From problem-solving to research utilization: How operations research and program evaluation can make programs better

HIV treatment, care, and support, and PMTCT programs are most effective when based on the best available research evidence. This is the fundamental premise of evidence-based medicine. Equally well known is the dilemma of transforming evidence into practice, which is the subject of knowledge translation and implementation science. Even when the findings of clinical trials make their way into international and national program guidelines, they run up against competing priorities within public health and community programs, resource constraints, and institutional and human inertia. Understanding how to effectively change the approach used in program operations requires understanding how programs work in the first place. Policymakers, program managers, and service providers routinely confront two fundamental and interrelated questions: Is the program working? Could the program work better? Answering these requires information, as does deciding the way forward. Most decisions are based on a combination of factors including personal experience, common sense, political realities, and program and/or research data. Operations research and program evaluation approaches can help managers be more systematic in examining existing program information, collecting new data if needed, and looking for alternative solutions. This technical brief examines this process

Family Planning Operations Research: A Book of Readings

For as long as there have been family planning programs, there has been family planning research. At the theoretical level, researchers examine the effect of fertility on health and socioeconomic development and study the determinants of fertility for individuals and populations. At the policy level, studies explore the role of family planning programs in modifying fertility and health. The development of new contraceptives is accompanied by clinical and pre-introductory trials in program settings. Surveys measure changes in contraceptive use and fertility, and the results are used to make decisions affecting programs. Finally, programs themselves carry out operations research (OR) to improve service delivery. This book provides an overview of how OR is used by family planning programs. The readings illustrate many of the major issues and topics that have benefited from OR, as well as many of the research designs encountered among OR studies. The book also provides information about the problems that programs and researchers encounter in carrying out OR and the challenges faced in translating research findings into changes in day-to-day program operations

Private sector approaches to effective family planning

Even if per-user costs are controlled or reduced, the rising demand for family planning services will far outstrip governments'and donors'financial resources in most parts of the developing world. This"resource gap"lies at the heart of donor-sponsored initiatives to involve the private sector in family planning, but there are other equally good arguments for doing so. Governments and donors are often unaware of how much the private sector (especially the commerical sector) already participates - and could participate - in family planning. The author discusses why the private sector should be involved in planning, how the private sector should be defined, what the experience has been so far with private sector involvement, and what might be expected in the future. To support family planning in the private sector, the author recommends that donors: (1) expand the total family planning market to help satisfy existing and future unmet needs for contraception; and (2) shift current users from subsidized to more nearly self-supporting outlets - without compromising coverage, equity, or quality of care. The kinds of private sector activities that donors should support depend in part on which contraceptive methods are to be emphasized. Nonclinical systems, for example, are the most efficient way to distribute supply methods (for example, oral contraceptives and condoms), as long as medical backup is available for women who suffer side effects or who wish to switch to another method. These systems of distribution free up scarce resources in clinical facilities and the time of limited medical personnel for the resupply of contraceptives. However, if sterilization is to be emphasized, a close link with existing hospital infrastructure is necessary. Nonclinical distribution favors commercial systems in urban and periurban settings and community-based distribution systems (either public or private) where commercial networks break down. Price subsidies might be considered in areas served by commercial systems, but where consumers cannot afford prevailing commercial prices. The author discusses a wide range of experiences in providing both"supply"methods and clinical methods, such as sterilization (including tubal ligation). Roving sterilization camps have proved effective in Nepal and Thailand, for example, where demand for the procedure was high; they may have backfired in other areas, such as India. Mobile clinic vans have been tried in such countries as Colombia andGuatemala, but their effectiveness and cost-efficiency have not been carefully analyzed. Among the topics the author covers: when to subsidize goods and services, when to introduce new subsidized nongovernmental organization outlets, which regulations may inhibit the expansion of private family planning efforts, how to foster demand for private sector family planning goods and services, and how to promote the private supply of such goods and services.Health Monitoring&Evaluation,Agricultural Knowledge&Information Systems,Health Economics&Finance,Gender and Health,Adolescent Health

Technical assistance to the Institute of Reproductive Health, Georgetown University in researching introduction strategies for the Standard Days contraceptive method (SDM)

The Institute of Reproductive Health (IRH), Georgetown University tested the impact of introducing the standard days contraceptive method (SDM) with the technical assistance (TA) of Population Council staff. FRONTIERS technical assistance had the immediate effect of allowing IRH to carry out evaluations of the SDM in Asia and Latin America. The IRH studies also produced important lessons learned on strategies for the introduction of natural methods. IRH staff responsible for the India and Ecuador projects learned specific skills in cost-analysis and research instrument design

Increasing access to family planning (FP) and reproductive health (RH) services through task-sharing between community health workers (CHWs) and community mid-level professionals in large-scale public-sector programs: A literature review to help guide case studies

This literature review covers case studies related to community-based distribution of family planning programs, and community health worker (CHW) programs that included family planning and other reproductive health services. It offers essential processes and implications for additional operations research which look at constraints and factors critical to introducing new program procedures or strengthening existing ones

Willingness to Pay Surveys for Setting Prices for Reproductive Health Products and Services: A User\u27s Manual

Social programs need to balance volume (coverage) and revenue (sustainability). The law of demand says that we cannot get both coverage and sustainability at the same time—as prices go up, demand will come down. Client loss with increasing prices is inevitable, except in those cases where starting prices are so low or demand is so high that demand is insensitive to price changes. Willingness to pay surveys allow program managers to simulate price-related changes in demand without actually changing prices, giving them a way to make pricing decisions based on empirical information. In making pricing decisions, managers of social programs face an equity dilemma—the problem of balancing the need for program sustainability with the social goal of making services available to low-income clients. Raising prices too high will deny services to poor clients. However, maintaining needlessly low prices will perpetuate reliance on external donors. Until recently, managers had to make pricing decisions without a reliable methodology for predicting the effect of price changes on program revenues or use. This user’s manual describes a simple survey technique to estimate client willingness to pay for goods and services, thus allowing managers to make rational pricing decisions

Encuestas de voluntad de pago para fijar precios de productos y servicios de salud reproductiva: Manual de usuarios

Social programs need to balance volume (coverage) and income (sustainability). The law of supply and demand states that we can not obtain coverage and support at the same time, because when prices rise, demand decreases. This manual presents willingness-to-pay (WTP) surveys that allow program managers to simulate changes in demand related to price, without actually changing prices. The Population Council with The Futures Group International developed these surveys that can be used for existing and new products and services, collect responses from clients with no formal education with sensitivity to their individual characteristics, and provide conservative estimates that accurately predict most reactions to price changes

Use of systematic screening to increase the provision of reproductive health services in Bolivia

The objective of this study was to determine if the use of a checklist to screen for unmet service needs could increase the number of services per visit provided to clients using rural Bolivian health facilities. Measurement included changes in services per visit before and after the introduction of the intervention, and a comparison of services received at screened and non-screened visits. Findings show that, to the degree that provider compliance can be secured, systematic screening of clients appears to be an effective method for reducing unmet health service needs. The findings of this study replicate those of other studies conducted in Africa, Asia, and Latin America. The Bolivia Ministry of Health plans to scale-up the intervention

FRONTIERS capacity building: An overview

The Population Council’s Frontiers in Reproductive Health Program is a cooperative agreement with USAID to improve family planning and reproductive health service delivery through operations research (OR). Frontiers builds on more than 20 years of research to improve family planning service delivery programs. A major goal of Frontiers is to transfer skills in OR so that public and private agencies in developing countries can conduct OR and apply research findings to reproductive health programs and policies. OR addresses problems in operational effectiveness, access, quality, and efficiency by investigating facets of programs that managers can control and change. As concluded in this overview report, Frontiers seeks to institutionalize capacity building by increasing the number of service delivery organizations that use OR and increasing the number of research organizations capable of conducting and teaching OR. Investment in capacity building will ensure that OR will make a continuing, significant contribution to reproductive health and family planning programs and policies

Building capacity to utilize operations research: Strategies and lessons learned

The effectiveness of development assistance depends on good decision-making. Many donors and international health agencies such as USAID, DFID, and WHO are placing more emphasis on the utilization of research results for policy and program development. Yet, while there is a long tradition of training researchers to produce research, there are few lessons on how to teach managers to request and use research results for making program decisions. Addressing this gap has been a major strategy of the Population Council’s Frontiers in Reproductive Health Program (FRONTIERS). Since its inception in 1998, FRONTIERS has complemented its support for operations research (OR) with an evolving range of capacity-building activities. This capacity building increases the number of program managers and researchers who can understand and conduct OR and utilize the resulting findings. As of 2005, over 700 program managers and researchers from 54 countries had participated in FRONTIERS capacity-building activities, including courses, training of trainers, infrastructure development efforts, and costing studies. This program brief presents lessons learned through FRONTIERS capacity-building work in fostering the increased use of OR by family planning and reproductive health programs