scholarly journals From raw data to a score: Comparing quantitative methods that construct multi-level composite implementation strength scores of family planning programs in Malawi

2021 ◽  
Author(s):  
Anooj Pattnaik ◽  
Diwakar Mohan ◽  
Scott Zeger ◽  
Mercy Kanyuka ◽  
Fannie Kachale ◽  
...  
Keyword(s):  
Family Planning ◽  
Health System ◽  
Health Facility ◽  
Program Implementation ◽  
Catchment Area ◽  
Mixed Effects ◽  
Combination Method ◽  
Summary Measure ◽  
National Family Planning ◽  
Simple Average

Background: Data that capture implementation strength can be combined in multiple ways across content and health system levels to create a summary measure that can help us to explore and compare program implementation across facility catchment areas. Summary indices can make it easier for national policymakers to understand and address variation in strength of program implementation across jurisdictions. In this paper we describe development of an index that we used to describe the district level strength of implementation of the Malawi national family planning program. Methods: To develop the index, we used data collected during a 2017 national, health facility and community health worker Implementation Strength Assessment survey in Malawi to test different methods to combine indicators within and then across domains (4 methods: simple additive, weighted additive, principal components analysis, exploratory factor analysis) and combine scores across health facility and community health worker levels (2 methods: simple average and mixed effects model) to create a catchment area-level summary score for each health facility in Malawi. We explored how well each model captures variation and predicts couple years protection and how feasible it is to conduct each type of analysis and the resulting interpretability. Results: We found little difference in how the four methods combined indicator data at the individual and combined levels of the health system. However, there were major differences when combining scores across health system levels to obtain a score at the health facility catchment area level. The scores resulting from the mixed effects model were able to better discriminate differences between catchment area scores compared to the simple average method. The scores using the mixed effects combination method also demonstrated more of a dose and response relationship with couple years protection. Conclusions: The summary measure that was calculated from the mixed effects combination method captured the variation of strength of implementation of the Malawi national family planning program at the health facility catchment area level. However, the best method for creating an index should be based on pros and cons listed, not least, analyst capacity and ease of interpretability of findings. Ultimately, the resulting summary measure can aid decisionmakers in understanding the combined effect of multiple aspects of programs being implemented in their health system and comparing strengths of programs across geographies.

scholarly journals The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0232504
Author(s):  
Anooj Pattnaik ◽  
Diwakar Mohan ◽  
Amy Tsui ◽  
Sam Chipokosa ◽  
Hans Katengeza ◽  
...  
Keyword(s):  
Family Planning ◽  
Health Facility ◽  
Catchment Area ◽  
Contraceptive Use ◽  
Modern Contraceptive ◽  
Summary Measure ◽  
Modern Contraceptives ◽  
Family Planning Programs ◽  
Modern Contraceptive Use ◽  
Combined Impact

To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility’s catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve. We used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength. Metrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.

scholarly journals The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi

2020 ◽  
Author(s):  
Anooj Pattnaik ◽  
Diwakar Mohan ◽  
Amy Tsui ◽  
Sam Chipokosa ◽  
Hans Katengeza ◽  
...  
Keyword(s):  
Family Planning ◽  
Health Facility ◽  
Catchment Area ◽  
Contraceptive Use ◽  
Modern Contraceptive ◽  
Summary Measure ◽  
Modern Contraceptives ◽  
Family Planning Programs ◽  
Modern Contraceptive Use ◽  
Combined Impact

AbstractBackgroundTo explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility’s catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve.Methods and findingsWe used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength.ConclusionMetrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.

OP22 Societal Perspective On Cost Drivers For Health Technology Assessment

2017 ◽  
Vol 33 (S1) ◽  
pp. 10-11
Author(s):  
Asif Khowaja ◽  
Craig Mitton ◽  
Rahat Qureshi ◽  
Stirling Bryan ◽  
Laura Magee ◽  
...  
Keyword(s):  
Health System ◽  
Pregnant Women ◽  
Health Facility ◽  
Societal Perspective ◽  
Program Implementation ◽  
Healthcare Providers ◽  
Policy Makers ◽  
Cost Drivers ◽  
Health Decision ◽  
Implementation Costs

INTRODUCTION:Understanding cost drivers and estimating societal costs are important challenges for economic evaluation of health technologies in low-and-middle-income countries (LMICs) (1). This study assessed community experiences of health resource utilization and perceived cost drivers from a societal perspective to inform the design of an economic model for the Community Level Interventions for Pre-eclampsia (CLIP) trials (2).METHODS:Qualitative research was undertaken alongside the CLIP trial in two districts of Sindh province, Pakistan. Nine focus groups were conducted with a wide range of stakeholders, including pregnant women, mothers-in-law, husbands, fathers-in-law, healthcare providers at community and health facility-levels, and health decision-/policy-makers at the district-level. The societal perspective included out-of-pocket (OOP), health system, and program implementation costs related to CLIP. Thematic analysis was performed using NVivo software.RESULTS:Most pregnant women and male decision makers reported a large burden of OOP costs for in- and out-patient care, informal care from traditional healers, self-medication, childbirth, newborn care, transport to health facility, and missed wages by caretakers. Many healthcare providers identified health system costs associated with human resources for hypertension risk assessment, transport, and communication about patient referrals. Health decision-/policy-makers recognized program implementation costs (such as the mobile health infrastructure, staff training, and monitoring/supervision) as major investments for the health system.CONCLUSIONS:Our investigation of care-seeking practices revealed financial implications for families of pregnant women, and program implementation costs for the health system. The societal perspective provided comprehensive knowledge of cost drivers to guide an economic appraisal of the CLIP trial in Sindh, Pakistan.

scholarly journals SOCIETAL PERSPECTIVE ON COST DRIVERS FOR HEALTH TECHNOLOGY ASSESSMENT IN SINDH, PAKISTAN

2017 ◽  
Vol 33 (2) ◽  
pp. 192-198
Author(s):  
Asif Raza Khowaja ◽  
Craig Mitton ◽  
Rahat Qureshi ◽  
Stirling Bryan ◽  
Laura A. Magee ◽  
...  
Keyword(s):  
Health System ◽  
Pregnant Women ◽  
Health Facility ◽  
Societal Perspective ◽  
Program Implementation ◽  
Healthcare Providers ◽  
Policy Makers ◽  
Cost Drivers ◽  
Health Decision ◽  
Implementation Costs

Background: Understanding cost-drivers and estimating societal costs are important challenges for economic evaluation of health technologies in low- and middle-income countries (LMICs). This study assessed community experiences of health resource usage and perceived cost-drivers from a societal perspective to inform the design of an economic model for the Community Level Interventions for Pre-eclampsia (CLIP) trials.Methods: Qualitative research was undertaken alongside the CLIP trial in two districts of Sindh province, Pakistan. Nine focus groups were conducted with a wide range of stakeholders, including pregnant women, mothers-in-law, husbands, fathers-in-law, healthcare providers at community and health facility-levels, and health decision/policy makers at district-level. The societal perspective included out-of-pocket (OOP), health system, and program implementation costs related to CLIP. Thematic analysis was performed using NVivo software.Results: Most pregnant women and male decision makers reported a large burden of OOP costs for in- and out-patient care, informal care from traditional healers, self-medication, childbirth, newborn care, transport to health facility, and missed wages by caretakers. Many healthcare providers identified health system costs associated with human resources for hypertension risk assessment, transport, and communication about patient referrals. Health decision/policy makers recognized program implementation costs (such as the mobile health infrastructure, staff training, and monitoring/supervision) as major investments for the health system.Conclusions: Our investigation of care-seeking practices revealed financial implications for families of pregnant women, and program implementation costs for the health system. The societal perspective provided comprehensive knowledge of cost drivers to guide an economic appraisal of the CLIP trial in Sindh, Pakistan.

Family-Planning Knowledge and Attitude Surveys in Pakistan (Review Article)

1964 ◽  
Vol 4 (2) ◽  
pp. 332-355 ◽  
Author(s):  
Khurshid Haroon ◽  
Yasmin Azra Jan
Keyword(s):  
Family Planning ◽  
Preliminary Data ◽  
Review Article ◽  
Research Projects ◽  
Family Planning Programme ◽  
The Family ◽  
National Family ◽  
National Family Planning ◽  
Knowledge And Attitude ◽  
The Government

Very little of the intense interest and activity in the field of family planning in Pakistan has come up in the form of publications. Since the formation of the Family Planning Association of Pakistan in 1953 and the initiative of the government in promoting a national family-planning programme in its Second Five-Year Plan, relatively few reports have been printed. Most of what has been written in Pakistan about family planning has either been reported at conferences abroad or published in foreign journals, or submitted as graduate dissertations at universities within the country and abroad1. While numerous papers presented at conferences in Pakistan have been given limited circulation in mimeographed form2, much of the preliminary data, emanating from most of the action-research projects in progress, are held up till substantive demographic changes are measured and approaches evaluated accordingly.

scholarly journals Sterilization regret in India: Is quality of care a matter of concern?

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Anjali Bansal ◽  
Laxmi Kant Dwivedi
Keyword(s):  
Quality Of Care ◽  
Family Planning ◽  
Health Facility ◽  
Fold Increase ◽  
Well Being ◽  
Poor Quality ◽  
Public Health Facility ◽  
The Family ◽  
Planning Methods

Abstract Background According to United Nations, 19% of females in the world relied only on the permanent method of family planning, with 37% in India according to NFHS-4. Limited studies tried to measure the sterilization regret, and its correlated factors. The study tried to explore the trend of sterilization regret in India from 1992 to 2015 and to elicit the determining effects of various factors on sterilization regret, especially in context to perceived quality of care in the sterilization operations and type of providers. Data and methods The pooled data from NFHS-1, NFHS-3 and NFHS-4 was used to explore the regret by creating interaction between time and all the predictors. Predicted probabilities were calculated to show the trend of sterilization regret amounting to quality of care, type of health provider at the three time periods. Results The sterilization regret was increased from 5 % in NFHS-1 to 7 % in NFHS-4. According to NFHS-4, for those whose sterilization was performed in private health facility the regret was found to be less (OR-0.937; 95% CI- (0.882–0.996)) compared to public health facility. Also, the results show a two-fold increase in regret when women reported bad quality of care. The results from predicted probabilities provide enough evidence that the regret due to bad quality of care in sterilization operation had increased with each subsequent round of NFHS. Conclusion Many socio-economic and demographic factors have influenced the regret, but the poor quality of care contributed maximum to the regret from 1992 to 2015. The health facilities have seriously strayed from improving the health and well-being of women in providing the family planning methods. In addition, to public facilities, the regret amounting to private facilities have also increased from NFHS-1 to 4. The quality of care provided in the family planning operation should be standardized in every hospital to strengthen the health systems in the country. The couple should be motivated to adopt more of spacing methods.

scholarly journals PENGENTASAN KEMISKINAN MELALUI PEMBANGUNAN JARINGAN EKONOMI PEDESAAN (Sebagai Suatu Strategi)*

Populasi ◽  
2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Prijono Tjiptoherijanto
Keyword(s):  
Family Planning ◽  
Rural Areas ◽  
Rural Families ◽  
Small Scale ◽  
Family Development ◽  
Small Scale Industry ◽  
Poor Families ◽  
National Family ◽  
National Family Planning ◽  
Poverty Elimination

Various policies have been implemented by Indonesian government in its efforts to eliminate poverty. This paper proposes BKKBN's (National Family Planning Coordinating Agency) attempts which stress on poverty elimination in non-backward area by way of prosperous family development through expanding rural economic network. The program is started with improving movement of "pride of village" through programs of Plaju (that of Harvesting, Processingand Selling), Pemaju (that of Packaging and Selling), and Penguja (that of Services entrepreneurs) followed by Takesra ( that of Savings for People's Prosperity) and Kukesra (that of Entrepreneurial Credit for Prosperous Family). Through the programs, rural families are expected to play roles in agribusiness and agrobusiness sectors, as well as in small-scale industry. With the benefit gotfrom the programs, it is then expexted that levels of families' income increase consequently, and number of poor families in rural areas can be eliminated.

Sign in / Sign up

Export Citation Format

Share Document