Overview of the Lives Saved Tool (LiST) What have we learned

Transcription

1 Overview of the Lives Saved Tool (LiST) What have we learned

2 Purpose of LiST Estimate the impact of increasing coverage of interventions on maternal, neonatal and child mortality as well as stillbirths Allow countries and programs to estimate the relative impact of a wide range of interventions for strategic planning Try to provide consistent estimates of impact of interventions for planning and costing and costeffectiveness tools, such as One Health and MBB

3 Overall structure of LiST A cohort model, with built in links to demographic projections For a base year, we describe a country in terms of U5M, NMR, MMR and stillbirths COD structure for both 0-1 and 1-59 months and for maternal deaths Coverage of interventions (approximately 80 interventions, some in packages) Background characteristics, such a deficiencies, exposure to falciparum Each intervention or package of interventions in the package has a prespecified effect on a risk factor (e.g., stunting, IUGR) and/or on a cause or causes of death One looks at the impact of increasing coverage of interventions on mortality and levels of risk factors. A key feature of the model is that one can scale up more than one intervention at a time and allows one to generate different counter-factuals.

4 What is in LiST? Roughly 80 single or packages of interventions Outputs include maternal, neonatal and child mortality, as well as stillbirths. There are also rates and age-specific outputs LiST is built with default data for 85 low- and middle-income countries. Demographics -- UN Population Div COD -- WHO estimates Mortality rates -- IGME Effectiveness -- CHERG reviews Coverage -- DHS, MICS, MIS and UN estimates, for vaccine coverage we use WHO/UNICEF country estimates LiST is a module in Spectrum which contains a full demographic module as well as modules for AIDS and family planning. All are linked to LiST. If one eliminated demographics, family planning and AIDS, a fairly simple model structure. However this simple structure can reflect a fairly complex set of interactions. Example of pneumonia

5 Improved H 2 O source within 30 minutes (0.17) Hand washing with soap (0.48) Improved excreta disposal (latrine, toilet) (0.36) Water connection in the home (0.63) Hygienic disposal of children s stools (0.20) Breast Feeding Promotion Diarrhea Incidence (RR 1.025) Pneumococcal vaccine (0.26) Breast Feeding.e.g. RR for no breastfeeding for first 6 months Stunting (-2 Z score: RR 1.3, -3 Z score: RR 3.2) Hib vaccine (0.18) Pneumonia Mortality Complementary feeding education/supplementation Multiple micronutrient supplementation (0.09) Balanced energy supplementation (0.32) Pregnant women protected via IPT or sleeping under an ITN (0.35) IUGR (OR 21.6) Zinc for prevention (0.15) (OR 1.18) Therapeutic feeding (0.062) Wasting (-1 Z score: RR Z score: RR Z score: RR 8.7) Oral antibiotics for pneumonia (0.7)

6 Use of LiST Global priority setting and advocacy with extensive use by large organization (e.g., WHO, UNICEF, B&MGF, USAID, DFID, GAVI, Global Fund, Save the Children) Strategic planning in countries Has been used in over 40 developing countries, but only 6 or 7 as part of national planning process Use of the model in evaluation Translating changes in coverage to estimates of deaths averted, e.g., Global Fund, Roll Back Malaria

7 Key issues for success On-going system for creating and updating assumptions in the model - Strong Good Interface Easy to learn and use Moderate, we prefer two days training and as used intermittently, no expertise Built-in default values, but all must be modifiable by user Moderate Set up for multiple language use Strong Organizational support for use in countries (UN or other organizations) Weak Publications, validation and documentation key for acceptance Strong Harmonization with other models and approaches The hardest piece of work Moderate, built into OHM and MBB Define your primary task and try to stick to that - Weak

8 To download LIST or more information www. CHERG.org or