Does your family planning program need a Reality Check? Leah Jarvis, MPH Program Associate for Monitoring, Evaluation, and Research

Does your family planning program need a Reality Check? Leah Jarvis, MPH Program Associate for Monitoring, Evaluation, and Research

Objectives By the end of the session, participants will be able to: Recognize the need for evidence-based planning and advocacy in family planning (FP) programs Understand the tools available for generating data for planning and advocacy in FP programs Use the Reality Check tool to plan for meeting a FP goal and to generate data for advocacy

Need for data in planning and advocacy FP goals are often set without analysis or planning Not all FP methods are created equal Lack of mechanism for sub-national planning Population-level statistics readily available but not used for planning At the end of the year, we got together and we did planning for the coming year. Before Reality Check, we just did it in the dark. We did it without a scientific method. We said that this year we dispensed at this level, so next year let s add a little bit, without a scientific base. former District Medical Chief, Togo

What is Reality Check? Applies widely available demographic data for evidence-based FP planning and advocacy Walks users through up to five What if scenarios What if past CPR trends continue? What if we just maintain our current CPR? What if we achieve 36% CPR goal by 2018? What if we meet unmet need? What if we increase CPR by 1.5% annually? Allows user to test changes in method mix Provides a flexible level of analysis (national, regional, district) Windows application English and French

Questions Reality Check can help answer If past CPR trends continue, what CPR would Malawi achieve in 2020? In 2025? The Malawian government set a goal of a 60% modern CPR by 2020. Are we on track to achieve this CPR goal? What would be the resources needed to achieve this goal? What would be the impact of achieving this goal? What would be the implications of revising the method mix? Is this goal realistic?

Reality Check Applications Policymakers and program managers can use Reality Check to set goals and plan to meet them. Advocates can use Reality Check to make the case for increased investment in FP. Logistics teams can use Reality Check to quantify the commodities and supplies needed to meet a goal.

Basic concepts underlying Reality Check Contraceptive prevalence rate (CPR) = Percentage of women of reproductive age (WRA) or married women of reproductive age (MWRA) [15 49 years of age] who use contraception No. of users of FP = No. of WRA or MWRA [15 49] * CPR No. of FP adopters in any given year = (no. of users in current year no. of users in previous year) + (no. of users in previous year * method discontinuation rate)

Estimating resources required to meet FP goals CPR Population of women of reproductive age Discontinuation rates FP users Contraceptive adopters Removals of implants Number of units per user/adopter Number of facilities* Facility caseload Data input Data output Contraceptives and supplies CYP factors Couple-years of protection Per-unit costs Costs *Facility caseload is the only input with no default value(s)

Estimating the impact of FP CPR Population of women of reproductive age FP users FP failure rates Pregnancy rate Pregnancy outcome estimate Abortions averted Unsafe abortion rate Data input Data output Unintended pregnancies averted Unsafe abortions averted Pregnancy outcome estimate Stillbirth rates Live births averted Maternal mortality ratio Maternal deaths averted

Method Discontinuation Rates Short-acting methods (pill, injectables, condoms) % who stop using a method during first year of use ~50% discontinuation rate Long-acting methods (IUD, implants) Reciprocal of mean duration of use 22% discontinuation for IUD 28% discontinuation for Jadelle 33% discontinuation for Sino-Implant (II) 42% discontinuation for Implanon Permanent methods (Female sterilization and vasectomy) % who age out of reproductive cycle after age 49 10% discontinuation rate

Not All FP is the Same Method No. of unintended pregnancies among 1,000 women in 1st year of typical use No method 310* Withdrawal 220 Female condom 210 Male condom 180 Pill 90 Injectable 60 IUD (CU-T 380A/LNG-IUS) 8/2 Female sterilization 5 Vasectomy 1.5 Implant 0.5 Source: Trussell J. Contraceptive Efficacy. In Hatcher RA, Trussell J, Nelson AL, Cates W, Kowal D, Policar M. Contraceptive Techology: Twentieth Revised Edition. New York NY: Ardent Media, 2011. * Guttmacher Institute

What Reality Check Can t Do Project resources needed for HIV, malaria, DALYs averted, or other health programs. Tell programs what goal is realistic. Tell programs exactly what they need to do to reach their goals.

Other complementary tools PipeLine (DELIVER) Logistics projections Planning for commodity orders and prevention of stock-outs Impact2 (Marie Stopes International) Estimates the impact of a single organization Spectrum/FamPlan (Futures) Demographic projections based on the proximate determinants of fertility framework Heavier data input requirements Crosswalk of FP Tools (Health Policy Project) List of FP tools, uses, audiences, strengths and weaknesses

Lessons Learned Strategic engagement of decision-makers Complementarity of Reality Check with other FP tools Follow-up Timing Recent data

Reality Check Experiences Kenya Malawi Ghana Togo Senegal Tajikistan

Case Study: Reality Check in Malawi

Malawi: Step 1: National Stakeholder Meeting Scenario 1: Continue current increase of 1.7% annually Scenario 2: Meet 2020 60% modern goal by increasing 2.7% annually + increase percentage using most effective FP

Malawi: Reality Check Future Scenarios 60% CPR Goal

Malawi: Family Planning Users by Scenario

Malawi: Caseload at Baseline and in 2020 Average number of clients per facility per month Baseline 2020 2010 Scenario 1 Scenario 2 Pill 34 62 102 Injectable 348 682 628 Male condom 52 113 124 Female condom 2 6 15 Implant 3 8 23 IUD 4 11 78 Female sterilization 52 141 188 Source: Demographic and Health Surveys, Reality Check

What Will the Scenarios Cost? Annual contraceptive, equipment, and supply costs Annual costs for 2020 Source: Demographic and Health Surveys, Reality Check

Step 2: District goals (mcpr, %)

Reality Check: Summing it Up Allows user to assess feasibility of CPR goals and generate data to inform FP programming Allows users to experiment with changing method mix Is user-friendly requires only basic computer skills Has minimal data requirements Provides flexible level of analyses: national, regional, district Allows a user to test multiple scenarios in minutes What if

Thank you!