Planning for LAPM Programs: The Science and Art of Reality √ ACQUIRE End-of-Project Event September 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

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 ACQUIRE Tanzania] Modern method CPR 26% for nation as a whole Regional modern method CPR ranged from 8% to 38% /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

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

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

30.8% % % % % % % 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 use Reality √ 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-’ projected to perform ~426,00 procedures Actual performance ~262,000 procedures To achieve 2010 goal, for need to  o.59 points per annum –~681,ooo procedures –Total 943,00 procedures 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 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 [ ] Revised projected caseload [2008]

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