Abstract
BackgroundIndividual family planning service delivery organisations currently rely on service provision data and couple-years of protection as health impact measures. Due to the substitution effect and the continuation of users of long-term methods, these metrics cannot estimate an organisation's contribution to the national modern contraceptive prevalence rate (CPR), the standard metric for measuring family planning programme impacts. Increasing CPR is essential for addressing the unmet need for family planning, a recognized global health priority. Current health impact estimation models cannot isolate the impact of an organisation in these efforts. Marie Stopes International designed the Impact 2 model to measure an organisation's contribution to increases in national CPR, as well as resulting health and demographic impacts. This paper aims to describe the methodology for modelling increasing national-level CPR as well as to discuss its benefits and limitations.MethodsImpact 2 converts service provision data into estimates of the number of family planning users, accounting for continuation among users of long-term methods and addressing the challenges of converting commodity distribution data of short-term methods into user numbers. These estimates, combined with the client profile and data on the organisation's previous year's CPR contribution, enable Impact 2 to estimate which clients maintain an organisation's baseline contribution, which ones fulfil population growth offsets, and ultimately, which ones increase CPR.ResultsIllustrative results from Marie Stopes Madagascar show how Impact 2 can be used to estimate an organisation's contribution to national changes in the CPR.ConclusionsImpact 2 is a useful tool for service delivery organisations to move beyond cruder output measures to a better understanding of their role in meeting the global unmet need for family planning. By considering health impact from the perspective of an individual organisation, Impact 2 addresses gaps not met by other models for family planning service outcomes. Further, the model helps organisations improve service delivery by demonstrating that increases in the national CPR are not simply about expanding user numbers; rather, the type of user (e.g. adopters, provider changers) must be considered. Impact 2 can be downloaded at http://www.mariestopes.org/impact-2.
Highlights
Individual family planning service delivery organisations currently rely on service provision data and couple-years of protection as health impact measures
This paper describes the methodology behind the first level of the Impact 2 model, showing how service provision data can be translated into modelled user numbers and the key model output at its top level: an organisation’s estimated percentage point contribution to increasing the modern contraceptive prevalence rate (CPR)
It attempts to isolate the impact of individual service delivery organisations, it does not attempt to show indirect population-level changes, such as reductions in the total fertility rate (TFR) or the maternal mortality ratio (MMR)
Summary
Individual family planning service delivery organisations currently rely on service provision data and couple-years of protection as health impact measures. An estimated 222 million women in developing countries have an unmet need for modern contraceptives [1] This deficit puts women at risk of unintended pregnancies, which can result in unsafe abortions or even maternal death. Such a high level of unmet need underscores the pressing global health problem of access to modern contraceptive services, an issue the wider reproductive health and donor community has recognised and prioritised. While any values can be entered into the model, default data and assumptions have been pre-loaded for all developing countries in order to improve the ease of use These default values are based on Demographic and Health Surveys (DHS) [10], United Nations (UN) Population Prospects [11], World Health Organisation (WHO) studies [12,13], and numerous other validated sources (see Table 1 for sources of data referenced in this paper). Note that the female partner who is protected by the man’s sterilisation is counted as the user because measures of contraceptive use are based on women using contraception
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