Metric: A program’s contribution to the increase of national contraceptive users after adjusting for substitution and loss of existing users.
Health service programs seek to ensure that they contribute to the overall growth of the market — in the case of family planning this translates to increases in mCPR, or increases in the total number of women using contraception (additional to a baseline). Measuring an increase in volume of FP services provided, or total or first-time FP clients seen, is not enough to capture additionality. Rather, a comprehensive picture must be taken that looks at overall increases in the number of women using a contraceptive method provided by a health program, and, where these increases are coming from (e.g. substitution versus non-users).
At the aggregate: additional users
Additional users is an aggregate concept that looks at increases in the total number of users from an agreed baseline, adjusting for substitution (so that you don’t count growth that is simply taking market share from another provider) and replacement of users who discontinue contraception to ensure there is a net increase in users. Note: it is not possible to identify whether an individual woman is “additional” or not. Both replacement of any users who drop out, and further increases, must be adopters to ensure these increases are contributing to national growth.
How do we measure additionality?
Marie Stopes International (MSI) created a model for estimating a program’s contribution to reaching additional users: Impact 2. The model uses the below inputs to estimate the aggregate contribution of an organization to increasing the number of women using contraception nationally, in other words, “additional users.”
- Trends in service provision or sales data (e.g. # pill cycles distributed, number of IUDs inserted)
- Client profile (% of clients who are (1) continuing to use an FP method from the program, (2) changed from a different provider to the program, and (3) adopters)
The service provision data is modeled into “users” by accounting for continued use of long-acting/permanent methods (LAPMs) into future years, and the number of short-term methods needed for a year of coverage. Then these “users” are modeled using the individual organization’s client profile data to estimate the contribution of the health program to increasing national contraceptive use from a selected baseline year. Only adopters can contribute to additional users.
The MWG is advocating for programs to actively measure additionality using a standardized tool across organizations in order to accurately capture progress towards FP2020 goals. The Impact 2 model not only captures adopters, but also adjusts calculations based on drop-out of existing FP users as well as continuation of FP users that have previously sought services from other providers within the same network, allowing for more accurately measuring additionality. Other programs within the MWG will be piloting the Impact 2 model within their programs to determine its applicability across organizations and how to best adapt the model for widespread usage.