Health Impact Metrics Dr. Nirali Chakraborty Population Services International Social Franchise...
-
Upload
lewis-brittian -
Category
Documents
-
view
217 -
download
4
Transcript of Health Impact Metrics Dr. Nirali Chakraborty Population Services International Social Franchise...
Health Impact Metrics
Dr. Nirali ChakrabortyPopulation Services International
Social Franchise Metrics Working Group
+
+ Outline
• Rationale for modeling health impact• Description of metrics• Input and output• Interpreting the data• Using the data• Impact Calculator
Page 2
+ Comparing impact
Page 3
+ Equivalent comparisons
Page 4
+ Health Impact: What
• Any metric which measures the population level effect of the intervention(s)– Reduction in Maternal/Child/Neonatal Mortality– Reduction in unmet need for FP– Couple Years of Protection (CYPs) provided– DALYs averted
Page 5
+ Health Impact: What
• Any metric which measures the population level effect of the intervention(s)– Reduction in Maternal/Child/Neonatal Mortality– Reduction in unmet need for FP– Couple Years of Protection (CYPs) provided– DALYs averted
Page 6
+ Health Impact: Why?
From your perspective, why is it– Important– Relevant– Interesting– Necessary
To calculate health impact?
Pair and share!
Page 7
+ Franchise decision making
Page 8
InformationD
ecis
ion
s DO
NO
RS
Reporting
Accountability
Impact
Need
Want Use
History – How did we arrive at the DALY averted?
Page 9
What is a DALY?A year of healthy life lost to death or illness
Disability-Adjusted Life Year
10
The DALY allows us make comparisons across
populations and health conditions.
When we sum up all the DALYs for a given country,
that’s their burden of disease.
When we sum up all the countries, that’s the Global
Burden of Disease.
DALYs from
X
disease
DALYs from
Y
disease
DALYs from
X
disease
DALYs from
Y
disease
DALYs from
X
disease
DALYs from
Y
disease
DALYs in Country
A
Global Burden of Disease
DALYs in Country
B
DALYs in Country
C
+ Evolution of PSI’s metrics
• Couple Years of Protection (CYPs): allows comparison across FP interventions of different duration
• Person-Years of Protection (PYPs): converts sales figures into a single metric to aggregate interventions for different health areas and different durations (does not estimate health impact)
• DALYs Averted: summary measure of population health which captures morbidity and mortality – allows aggregation and comparison across health area and country Page 12
CYPs PYPs DALYs Averted
ACTs distributed
IUDs inserted
Projected Impact
Condoms sold
PSI uses modeled projections of health impact to target and track progress
Page 13
We measure outputs, like the number of IUDs inserted or ACTs distributed
We use mathematical models to project impact based on those outputs
Inputs Outputs
Products and
services
DALYs averted
+ Calculation and Data Needs
• Most programs maintain records of how many health services and commodities are provided in a given year.
• These statistics can be multiplied by a country-specific coefficient for each item.
• Each coefficient is based on assumptions of the health benefits provided by a particular health service or commodity within a given country.
2 millionantibiotics distributed
x .5DALYs averted coefficientfor pneumonia treatment
in that country
= 1million
DALYs averted bypneumonia treatment
Calculating DALYs averted
+ What do DALYs averted tell us?
• One DALY averted means that the services provided by a franchise resulted in a year of healthy life saved.
• Unlike Couple Years of Protection (CYPs), DALYs averted take into account the wide range of services that are now offered by social franchise programs.
Inputs Outputs
Products and
services
DALYs averted
?
PAGE 20
Estimated Family Planning Users
Pregnancies averted
Births averted
Maternal deaths averted
DALYs averted(maternal morbidity & mortality,
child mortality)
Child deaths averted(Due to improved birth
spacing)
Family planning services/products provided
Apply continuation and mortality rates to past LAPM clients
Count backwards
Products providedUnits needed per year
Long acting &
Permanent methodsShort-term methods
PAGE 21
+ Calculating DALYs averted
Children at risk of malaria
+ Calculating DALYs avertedChildren at risk of malaria
Children who will get malaria without a preventive
intervention (LLINs)
+ Calculating DALYs avertedChildren at risk of malaria
Children who will
get malaria after LLIN scale up Children who will get
malaria without a preventive intervention (LLINs)
+ Calculating DALYs avertedChildren at risk of malaria
Children who will get malaria without a preventive
intervention (LLINs)
Children who will
get malaria after LLIN scale up
Malaria averted
+ Calculating DALYs avertedChildren at risk of malaria
Children who will get malaria without a preventive
intervention (LLINs)
Children who will
get malaria after LLIN scale up
Malaria averted= Impact per net
Number of nets
Malaria averted
So what?
Page 27
+ Uses of DALYs Averted at PSI
• Primary internal performance indicator – focuses attention on health impact
• Used for setting targets at project and country level
• Can be used to inform decisions about trade-offs between interventions
Page 28
+
page 29
PSI Impact CalculatorProject impact by country
Learn about PSI’s models
Prepare bid proposals
Inform targets
Share your analysisSee 2013 impact
Impactcalculator.psi.org30
PSI Impact CalculatorProject impact by country
Learn about PSI’s models
Prepare bid proposals
Inform targets
Share your analysisSee 2013 impact
Impactcalculator.psi.org31
Project impact by country
Impactcalculator.psi.org
To start, type impactcalculator.psi.org directly into your browser.
This will take you to the landing page
Questions? Email [email protected]
From the landing page, simply click
“Project Impact by Country”
And choose your country of interest from the drop down menu to get started
32
Project impact by country
Impactcalculator.psi.orgQuestions?
Email [email protected]
To start, click the box next to the intervention(s) you are interested in.
You can also activate or deactivate ALL of the interventions in a health area
Once activated, simply enter your future sales or distribution numbers.
33
Project impact by country
Impactcalculator.psi.orgQuestions?
Email [email protected]
Let’s take an example…
If PSI inserted 20,000 contraceptive implants (3-year)in the Dominican Republic in 2014…
We would avert
3,681 DALYs46 deaths, and 9,298 unintended pregnancies
We would also provide
50,000 CYPs
34
Project impact by country
Impactcalculator.psi.orgQuestions?
Email [email protected]
A note on projecting impact for condoms: Condoms have impact across two health areas:
HIV & TB, and Reproductive Health.
Projected impact is displayed in both health areas
Within each health areathe additional impact figures from the alternate heath area
are also displayed.
The aggregate impact from both health
areas is displayed in the right margin.
Other impact indicators, such as new infections
averted, are displayed in the Excel export.
35
Project impact by country
Impactcalculator.psi.orgQuestions?
Email [email protected]
So, if PSI distributed 20,000,000 condoms in the Dominican Republic in 2014…
We would avert 41,874 DALYs146 deaths584 new HIV infections and 29,443 unintended pregnancies
We would also provide 166,667 CYPs
36
Project impact by country
Impactcalculator.psi.org Questions? Email [email protected]
‘In Country interventions’ and ‘Additional PSI interventions’
The interventions that display automatically are ‘In Country Interventions’.These are all interventions reported by the country for 2013 or 2014.
‘Additional PSI Interventions’ can be displayed and will appear below. These are all interventions for which we have a DALY coefficient in this country.
Simply click the ‘plus sign’ to expand and scroll down.
37
PSI Impact CalculatorProject impact by country
Learn about PSI’s models
Prepare bid proposals
Inform targets
Share your analysisSee 2013 impact
Impactcalculator.psi.org38
See 2013 Impact
Impactcalculator.psi.orgQuestions?
Email [email protected]
Using our previous example, you can access 2013 data in two ways
1. Click 2013 impact under any intervention. Last year’s data will display automatically.
2. Click Total 2013 data in the right margin to download an excel file with last year’s data.
39
PSI Impact CalculatorProject impact by country
Learn about PSI’s models
Prepare bid proposals
Inform targets
Share your analysisSee 2013 impact
Impactcalculator.psi.org40
Learn about PSI’s models
Impactcalculator.psi.orgQuestions?
Email [email protected]
Intervention specific model overviews provide a quick glance at how PSI models impact. Access them in one of two ways.
1. Click ‘Learn about PSI’s models’ from the landing page and select your intervention of interest
2. Click the name of any intervention from inside the calculator and the model overview will display
41
Learn about PSI’s models
Impactcalculator.psi.orgQuestions?
Email [email protected]
Here’s one example of a model overview
Scroll down for more details
42
Learn about PSI’s models
Impactcalculator.psi.orgQuestions?
Email [email protected]
Include impact estimates confidently in new business proposals.
Each model overview contains an example ‘Statement of Modeled Results’. Use this to tailor your message based on your own impact projections.
43
PSI Impact CalculatorProject impact by country
Learn about PSI’s models
Prepare bid proposals
Inform targets
Share your analysisSee 2013 impact
Impactcalculator.psi.org44
Share your analysis
Impactcalculator.psi.orgQuestions?
Email [email protected]
Sharing is easy
Display only the interventions you are interested in.
Share by exporting your analysis to excel or simply hitting print
45
+ Couple Years of Protection
• USAID championed measurement method• Recently revised to reflect new methods and
updates to research• Based on efficacy and effectiveness of each
contraceptive method• Each method has a coefficent, indicating how
long a couple is protected per use/package of method.
+
Page 50
Method CYP per unit
Copper-T 380-A IUD5 year IUD e.g. LNG-IUS
4.6 CYP per IUD inserted3.3 CYP
3 year implant (e.g. Implanon) 2.5 CYP per implant
4 year implant (e.g. Sino-Implant) 3.2 CYP per implant
5 year implant (e.g. Jadelle) 3.8 CYP per implant
Emergency Contraception 20 doses per CYP
Fertility Awareness Methods 1.5 CYP per trained adopter
Standard Days Method 1.5 CYP per trained adopter
LAM 4 active users per CYP
Sterilization 10 (Global)13 (India, Nepal, Bangladesh)
Oral Contraceptives 15 cycles per CYP
Condoms (Male and Female) 120 units per CYP
Vaginal Foaming Tablets 120 units per CYP
Depo Provera (DMPA) Injectable 4 doses per CYP
Noristerat (NET-En) Injectable 6 doses per CYP
Cyclofem Monthly Injectable 13 doses per CYP
Monthly Vaginal Ring/Patch 15 units per CYP
Questions?