Planning for LAPM Programs: The Science and Art of Reality √

Planning for LAPM Programs: The Science and Art of 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 trends Future 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

The Art of Reality √: Tanzania Experience • Empowering districts to use data for decision making (Reality √) for evidence-based FP advocacy and planning

Tanzania: National Goal of 30% Modern Method Use by 2010 In 2004/05 [start of ACQUIRE Tanzania] • 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 expanded to all 21 mainland regions and 5 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”

Tanzania: Scenario—Female Sterilization Prevalence of 2.5% by 2010 in 10 Focus Regions Is this realistic? In the focus regions there are… # procedures persites # modes of service delivery # site • >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 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 Source: NIPORT 2005 and NPORT et. al. 2007

Bangladesh: Role of LAPMs in Method Mix Total CPR # LAPM Users (million) 30.8% 2.0 39.9% 2.3 44.9% 2.3 49.8% 2.3 54.3% 2.1 58.5% 1.9 55.8% 2.1 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 use Reality √ • 5 units—logistics, planning, MIS, Field Services, Clinical Services • Each unit had different perspective and need for Reality √ 31.5% 65.9% 56.4% 63.1% 56.3% 43.9% 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 ■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

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

Planning for LAPM Programs: The Science and Art of Reality √