The impact of an organization’s services is an important component of understanding how to improve service delivery and the overall health of patients.

Metrics for Management, in collaboration with the Metrics Working Group, is focusing on Additionality and Health Impact.


Health service programs seek to ensure that they contribute to the overall growth of the market — in the case of family planning (FP) this translates to increases in modern contraceptive prevalence rates (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).

In collaboration with the Metrics Working Group, Metrics for Management is measuring the aggregate concept of additional users, which looks at increases in the total number of users from an agreed baseline, (adjusting for substitution and replacement of users who discontinue contraception) to ensure there is a net increase in users. Both replacement of any users who drop out, and further increase, must be adopters to ensure these increases are contributing to national growth.

Enable programs to estimate their annual contribution to the increase in national contraception users after adjusting for substitution and loss of existing users.

Marie Stopes International (MSI) created a model for estimating a program’s contribution to reaching additional users called Impact 2. The model uses trend and client profile information to estimate the annual aggregate contribution of an organization to increasing the number of women using contraception nationally, in other words, additional users.

Data required includes:

  • 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)

Metrics for Management, in conjunction with the Metrics Working Group, has developed supporting documents to provide context, background, and assistance in the use of Impact 2. Please visit our publications page to access documentation to help you measure, interpret, and present additionality results.

For access to Impact 2 and extended guidance documentation visit MSI’s website.

  • Impact 2 was developed by Marie Stopes International. It is an Excel-based tool that, among a variety of other reproductive health impact calculations, includes an option to estimate a franchise’s contribution to national additional users. Impact 2 converts service provision and commodity distribution data into estimated family planning users for short-term, long-term and permanent family planning methods.
  • To use Impact 2, visit


In collaboration with the Metrics Working Group, we have supported a method to measure health impact. This metric makes it possible for a program to know if it has achieved what it set out to do: improve population health. Outputs like clients served and services used are often measured and tracked by programs. However, clients served does not tell the broader story of how many clients completed services; just as services used does not account for the varying degrees of health benefits provided by various health services and commodities. Health impact measurement estimates the public health value of a program, and it is an important precursor for understanding the cost-effectiveness of a program.

Use Disability-Adjusted Life Years (DALYs) averted to calculate the overall health impact of a program in a given year.

Most programs maintain records of how many health services (including referrals and diagnostic tests) and commodities they provide each year. These statistics can be run through a mathematical model created by Population Services International. The PSI Impact Calculatoris a tool to estimate and compare the potential impact of health interventions. The tool works by attaching a country-specific coefficient (or estimate of health impact per unit of intervention) to each item. Results are expressed inthe form of disability-adjusted life years (DALYs) averted. One DALY averted means that the services provided by a program resulted in a year of healthy life saved.

Population Services International (PSI) has developed a health impact calculator to estimate and compare the potential impact of health interventions, which has been reviewed and endorsed by the members of the Metrics Working Group. The tool allows you to calculate health impact by country, as well as how to communicate this information to your stakeholder.

To use the calculator, visit


Contact us to learn how Metrics for Management can help you use targeted, accurate & measurable data to expand & improve your services.