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