Estimating the contribution of a service delivery organisation to the national modern contraceptive prevalence rate: Marie Stopes International's Impact 2 model

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.

Changes in Morbidity and Abortion Care in Ethiopia After Legal Reform: National Results from 2008 and 2014

“…Yet, in 2014 alone, an estimated 961 maternal deaths and nearly 180,000 unsafe abortions were averted as a result of the abortion care and postabortion contraceptive services provided by public, private and NGO health providers. 39 This translates into an estimated US$4,132,133 in direct health costs saved by families and the health care system on pregnancy-related care. 25,39 Ethiopia has now joined a number of countries that have recently increased access to safer abortions through legal reform, but are struggling to implement these changes under resource constraints, competing health priorities and a slow pace of change.…”

“…39 This translates into an estimated US$4,132,133 in direct health costs saved by families and the health care system on pregnancy-related care. 25,39 Ethiopia has now joined a number of countries that have recently increased access to safer abortions through legal reform, but are struggling to implement these changes under resource constraints, competing health priorities and a slow pace of change. 13,40 In Sub-Saharan Africa, liberalization of colonial laws restricting abortion is still rare: Since 1972, only Ethiopia, Ghana, Mozambique, Rwanda, South Africa and Zambia have changed their abortion laws through either legal or policy changes.…”

“New Users” Are Confusing Our Counting: Reaching Consensus on How to Measure “Additional Users” of Family Planning

“…Impact 2 model uses service statistics and client-use profile data to estimate contributions to additional users: The Impact 2 model, developed by Marie Stopes International, allows organizations to estimate their contribution to national-level additional users, based on program-level and other input data 17 , 18 . First, the number of services provided is converted into the number of estimated users in a given country (accounting for long-acting and permanent method continuation, mortality, and short-acting methods needed for a year of coverage).…”

Accessibility of long-term family planning methods: a comparison study between Output Based Approach (OBA) clients verses non-OBA clients in the voucher supported facilities in Kenya

“…Globally, there are more than 221 million women who wants to prevent unwanted pregnancies and assert their reproductive rights [1, 2]. Low and middle-income countries (LMIC) experience up to 99% of the 287,000 maternal deaths that happen globally per annum and family planning (FP) can prevent up to 30% of the deaths [1, 3].…”

“…The unmet gap puts many women at a risk of unwanted pregnancies which could result in maternal deaths and unsafe abortions [2]. The unmet needs show a pressing health problem of access to contraceptive services which has pushed the donor and reproductive health community to prioritize family planning.…”