evidence-based FP advocacy and planning
The Art of Reality √: Tanzania Experience
Tanzania: National Goal of 30% Modern Method Use by 2010
In 2004/05 [start of ACQUIRETanzania] Modern method CPR 26% for
nation as a whole Regional modern method CPR
ranged from 8% to 38%
1996-2004/05 trend CPR ~ 1 point per annum
– 30% goal for 2010 achievable/realistic
10 focus regions CPR ~ 0.5 points per annum
2007 ACQUIRE Project expandedto all 21 mainland regions and5 Zanzibar regions
NBS 2006, Tanzania Demographic and Health Survey 2004-05
Tanzania:Setting Evidence-Based Regional Goals
Grouped 10 Focus Regions by 2004 prevalence modern method use– "High" prevalence regions: 30%+
– "Medium" prevalence regions: 15-29%
– "Low" prevalence regions: <15%
Looked at past experience/trends in Tanzania Looked at other country experience
– Implants in Ghana
– IUD in Kenya
Six scenarios– ”high”, “medium” and “low” prevalence for “focus” and
“non-focus”
Is this realistic? In the focus regions there are… >200,000 women have an unmet need to limit
47 facilities actively providing female sterilization service– Perform ~ 15 procedures per site per month = 705
per month
Tanzania: Scenario—Female Sterilization Prevalence of 2.5% by 2010 in 10 Focus Regions
# procedures per sites
# site # modes of service delivery
To achieve prevalence of 2.5% by 2010 need to perform ~56,000 procedures, i.e. 1,167 procedures a month
To achieve prevalence of 2.5% by 2010 need to perform ~56,000 procedures, i.e. 1,167 procedures a month
Tanzania: Role of Reality √ in District Action Planning Process
Setting Commodity needs—amount and budget
Determining service capacity
– Training needs for existing staff (and budget)
– Deployment of new staff (and budget)
– service modalities
• Integration FP with other RH services
• Designated service days
• Outreach (mobile services)
Monitoring progress
Planning is not just for the planning unit:– “All departments should sit
together and plan for the future.”
The Art of Reality √: Bangladesh Experience
Bangladesh: Impressive Gains in Reducing Fertility
6.3
5.1
3.4 3.3 3.33
2.72.7
2.22
2.5
3
3.5
4
4.5
5
5.5
6
6.5
7
1975 1985 1993/94 1996/97 2000 2004 2007 2010
TF
R
TFR TFR Goal
6.3
5.1
3.4 3.3 3.33
2.72.7
2.22
2.5
3
3.5
4
4.5
5
5.5
6
6.5
7
1975 1985 1993/94 1996/97 2000 2004 2007 2010
TF
R
TFR TFR Goal
Source: NIPORT 2005 and NPORT et. al. 2007
25.8%20.6% 17.7%
13.4% 10.0% 10.2%
4.5%
4.5%4.9%
3.9%3.2%
2.4% 2.9%
39.3% 47.9% 55.6% 62.8%64.3% 69.0%
72.0%
24.7% 21.8% 18.8% 15.7% 19.1% 18.6% 14.9%
31.5%
0%
20%
40%
60%
80%
100%
1989 1991 1993-94 1996-97 1999-2000 2004 2007
Permanent Long-acting Short-acting Traditional
25.8%20.6% 17.7%
13.4% 10.0% 10.2%
4.5%
4.5%4.9%
3.9%3.2%
2.4% 2.9%
39.3% 47.9% 55.6% 62.8%64.3% 69.0%
72.0%
24.7% 21.8% 18.8% 15.7% 19.1% 18.6% 14.9%
31.5%
0%
20%
40%
60%
80%
100%
1989 1991 1993-94 1996-97 1999-2000 2004 2007
Permanent Long-acting Short-acting Traditional
30.8%
2.0
58.5%
1.9
54.3%
2.1
49.8%
2.3
44.9%
2.3
39.9%
2.3
55.8%
2.1
Total CPR
# LAPM Users (million)
Bangladesh: Role of LAPMs in Method Mix
Source: NIPORT 2005 and NIPORT et. al. 2007
Bangladesh: National Goal of 72% Method Use by 2010
In 2007 CPR 55.8% for nation as a whole Regional CPR ranged from
31.5% to 65.9%
2008 DGFP trained in useReality √ 5 units—logistics, planning, MIS,
Field Services, Clinical Services Each unit had different
perspective and need for Reality √
43.9%56.3%
31.5%
56.4%
65.9%
63.1%
Source: NIPORT et. al. 2007, Bangladesh Demographic and Health Survey 2007, Preliminary Report
Bangladesh: Scenario—Vasectomy Prevalence of 2.46% by 2010
Is this realistic? 0.31 points per annum
– 821,560 procedures ‘04-’10
2004-07 projected to perform ~426,00 procedures
Actual performance 2004-07 ~262,000 procedures
To achieve 2010 goal, for 2008-10 need to o.59 points per annum– ~681,ooo procedures 2008-
2010– Total 943,00 procedures 2004-
10
Projected vasectomy users
89.3
105.8113.7 114.9 119.6
127.7
148.3
47.159.2 56.7
98.498.4
206.6
227.1
247.7
0.0
0.5
1.0
1.5
2.0
2.5
3.0
2004 2005 2006 2007 2008 2009 2010
Vase
ctomy
Prev
alenc
e
0
50
100
150
200
250
Vase
ctomy
adop
ters (
thous
ands
)
Vasectomy prevalence
Initial GOB projection (2004) to achieve goal 2.46% in 2010
Actual # adopters {2004-2007)
Revised projection (2007) to achieve 2.46% in 2010
■ 286,000 additional procedures needed to achieve goal 2.46%
Bangladesh: What caseload required to reach an vasectomy prevalence of 2.46 in 2010?
Caseload would need to be nearly 50% greater than initial projected for 2008-2010
Can this be achieved?– Stimulate demand My husband is precious
communications campaign– Increase service capacity
by training more providers• Expand number of sites
Year
GOB Projected caseload[2004]
Actual average caseload[2004-07]
Revised projected caseload[2008]
2005 19 10
2006 20 10
2007 20 17
2008 21 3636
2009 22 3939
2010 26 5555
Bangladesh: Value of Reality √
Empowered DGFP staff—evidence-based planning and decision making
Triggered collaboration among various units of MOHFW and DGFP.
We have a tool for the future that will enable
– division and district staff to participate more effectively in planning at their levels
– MOHFW and DGFP to develop and refine strategies to address the imbalanced method mix
Reality √: Summing Up
Supports realistic, evidence-based planning and resource deployment
Enables units at different levels—geographic/ technical departments—to coordinate and plan their contribution to a national goal
Informs mid-course adjustments