health impact metrics dr. nirali chakraborty population services international social franchise...

Health Impact Metrics

Dr. Nirali ChakrabortyPopulation Services International

Social Franchise Metrics Working Group

+

+ Outline

• Rationale for modeling health impact• Description of metrics• Input and output• Interpreting the data• Using the data• Impact Calculator

+ Comparing impact

+ Equivalent comparisons

+ Health Impact: What

• Any metric which measures the population level effect of the intervention(s)– Reduction in Maternal/Child/Neonatal Mortality– Reduction in unmet need for FP– Couple Years of Protection (CYPs) provided– DALYs averted

+ Health Impact: Why?

From your perspective, why is it– Important– Relevant– Interesting– Necessary

To calculate health impact?

Pair and share!

+ Franchise decision making

InformationD

ecis

ion

s DO

NO

RS

Reporting

Accountability

Impact

Need

Want Use

History – How did we arrive at the DALY averted?

What is a DALY?A year of healthy life lost to death or illness

Disability-Adjusted Life Year

10

The DALY allows us make comparisons across

populations and health conditions.

When we sum up all the DALYs for a given country,

that’s their burden of disease.

When we sum up all the countries, that’s the Global

Burden of Disease.

DALYs from

X

disease

DALYs from

Y

disease

DALYs from

X

disease

DALYs from

Y

disease

DALYs from

X

disease

DALYs from

Y

disease

DALYs in Country

A

Global Burden of Disease

DALYs in Country

B

DALYs in Country

C

+ Evolution of PSI’s metrics

• Couple Years of Protection (CYPs): allows comparison across FP interventions of different duration

• Person-Years of Protection (PYPs): converts sales figures into a single metric to aggregate interventions for different health areas and different durations (does not estimate health impact)

• DALYs Averted: summary measure of population health which captures morbidity and mortality – allows aggregation and comparison across health area and country

CYPs PYPs DALYs Averted

ACTs distributed

IUDs inserted

Projected Impact

Condoms sold

PSI uses modeled projections of health impact to target and track progress

We measure outputs, like the number of IUDs inserted or ACTs distributed

We use mathematical models to project impact based on those outputs

Inputs Outputs

Products and

services

DALYs averted

+ Calculation and Data Needs

• Most programs maintain records of how many health services and commodities are provided in a given year.

• These statistics can be multiplied by a country-specific coefficient for each item.

• Each coefficient is based on assumptions of the health benefits provided by a particular health service or commodity within a given country.

2 millionantibiotics distributed

x .5DALYs averted coefficientfor pneumonia treatment

in that country

= 1million

DALYs averted bypneumonia treatment

Calculating DALYs averted

+ What do DALYs averted tell us?

• One DALY averted means that the services provided by a franchise resulted in a year of healthy life saved.

• Unlike Couple Years of Protection (CYPs), DALYs averted take into account the wide range of services that are now offered by social franchise programs.

Inputs Outputs

Products and

services

DALYs averted

?

PAGE 20

Estimated Family Planning Users

Pregnancies averted

Births averted

Maternal deaths averted

DALYs averted(maternal morbidity & mortality,

child mortality)

Child deaths averted(Due to improved birth

spacing)

Family planning services/products provided

Apply continuation and mortality rates to past LAPM clients

Count backwards

Products providedUnits needed per year

Long acting &

Permanent methodsShort-term methods

PAGE 21

+ Calculating DALYs averted

Children at risk of malaria

+ Calculating DALYs avertedChildren at risk of malaria

Children who will get malaria without a preventive

intervention (LLINs)


Children who will

get malaria after LLIN scale up Children who will get

malaria without a preventive intervention (LLINs)




Children who will

get malaria after LLIN scale up

Malaria averted




Children who will

get malaria after LLIN scale up

Malaria averted= Impact per net

Number of nets

Malaria averted

So what?

Page 27

+ Uses of DALYs Averted at PSI

• Primary internal performance indicator – focuses attention on health impact

• Used for setting targets at project and country level

• Can be used to inform decisions about trade-offs between interventions

Page 28

+

page 29

PSI Impact CalculatorProject impact by country

Learn about PSI’s models

Prepare bid proposals

Inform targets

Share your analysisSee 2013 impact

Impactcalculator.psi.org30




Inform targets



Project impact by country

Impactcalculator.psi.org

To start, type impactcalculator.psi.org directly into your browser.

This will take you to the landing page

Questions? Email [email protected]

From the landing page, simply click

“Project Impact by Country”

And choose your country of interest from the drop down menu to get started

32

mailto:[email protected]


Impactcalculator.psi.orgQuestions?

Email [email protected]

To start, click the box next to the intervention(s) you are interested in.

You can also activate or deactivate ALL of the interventions in a health area

Once activated, simply enter your future sales or distribution numbers.

33





Let’s take an example…

If PSI inserted 20,000 contraceptive implants (3-year)in the Dominican Republic in 2014…

We would avert

3,681 DALYs46 deaths, and 9,298 unintended pregnancies

We would also provide

50,000 CYPs

34





A note on projecting impact for condoms: Condoms have impact across two health areas:

HIV & TB, and Reproductive Health.

Projected impact is displayed in both health areas

Within each health areathe additional impact figures from the alternate heath area

are also displayed.

The aggregate impact from both health

areas is displayed in the right margin.

Other impact indicators, such as new infections

averted, are displayed in the Excel export.

35





So, if PSI distributed 20,000,000 condoms in the Dominican Republic in 2014…

We would avert 41,874 DALYs146 deaths584 new HIV infections and 29,443 unintended pregnancies

We would also provide 166,667 CYPs

36



Impactcalculator.psi.org Questions? Email [email protected]

‘In Country interventions’ and ‘Additional PSI interventions’

The interventions that display automatically are ‘In Country Interventions’.These are all interventions reported by the country for 2013 or 2014.

‘Additional PSI Interventions’ can be displayed and will appear below. These are all interventions for which we have a DALY coefficient in this country.

Simply click the ‘plus sign’ to expand and scroll down.

37





Inform targets



See 2013 Impact



Using our previous example, you can access 2013 data in two ways

1. Click 2013 impact under any intervention. Last year’s data will display automatically.

2. Click Total 2013 data in the right margin to download an excel file with last year’s data.

39





Inform targets






Intervention specific model overviews provide a quick glance at how PSI models impact. Access them in one of two ways.

1. Click ‘Learn about PSI’s models’ from the landing page and select your intervention of interest

2. Click the name of any intervention from inside the calculator and the model overview will display

41





Here’s one example of a model overview

Scroll down for more details

42





Include impact estimates confidently in new business proposals.

Each model overview contains an example ‘Statement of Modeled Results’. Use this to tailor your message based on your own impact projections.

43





Inform targets



Share your analysis



Sharing is easy

Display only the interventions you are interested in.

Share by exporting your analysis to excel or simply hitting print

45


+ Couple Years of Protection

• USAID championed measurement method• Recently revised to reflect new methods and

updates to research• Based on efficacy and effectiveness of each

contraceptive method• Each method has a coefficent, indicating how

long a couple is protected per use/package of method.

+

Page 50

Method CYP per unit

Copper-T 380-A IUD5 year IUD e.g. LNG-IUS

4.6 CYP per IUD inserted3.3 CYP

3 year implant (e.g. Implanon) 2.5 CYP per implant

4 year implant (e.g. Sino-Implant) 3.2 CYP per implant

5 year implant (e.g. Jadelle) 3.8 CYP per implant

Emergency Contraception 20 doses per CYP

Fertility Awareness Methods 1.5 CYP per trained adopter

Standard Days Method 1.5 CYP per trained adopter

LAM 4 active users per CYP

Sterilization 10 (Global)13 (India, Nepal, Bangladesh)

Oral Contraceptives 15 cycles per CYP

Condoms (Male and Female) 120 units per CYP

Vaginal Foaming Tablets 120 units per CYP

Depo Provera (DMPA) Injectable 4 doses per CYP

Noristerat (NET-En) Injectable 6 doses per CYP

Cyclofem Monthly Injectable 13 doses per CYP

Monthly Vaginal Ring/Patch 15 units per CYP

Questions?

health impact metrics dr. nirali chakraborty population services international social franchise...

Documents