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IMPACTNOW MANUAL - Health Policy Project

1. D erge erter lt Cond ror Format SFromirune 8 4 U i w A EST RTE Brera 6 s 5 3 Condo oJ penat Norm at Bed Good ConCourtry f Dmbabwe E Get Started Configure Country Start Year End Year Select which women you want to include in your analysis Select a policy goal to configure your outputs Set o Goad for OR Al women of reproductive age gt et Goa for Unmet Need Oriy women in uren of reproductive age C Set goai tor Future Budgets Next you will need to select the range of years you are interested in observing The Start Year serves as your baseline year and End Year serves as the year for which your estimates will be calculated e For the Start Year select 2014 e For the End Year select 2020 Home Insert Page lwyout Formutas Doete Penew View A cut 42 Copy taon iM Aa F Toss Fotai Bez gt HA rP a doe j Contndyr fe 2020 E ee o a Forward Get Started Configure Country Zimbabwe i Start Year End Year 20 7 Select which we gt Select a policy goal to configure your outputs Set a God for CR Set a Goal for Unmet Need Only women in union of reproductive age gt et 4 Qo for ruture munigets 28 ImpactNow Manual Task 1 5 Choosing the population of interest Next you will need to choose which range of women you would like to include i
2. e Your Scen2 inputs should now look like the image below with the percentage of women that are in union updated to 62 2 percent You may click on the Health Care Utilization per Pregnancy tab to see that the ANC figure has been updated as well cme E test Aatsm Home Insert Page Layout Formulas Data Review View a J a Cut Calibri 21 Ag Sp Wrap Text General E z Normal Normal B Good Cr 43 Copy j e zz F Format Painter Fa se A ESB iE By merge amp center 9 BB fo ormatting as Tie gt calculation Clipboard Font Alignment A Number Al S te Sceni eS EE Configuratior Inputs Jutputs m aiii Health Indicators Scen2 Health indicators Scenario Name Scen2 of women that are in union Abortion Rate per 100 live births Stillbirth Rate per 1000 live births Unsafe abortion ratio per 100 live births of unsafe abortions needing PAC Discount Rate for Monetary Costs and Benefits Ready e Next click on Scen3 and then click on either the Load Usual or Load Scen2 button These buttons provide you with the ability to load inputs from either of the first two scenarios Since both scenarios now have the same inputs you may select either button 36 ImpactNow Manual e Again a dialog box will appear to alert you that all Scen3 inputs will be updated to mirror the inputs of either the Usual or Scen2 scenario Formatti
3. Al I ImpactNOW QUSAD fuos Ke Version 0 9686 30 Jun 2014 About impactNOW Is a product of collaboration between Marie Stopes international MS and Health Policy Project HPP with support from USAID Impact NOW is designedto analyze the health and economicimpacts of family planninguse inthe near term itis designedtobe used st the national or regional level andthe results are estimotesto be used for advocacy relatedtofamily planning and reproductive health programs Default deta are providedfor all inputs the user may choose to use these default data or alternately to replace specific parameters with their own data as they see fit Impact NOW provides automated comparisons across two orthree scenarios Methodology is largely based on MSI s Impact 2 tool For more information contact esmith tuturesgroup com Note you must enable macros to use the ImpactNOW Model This version is a working beta v0 968b 4 27 2014 Please contact us to report any bug Please do not distribute 27 Exercise 1 Getting Started Task 1 4 Choosing the country and range of years You are now in the Configuration page of the tool Before running your estimate you will need to select which country or region you are interested in exploring e From the Country dropdown menu select Zimbabwe Zn nar gt Home insert Page Layout Formus Date Review View A Calibri u A 2 wrep Text Generasi i rom Totals 2 Wahrung
4. November 2014 Estimating the Health and Economic Impacts of Family Planning Use Suggested citation Health Policy Project United States Agency for Intemational Development USAID and Mane Stopes Intemational 2014 ImpactNow Manual Estimating the Health and Economic Impacts of Family Planning Use Washington DC Futures Group Health Policy Project ISBN 978 1 59560 060 8 The Health Policy Project isa five year cooperative agreement funded by the U S Agency for Intemational Development under Agreement No AID O AA A 10 00067 beginning September 30 2010 It is implemented by Futures Group in collaboration with Plan Intemational USA Futures Institute Partners in Population and Development Afnca Regional Office PPD ARO Population Reference Bureau PRB RTI Intemational and the White Ribbon Alliance for Safe Motherhood WRA ImpactNow Manual Estimating the Health and Economic Impacts of Family Planning Use NOVEMBER 2014 Health Policy Project and Mane Stopes Intemational The information provided in this document is not official U S Govemment information and doesnot necessarily represent the views or positions of the U S Agency for Intemational Development TABLE OF CONTENTS ADDIGVIAU0NS ridhia aaa aaa aaa aai Aaaa aiaa aaao aAA aaa Ana vV MUO d c UON suin aa Aaaa aaia 1 Getting Sarie dsa Eaa A Aaa AAAA aAA a aRar 2 E EELO E E URE EAE TC E E TO ASI NEE AE ONE E E EE N E E 2 Navo a oi N E arene ne
5. of unsafe abortions needing PAC Utilization per Discount Rate for Monetary Costs and Benefits Pregnancy Health Core Parameter Utilization per Live Birth Women ages 15 49 MMR e Click on Scen and find the Load Usual button After clicking this button a dialog box will appear This box will alert you that all Scen2 inputs will now be updated to mirror the Usual scenario inputs 35 Exercise 2 Modifying Inputs Voss pe Ther 30 Jun Alais Read Only Home insert Page Layout Formulas Data Review View cut Calibri jt Aa S XV Fi Wrap Tet General Bi 5 Bad Good Aray a 8 92 Conditional Format Calculation arte ges t lt gt 9 on ona orma Expenetory J Format Painter BIE a a EEE EE Beerge a center AE cd ao Formatting as Table L z tik tyles clipboard A Font z Align m ent t gt Number a Inse Al C f s nl O E S Inputs Set Policy Goals Previous Forward Health indicators Scenario Name Scen Load Default Data J of women that are in union P Are you sure you want to load from another scenario All settings on Abortion Rate per 100 live births this page will be replaced with the settings from the chosen scenario Stillbirth Rate per 1000 live births Unsafe abortion ratio per 100 live births of unsafe abortions needing PAC Discount Rate for Monetary Costs and Benefits _ ages 15 49 MMR 90 00 Ready
6. or a trusted data source you prefer to use you may replace any of the defaults Be sure to note your source in the Source cell Inter quartile plausibility range forthe pregnancy rate of women with unmet need When estimating the number of unintended pregnancies averted due to family planning analysts must also estimate how many unintended pregnancies there would have been in the absence of FP use Because ImpactNow analyzes FP users who wish to delay or avoid pregnancy in the absence of family planning these women would have had an unmet need for it The radio buttons for the Inter quartile plausibility range for the pregnancy rate of women with unmet need allow you to choose an assumption about the annual pregnancy rate for women with unmet need Estimates vary between 23 percent the Low assumption and 38 percent the High assumption Selecting the Low assumption will result in lower impacts Selecting the High assumption will result in higher impacts The default selection is the Medium assumption 31 percent ImpactNow Manual If you maintain all other inputs and policy goals and differentiate between two scenarios only by selecting the Low assumption in one and the High assumption in another the model will produce an inter quartile plausibility range of estimated impacts Such a range takes into account the uncertainty behind one of the key yet difficult to observe parameters of the model O
7. is equal to the sum of all users in 2014 taken from the FP users calculation above To project future numbers of users the continuer cohorts are first projected forward in their rows to the right using annual continuation rates Then in years beyond the base year the number of continuers in each year of analysis is summed and compared with the corresponding number of users from the previous calculation The difference between the number of IUD users using the methodology in the previous section and the number of continuers is the calculated number of acceptors for that year highlighted in yellow on the diagonal Thus the acceptors highlighted in yellow are calculated as the residual between the number of IUD users and the number of IUD continuers from past years For example the number of acceptors in 2017 is calculated using the following formula 2016 acceptorsz917 USETS7917 3 continuers 2013 In turn the continuers in 2017 are calculated as ore continuers acceptors29 3 4 5 year continuation rate acceptors2914 3 5 year continuation rate acceptors7915 2 5 year continuation rate acceptors7916 1 5 year continuation rate 15 ImpactNow Manual In the 2017 example shown in Table 2 above ImpactNow first sums up the number of continuers from past cohorts from the 2017 column 3 060 4 205 2 404 3 351 13 020 The model then compares the total number of continuers with the number of users it previously calculate
8. with support from USAID ImpactNOW is designedto analyze the heath and economicimpacts of family planninguseinthe near term It is designedto be used at the national or regional level andthe results are estimoatesto be used for advocacy relatedtofamily planning and reproductive health programs Default dats are provided for all inputs the user may chooseto use these default data or alternately to replace specificparameters with their own data as they see fit impact NOW provides automated comparisons across two or three scenarios Methodology is largely based on MSI s impact 2 tool For more information contact esmith tuturesgroup com Note you must enable macros to use the ImpactNOW Model This version is a working beta v0 968b 4 27 2014 Please contact us to report any bug Please do not distribute 25 Exercise 1 Getting Started Task 1 2 Save and name a new version of ImpactNow identifying it asa practice file You will want to name and save each new file you run with ImpactNow This will help you pull up previous files e Click File gt Save As e The Save As box will pop up as in the picture below YT oe Se eS part Neva QAR Osim Read Onby Mirian For p ee File Home Insert Page Layout Formuta Data Review le ut _ a aa a i x Seve As z gt 2 SEa 2e Snn a a de gt me gt ew luite a o i re As a a 1 Microsoft Excel Libranes Murphy Caitlin
9. 235 375 904 393 605 442 994 Unsafe Abortions Averted Maternal deaths averted Infant deaths averted 359 966 376 917 424 212 10 398 10 925 9 296 36 655 38 381 43 198 Scenario Comparison DALYs averted 3 784 398 3 965 052 4 264 948 Incremental Maternal amp infant healthcare costs averted 119 616 819 125 249 365 140 965 490 Cost 12 80 10 05 5 05 Effectiveness 86 648 476 91 266 983 80 794 920 1 1 2 10 656 021 11 180 281 12 133 481 564 769 592 555 956 167 1 513 155 2 434 109 1 776 247 7 523 151 7 046 769 5 861 651 0 0 133 231 476 382 Female sterilization users 202 464 212 425 237 198 9 961 IUD users 31 968 33 541 2 014 879 1 573 Implant users 514 293 777 971 24 116 Standard Days Method SDM users Other modern users All traditional users Male sterilization acceptors Female sterilization acceptors IUD acceptors Implant acceptors SDM acceptors Acceptor results are expressed as the average annual number of acceptors over the course of the period of analysis 4 718 11 534 43 065 95 904 100 623 109 201 234 432 245 966 266 937 51 Exercise 4 ImpactNow Output Analysis Task 4 5 Navigating to selecting and interpreting the incremental cost effectiveness ratio e From Scenario Comparison navigate to the fourth and final tab Incremental Cost Effectiveness ImpactNOWw Configuration Inputs Set Policy Goal
10. 3 R f a m ME Desktop fa Computer Network LARIE STOPES Recent Places Capacity Building Project ya Impact Now 0 968 Zim amr Treinmyahbin 4E Desktop ta Z Libraries ya Impact Now 0968 Zim MDG Briefs al Traimngodsm se 4 A Murphy Catin i d AppData My Documents Scanned Documents M B Contacts N e z 1 AA 5 Filename impact Now 0968 Zim Training xism iat Save as type Excel Macro Enabled Workbook dsm Hide Folders For more information contact esmith tuturesgroup com Note you must enable macros to use the Impact NOW Model This version is a working beta v0 968b 4 27 2014 Please contact us to report any bug Please do not distribute e Save this file to your desktop or another folder as ImpactNow Zim Training 26 ImpactNow Manual Task 1 3 Enable macros to start using tool To use ImpactNow you will need to enable macros in Excel Otherwise you will not be able to move forward to the next screen e You can enable macros by finding the yellow toolbar along the top of the screen e Click the Enable Content button within this toolbar e Click Next goIswe eu pact Now for tet 30 Jun 2014m Read On A T Home Insert Pege Layout Formulas Data Renew View r a Calibri 2a A a gt ay Wrap Text General F Eo Normal Baa Good Neutra lt D Copy i J Format Painter Big DA EER ER Bi merce a center at Formatting as Table Check Col
11. Low 23 Inter quartile plausibility range for the pregnancy rate of women with unmet need Medium 31 O High 38 Healthcare utilization The Healthcare utilization per pregnancy and Healthcare utilization per birth inputs are used to calculate the costs averted when an unintended pregnancy is averted There are three components to this calculation the percentage of pregnancies births needing treatment the percentage of those in need who receive the treatment and the cost of the intervention The radio buttons at the top of each table adjust the percentage of those in need of treatment and those who receive the treatment When Full Access is selected it is assumed that 100 percent of those in need of each treatment receive it When Actual Access is selected national or regional defaults for access to each intervention are read from the default database Selecting Full Access will model a world where everyone who needs a specific treatment receives it and will result in higher cost savings in the outputs On the other hand assuming Actual Access where only a fraction of individuals who need a specific treatment receive it models the current state of the healthcare system and will result in lower cost saving in the outputs Full Access f Actual Access Of the births that of births requiring require attention the Associated Costs for attention for that are able to treatment of Treatm
12. aeicenstiel eatioeneahcund 16 Live ECS AN CINCO se ssacid cost eat see ntt a tu niceeseeens seine sansa 18 Abortions averted total and UnSale sai ccccccsnccciiccsescacsdisnctswacseenovesseteseeneceg tasbssectovsnnesepenesbagnuseneesvemmonsereounens 19 Materials earns ay Crs Cia braces dee secon eis Sin ce atevmaclint a earns He ata ey needains 19 CTT eat Seay ete its seta ed ace tetac teas lel dase d aha hetan sien vest aenedaned cadets calor veseadsaenedeced cada vealede 20 DALI oe CGS i act as atc ogee te ae 21 Family Pannie COSS fice ge atecerds lt casita tiie aoa decd E aw eatteaieserdin aati 21 Healthcare costs averted ets ss canis seeatve dat cit tates pesee an cengsumacecat idctguenupeslomenat cane suacee dst Sane seipedmaenanaeseanceucutudcts 21 OS DSS EF AN a sc cease tea tie hese is atc peasants a tue ital nee ment uestace demain 22 McrementilcostenectivenessS TIl Onnen a a E N 23 RE EIEC CS nsina a aaa Aaa Aaaa aa 24 Beic ise 1 Getting SHAME siia aaa iaa aaa aa aaa a aaia aS 25 T O E E E A E E MRE De 25 Savne aAa COn OUT e A A N 25 Task 1 1 Begin by double clicking on the too ccccccssesssssssseeceeceeeeeeceeeeaaaeeeeseeeeeeeeeceeeeeeeeeeeaaaaaeeeseses 25 Task 1 2 Save and name a new version of ImpactNow identifying it as a practice file 000 26 Task 3 Epable macros 10 Start usine OOM resuena a hccawbaneisagniaceeceaaenavenseatedeonaacuates 2a Task 14 Choosing the country and tange Ol yel Sisari a a telec
13. as a baseline against which the second and third scenarios are compared Thus the first scenario should be some type of business as usual base case or constant It could be a scenario where all parameters are held constant into the future or it could be a scenario where past trends are continued uninterrupted into the future The second and third scenarios should represent specific policy goals or interventions The first scenario serves as a counterfactual against which analysts can measure the incremental impacts of the second and third policy scenarios When you open the ImpactNow file you will see a Welcome page that gives basic information about ImpactNow and the version number Click on the Next arrow to continue ImpactNow USAID Hae srons UF aonr a a INTERNATIONAL Version 1 0 26 Sep 2014 About ImpactNOW is a product of collaboration between Marie Stopes International MSI and Health Policy Project HPP with support from USAID ImpactNOW is designedto analyze the health and economicimpacts of family planning use inthe near term Itis designedto be used at the national or regional level andthe results are estimatesto be usedfor advocacy relatedto family planning and reproductive health programs Default data are providedfor all inputs the user may choose to use these default data or alternately to replace specificparameters with their own data as they seefit ImpactNOW provides automated comparisons across two orthre
14. can enter any text into the yellow box The name you give each scenario will automatically appear throughout the model It is recommended that the first scenario represent some type of business as usual scenario that models what you might expect to happen in the absence of specific policy interventions Such names could be business as usual base case or constant depending on the assumptions you make The names for the second and third scenarios may be shorthand for the policies or assumptions they model Just below the scenario name are buttons that can load inputs into the scenario In the first scenario there is only one button this button loads the defaults for your country and years These defaults are already loaded when you leave the Configuration page this button will reload them overwriting any changes you have made to the defaults In the second scenario there are two buttons the first to Load Default Data and the second to load the same inputs as the first scenario In turn the third scenario has three buttons to Load Default Data to load the inputs from the first scenario and to load the inputs from the second scenario Below is an example from the third scenario Scenario Name FP2020 Commitment Each of the five input categories contains cells to enter the values of the parameters and to note the sources Default values are provided for each parameter When you have more specific or up to date data
15. inputs into the Method Mix policy Gal ccccccsssssssssesseeeeeeeeceeeeeeseeeeaaeeeeeeeees 40 Task 3 4 Navigating to page three of the Set Policy Goals section ccccccccccececeeeeeeaeeeseseseeseeeeeeees 43 Exercise 4 ImpactNow Output Ana lySis ssccssssssssccsssssssscesnssseeeesnnssseseesnnssseeeesnnssseseesnsssesessnessessessans 44 YS COI CS lees eral atts eh a eh arash atl ot nats cabal Saari fuS haan thtnail cttslanlaes Malas isl ae saath 44 Task4 1 Navigating tothe Outputs Paces iciiciccncectdyAcchel Gawd sedwancddeacenstiedaladebeuvedwtdelvnddgneacenendedabedibenseaeens 44 Task 4 2 Selecting viewing and interpreting output indicators Of INLeTESt ccccceeeceeeeeeeeeeeeeaaaeeeeeeeees 45 Task 4 3 Viewing and copying pasting summary table results cc cessesseeeseeeeeeeeeeeeeeeeeeeaeseeeeeeeees 46 Task 4 4 Viewing and copying pasting scenario comparison tables ccccccseecceeeeeeeeeeeeeeeaeeeeeeeees 49 Task 4 5 Navigating to selecting and interpreting the incremental cost effectiveness ratio 52 GIOUD EXC SIC Se aA AARAA a 54 TONY MUGEN Sie a E ee ee eee 54 IN PRACT VC i226 Sas facncs 8ie E E A Sed cin Stata ab dante alae Seagate lotion esean 54 1V ABBREVIATIONS CPR DALY FP FP2020 HPP ICER IUD LAPM MMR MSI PBI USAID WRA YLD YLL contraceptive prevalence rate disability adjusted life year family planning Family Planning 2020 Health P
16. of the national estimates were below a 23 percent pregnancy rate while 75 percent of the estimates were above 23 percent Similarly 75 percent of the national estimates were below 25 percent were above a 38 percent pregnancy rate Selecting the Low assumption will result in a higher estimated number of unintended pregnancies averted by family planning while selecting the High assumption will result in a lower estimated number The default setting in ImpactNow is to use the Medium estimate of a 31 percent annual pregnancy rate for women with unmet need In the case of LAPM the calculations also account for the users age LAPM users particularly sterilization users may be older than users of short term methods due to the long term nature of the 16 Methodology methods The average age of users for each LAPM is calculated using the acceptors tables which show the distribution of users by time since acceptance A discount factor is then applied to the pregnancy rate of women with unmet need according to the average age of the LAPM users in that year Table 3 Age Specific Fertility Disc ount Factors 15 19 1 20 24 i 25 29 13 30 34 1 1 35 39 1 40 44 0 6 45 49 0 1 Source Weinbergeretal 2012 Unintended pregnancies averted are added across all methods Subsequent calculations do not require any information about FP methods but rather are calculated based on total unintended pregnancies averted 17 ImpactNow Manual Liv
17. output summary tables by scenario e Display in depth comparison tables which evaluate cumulative rather than annual values of each indicator output across the three scenarios e Interpret the incremental cost effectiveness ratio for select indicators Task 4 1 Navigating to the Outputs pages e Navigate away from the Set Policy Goals section by clicking Outputs in the navigation bar ImpactNoWw Configuration Inputs Set Policy Goals Outputs Previous Forward e You will see four pages in the Outputs section 1 Indicator Analysis 2 Summary Tables 3 Scenario Comparison and 4 Incremental Cost Effectiveness Ensure that you have navigated to the first tab by clicking Indicator Analysis ImpactNOW Configuration Inputs Set Policy Goals Previous Forward CPR Analysis Choose Output Births averted Indicator Analysis 450 000 CPR by Year 400 000 Tables 300 000 250 000 Usual z 200 000 m Scen2 Scenario sin ate Comparison Scen3 100 000 Incremental Cost Effectiveness 2014 2015 2016 2017 2018 2019 2020 232 358 241 427 250 496 259 565 268 634 277 703 286 772 229 036 242 646 256 637 271 012 285 775 300 928 316 476 229 036 252 255 276 878 302 940 330 477 359 526 390 123 Acceptor results are expressed as the average annual number of acceptors over the course of the period of analysis 44 ImpactNow Manual Task 4 2 Selecting viewing and interpreting output indica
18. rates population and maternal mortality rate The source of each input is noted to the right of the input value You can navigate through other input categories by clicking through the tabs on the left side of the screen Health Indicators Effectiveness of Contraceptives Median Age of Use for Contraceptives Health Care Utilization per Pregnancy Health Care Utilization per Live Birth If you navigate back to the first input tab Health Indicators you will note that there is a button labeled Load Default Data This button restores the default data for the country you selected on the Configuration page This button is helpful if you have altered inputs but would like to re populate the page with default data xj l 5 ted H 4 Impact Now for test 30 Jun 2014 dsm Read Only File Home I P F 3 D Review lew i lib 11 Aa E gt sy Wrap Text General 4 Fi BY Noma Normal Bad mal Good Neutral al j Ta g p BZU Dy De Ay EEE RE HmMegekcenter A 9 E onei myn Calculation CheckCell Input T Ins Al X f ImpactNOW 4 Configuration Inputs Set Policy Goals Outputs Health Indicators Usual Health Indicators Scenario Name Usual Load Default Data of women that are in union Abortion Rate per 100 live births Stillbirth Rate per 1000 live births Comments Source or Contraceptives Unsafe abortion ratio per 100 live births Health Care of unsafe abortions needing PAC Utilization per Pregnancy r
19. results will appear in the Outputs section This section is divided into four tabs Indicator Analysis Summary Tables Scenario Comparison and Incremental Cost Effectiveness Ratio Indicator Analysis The first tab is Indicator Analysis You should select an indicator of interest from the yellow drop down menu above the graph The model will then graph the results for all three scenarios and display the annual values for each scenario in the table below On the right side of the page is a box with the main policy goal which serves as a reminder this box cannot be edited This tab allows you to quickly see the results of the outputs of greatest interest both graphically and numerically and to compare these results across the three scenarios Choose Output Births averted 400 000 4 350 000 300 000 250 000 business as Usual 200 000 ames API scenaro 150 000 FF7020 Commitment 100 000 20 000 0 2015 2016 2017 2018 2019 2020 Business as Usua 162 325 AS Sela 200s 2 ie Ws ee ele 2s ie LAPM scenario 162 325 204738 225 050 255 095 276 205 300 195 FP2020 Commitn 162 525 213 461 255 270 267 706 323 374 360 252 Summary Tables The second tab in the Outputs section is Summary Tables There is one table for each scenario each table provides the annual values for all outputs This tab displays all results in one location This may be useful if you wish to copy and paste all of the result
20. the outputs in a way that is effective for advocacy Nanative 1 The first lady of Benin has announced a new five year Safe Childhood Initiative with the goal of reducing preventable child deaths This movement has garnered national attention and the government has made new funding available for programs that reduce child deaths You are a program manager for an FP service delivery nongovernmental organization and would like to make the case that family planning can contribute to safe childhood Being a conscientious FP advocate you also want to advocate for provision of modern contraceptive methods by the government Please use ImpactNow to demonstrate the benefits of increasing the contraceptive prevalence rate in Benin to 25 percent by 2018 Create multiple scenarios to explore different ways of achieving this goal Identify at least one country specific source for demographic data and use this source in your projection Nanative 2 Uganda s Minister of Health is concerned about the extremely high rate of population growth in his country Unsurprisingly the country also has very high unmet need for family planning As an officer within the Reproductive Health Unit of the Ministry of Health the minister would like you to estimate the total FP program resources that would be necessary to cut unmet need by half The minister would also like you to estimate the difference in resource requirements if the country diversified its method mix to inclu
21. year IUD 2014 2020 Analysis Year of Analysis rota 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 E os o oe ose T TE 3 57 3 12 COA 5 20 Q BEN 5 zo fe hen O ams The light grey cells on the diagonal are where the year of analysis and the year of insertion align that is they represent the starting cohorts of UD acceptors in that year These starting cohorts in light grey on the diagonal are based on the assumption that the first cohort was one woman the second was two the third was three etc They have been discounted for half a year of discontinuation under the assumption that IUD insertion happened throughout the year but the cohort 1s counted on December 31 Tracing one row for example 2011 forward in time to the right we see with each year column there are fewer hypothetical women remaining in each cohort Starting with the 2011 cohort some hypothetical women have the UD removed in 2012 more have it removed in 2013 and so on The annual decline in each cohort is based on continuation rates used in MSI s Impact 2 model Marie Stopes International 2012 Because this IUD only lasts for five years by 2016 there are no more hypothetical women from the 2011 cohort considered to be still using the IUD The purpose of the dummy table is to create artificial past acceptor cohorts for a specific LAPM to make projections about future numbers of acceptors It is ne
22. 1122 278 1194008 1264 407 1332 934 1399 02 1462 074 1521 479 9296 200709 _7 Infant deaths averted 4620 609 5089 027 5585 763 6111 542 6667 089 7253 13 7870 389 43197 54875 8 DALYS averted 464627 6 508959 1 555597 3 604567 7 655894 1 709598 9 765702 9 4264947 679 9 Maternal amp infant healthcare costs averted 15078318 16606895 18227881 19943643 21756547 23668960 25683246 140965489 5 10 Unmet Need 0 128 0 102167 0 076333 0 0505 0 024667 0 00117 0 027 0 0505 11 Total FP costs 11080880 11360892 11571447 11706245 11758986 11723371 11593099 80794919 54 12 Cost benefit ratio 1 360751 1 46176 1 575246 1 703676 1 850206 2 018955 2 215391 1 740854977 13 Total users 1362726 1478439 1598851 1723959 1853766 1988270 2127471 12133480 98 14 Condom users 72224 45 89938 39 109787 7 131882 9 156334 2 183252 2 212747 1 956166 982 15 Injectable users 193507 211909 6 231300 4 251698 1 273121 5 295589 4 319120 6 1776246 638 16 Pill users 962084 2 943737 1 912410 8 867151 6 807006 731020 4 638241 2 5861651 38 17 Male sterilization users 0 4928 131 10659 17239 59 24716 88 33137 83 42549 42 133230 8469 18 Female sterilization users 25891 79 28336 75 30911 11 33617 21 36457 39 39434 01 42549 42 237197 6809 19 IUD users 4088 177 77618 07 163082 8 261179 9 372606 9 498061 5 638241 2 2014878 519 20 Implant users 62685 37 76139 63 91134 49 107747 5 126056 1 146137 8 168070 2 777971 0223 21 Standard Days Method SDM users 0 0 0 0 0 0 0 0 22 Other modern users 12264 53 13
23. 2 Singh Susheela and Jacqueline E Darroch 2012 Adding It Up Costs and Benefits of Contraceptive Services Estimates for 2012 New York Guttmacher Institute and United Nations Population Fund Weinberger M F Pozo Martin T Boler K Fry and K Hopkins 2012 Impact 2 An Innovative Tool for Estimating the Impact of Reproductive Health Programmes Methodology Paper London Marie Stopes International WHO United Nations Children s Fund UNICEF United Nations Population Fund UNFPA The World Bank and United Nations Population Division 2014 Trends in Maternal Mortality 1990 to 2013 Estimates by WHO UNICEF UNFPA The World Bank and the United Nations Population Division Geneva WHO 24 EXERCISE 1 GETING SIARTED Intoduction ImpactNow is an Excel based model that estimates the health and economic impacts of family planning in the near term It is designed to model the impacts of different policy scenarios and estimate the answers to many what if questions about policy options For example you may want to know answers to questions such as What are the reproductive health impacts of reaching our FP2020 commitment To become familiar with the tool you will complete practice exercises which look at the estimated impact of different contraceptive prevalence rate CPR goals ImpactNow allows analysts to look at three CPR goals simultaneously and produces the estimated health outcomes and economic impact associ
24. 20 Commitment 30 740 018 GSE ie 10 905 497 524 920 5 2i 10 METHODOLOGY Overview The calculations in ImpactNow flow in a linear cascade beginning with the number of users of each family planning method The numbers of unintended pregnancies averted and subsequent live births averted are based on the number of users of each method In turn maternal and infant deaths averted are based on the number of live births averted disability adjusted life years DALYs averted are based on maternal and infant deaths averted The three different policy goal options CPR Unmet Need and Future Budgets entail different calculations to arrive at the number of FP users However the subsequent calculations are identical regardless of which policy goal you select Costs of family planning are based on the number of users of each method Costs averted are based on the average costs associated with a pregnancy and a live birth All outputs are calculated for each year of the analysis using the projected number of users method mix and FP costs associated with that year Each year is an independent calculation and does not depend on the results of the previous year Where the inputs are only for the first and final year of a value a constant linear scale up for intermediate years is assumed Figure 1 Methodological Framework Adopters of LAPMs FP users by method CPR or Unmet Need Unintended pregnancies averted A
25. 305 95 14389 66 15515 63 16683 89 17894 43 19147 24 109201 3288 23 All traditional users 29979 96 32525 67 35174 71 37927 11 40782 85 43741 93 46804 36 266936 5815 24 Male sterilization acceptors 0 25 Female sterilization acceptors 0 26 IUD acceptors 128735 2 128735 2 128735 2 128735 2 128735 2 128735 2 128735 2 901146 4143 27 Implant acceptors 38028 42 38028 42 38028 42 38028 42 38028 42 38028 42 38028 42 0 28 SOM acceptors 0 0 0 0 0 0 0 0 2a e Switch back to the ImpactNow file View the second part of the Scenario Comparison table columns four and five These columns compare Scen2 and Scen3 to the Usual case or the baseline scenario lt gt Previous Forward CPR Analysis Scenario Comparison Acce ptor results are expressed as the avera annual number of acce 3 tors over the cours of the period of analysis 50 ImpactNow Manual e Finally view the third part of the table columns six and seven This part of the table states the comparison as a percentage of the Usual scenario value this has the benefit of expressing the size of the difference in outputs relative to the absolute level of output ImpactNOW Configuration Inputs Set Policy Goals Previous Forward CPR Analysis years incremental difference reer aierence compared to Usual compared to Usual Indicator Usal XS S S Seng Senz Scen3 senz sens i i 2 627 450 i 1 816 953 1 902 511 2 141
26. 464 268 634 55 577 53 220 1 598 5 419 563 507 17 685 164 0 12 810 845 1 1 575 476 83 500 223 718 1 112 286 0 29 934 4 726 72 472 0 14 179 34 660 0 6 152 1 027 20 037 0 2019 401 579 277 703 57 453 55 017 1 725 5 602 87 325 18 282 211 o 13 243 336 1 1 628 664 86 319 231 270 1 149 837 0 30 945 4 886 74 919 0 14 658 35 631 0 6 152 1 027 20 037 0 zm lt lt Previous Forward ImpactNow Manual e To conduct your own data analysis with these tables in a separate file open a new blank workbook in Excel d Home Inset Pagelayout Formulas Data Review View bed Save Available Templates GAL Save As BF open gt 3 Home af Close OK Info Recent Sample My templates New from templates templates existing Search Office com for templates a aw m Save amp Send Budgets Calendars Cards Charts and Forms Inventories Invoices Help diagrams 2 Options Bee awa swe Memos Planners Plans and PowerPoint Projects Receipts Records proposals presentations and slides Reports Schedules Statements Stationery Time sheets and specialty paper e After opening the new workbook switch back to the ImpactNow file scrolling to Scen3 on the Summary Tables tab Select the full table and click Copy Home tnsert Pagelayout Formulas Data Revew View calibri po An gt Sy rap Text General H E Totals T
27. 48 424 212 490 550 64 245 e Inthe Unsafe Abortions Averted example the ICER tells us that setting an ambitious contraceptive policy goal one that aspires to increase contraceptive prevalence and decrease maternal deaths as per Scen3 could avert one unsafe abortion for each US 7 invested in family planning 52 ImpactNow Manual e Next select Infant Deaths Averted from the yellow drop down menu Please interpret the following ICER o The ICER tells us that by making an ambitious policy goal one that aspires to increase contraceptive prevalence and decrease maternal deaths by 2020 we could Answers found at the end of this exercise i Task 4 2 Answers o Usual 414 693 o Scen2 457 648 o Scen3 564 147 o Which scenano averted the most unintended pregnancies in 2020 Answer Scen3 i Task 4 2 Answers o Usual 5 785 o Scen2 6 385 o Scen3 8 0 o Which scenano prevented the most infant deaths in 2020 Answer Scen3 iii Task 4 5 Answer The ICER tells us that by setting an ambitious policy goal one that aspires to increase contraceptive prevalence and decrease matemal deaths by 2020 we could avert one infant death for each US 73 invested in family planning 53 GROUP EXERCISE Instructions Please review the following narrative with your group Use the details below to build an appropriate ImpactNow application After completing the projection use the paper and markers provided to visualize
28. Commitment LAPM scenario FP2020 Commitment Unintended pregnancies averted 1 734 229 2 005 586 2 259 149 271 358 524 920 16 26 Births averted 1 243 854 1 438 482 1 620 346 194 628 376 492 16 26 Maternal deaths averted 3 161 3 626 4 064 466 903 15 25 Incremental Cost Effectiveness Ratio The fourth tab in the Outputs section is the Incremental Cost Effectiveness Ratio The second and third scenario outcomes and FP costs are compared with the FP costs and outcomes in the first scenario The incremental costs are then divided by the incremental outcomes to arrive at the ICER The ICER tells us the amount of additional funds that must be invested in family planning to achieve each additional unit of the selected outcome Based on the example below you could state We estimate that by switching to more LAPM use we could avert one unintended pregnancy for each US 20 invested in family planning This tab analyzes one indicator at a time you can select the indicator of interest from the yellow drop down menu The table shows the exact values while the graph shows one point for each scenario In this analysis the first scenario serves as a baseline against which the second and third scenarios are compared Unintended pregnancies averted Program FP Costs Outcomes Incremental FP Costs Difference in X outcome ICER Business as Usual 39 834 530 1 734 229 LAP M scenario 5 45 20 7 2 74 2 005 586 a 452 44 271 358 5 20 P FP20
29. DALYs averted YLL averted YLD averted DALYs averted maternal deaths averted YLL per maternal death averted maternal deaths averted YLL per maternal death averted DALY ratio YLD YLL all maternal conditions For child health DALYs averted child deaths averted YLL per child death averted ImpactNow reports the total DALYs averted summing the child and maternal DALYs averted Total DALYs averted maternal DALYs averted child DALYs averted Region specific values for YLL per maternal death averted DALY ratio for all maternal conditions and YLL per child death are taken from the 2010 Global Burden of Disease report IHME 2013 Family planning costs Total costs invested in family planning are based on the number of users of each method and the annual cost of each method n Total FP costs gt users of method annual cost per user of method E FP costs are only displayed as an output when you select either a CPR or Unmet Need goal Healthcare costs averted Healthcare costs averted are those normally incurred in the course of pregnancy childbirth and some basic neonatal costs First the model calculates average costs per pregnancy and per live birth 21 ImpactNow Manual If you select Full Access on the Inputs page then the average cost calculations assume that all women births needing each intervention will receive it In this case average cost per pregnancy n gt of women
30. ENC T ete Ctr 3 Conn gurao hte 5uhieelek edo kathch cenit a a e a a lalveh tect a 5 Ga OUI Kc ieeerene reece ep rine tere ret tre cratee rnerar A 7 Scenaro names ana default dalarn Enr EE N EA E Z Inter quartile plausibility range for the pregnancy rate of women with unmet need 0000000000000000 7 Healthcare utli zaton PO OOS ane S SEPO y LOA acat siheh Geared dea saraciedeeMuaheet a denentehamaecriie a aa lenentedaeteniees 8 UNE eases teed ccc ane ae E ons teednseneles 9 In CAO ANALYS IS rotoi iE E E E EREA taghtssbedoueseondeuaates 9 DNA S TADLES e EENE E EE E E E E E E 9 Scenari o COMPOTISON arao Eaa ee E E T T NTA N OA 9 Incremental COTTE ecAVenre s ECRI Onena T E daeae sede aaa 10 M thodol gy osa aaa a aaa aa aaa aaa aaa aaa iaaa a 11 OVO Le aR r E E A ey ere Treen 11 Women of reproductive age at risk for unintended pregnancy eseeesessssssssssseeeetereresssssssssssssseseeereee 12 Conrace Pive PEC Vale Cel Ale an asd vdecease ted ic tee ntbuctoa ti aerbactmet mabe onsiudautneNancaiatanceibenhetesqtuns 12 Lacan Sota cx oy 0 E ner arene ete N EEEE everett nim ry E veer rac A E rere E AE T 12 Users oram y pianin sins lactate es ae asec a a dadaaea toute siaoid eet ealielereaass 13 Acceptors of long acting and permanent methods ccccccccccccccscessssssesesseeeeceeeceeeeeeeeaauaaaessesseeeeeeeeees 13 Bie GNANCIES AVC srciiancshethedicadeacucatepondwaadthanGengrned eal iaeuiahenaudatad axicenst el eaditenGehemendaeaa
31. ICER calculation you must first choose the output in which you are interested For example you may be interested in maternal health and want to know how much more money must be invested in family planning to prevent one more maternal death In this case the ICER would compare the investments in family planning in the base and policy scenarios and also compare the maternal deaths averted in the base and policy scenarios The formula is ICERoutcome x FP costs in policy scenario FP costs in base scenario outcome X in policy scenario outcome X in base scenario For example if the base scenario costs US 259 million and averts 34 114 maternal deaths while the policy scenario costs US 278 million and averts 36 673 maternal deaths then the ICER would be ICER maternal deaths averted 278 000 000 259 000 000 36 673 34 1 14 7 425 per maternal death averted That is each incremental US 7 425 invested in family planning averts one more maternal death 23 REFERENCES Department of Reproductive Health and Research and World Health Organization WHO 2011 Unsafe Abortion Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008 6 edition Geneva WHO Institute for Health Metrics and Evaluation IHME 2013 The Global Burden of Disease Generating Evidence Guiding Policy Seattle IHME Marie Stopes International 2012 Impact 2 Available at http mariestopes org Impact
32. aceptive use compared to the Usual scenario e Scenario 3 Scen3 representing the most ambitious contraceptive use policy goal and therefore the largest increases in contraceptive use over time Task 3 1 Navigating to the Set Policy Goals pages e Navigate away from the Inputs pages of ImpactNow by clicking Set Policy Goals in the navigation bar at the top of the Configuration page ImpactNOW Configuration Set Policy Goals Outputs e You will see three pages in the Set Policy Goals section 1 the main contraceptive prevalence rate CPR policy goal 2 the method mix goal and 3 FP costs Ensure that you have navigated to the first page by clicking CPR IimpactNow ime Configuration Inputs Sat Policy Goals Outputs z lt gt al a Previous Forward CPR Policy Goal Unmet Need Yr1 and CPR Unmet Need Basa Base Source Comment Source Comment 24 05 DHS 2011 3185 2 95 12 95 Method Mix 38 ImpactNow Manual Task 3 2 Entering new baseline figures On the first tab in the Set Policy Goals section you will see seven yellow input fields five for data and two for base year sources The first two fields correspond to unmet need in the base year e Adjust the baseline unmet need estimate by entering 12 8 in the 2014 yellow field corresponding to Unmet Need Base Change the source information to DHS 2010 2011 ImpactNOW Configuration Inputs Set Pol
33. aioesl F ai Calculation icheckCell input gt inse COTE FUMES Formatting as Table gt Y30 f ImpactNOW a Inputs Outputs e gt Health Indicators Effectiveness of Contraceptives Median Age of Use for Contraceptives Health Care Utilization per Pregnancy Health Care Utilization per Uve Birth Ready Health Indicators Usual Scenario Name Usual Load Default Data of women that are in union 62 2 2011DHS Abortion Rate per 100 live births Sete tints eter Stillbirth Rate per 1000 live births Unsafe abortion ratio per 100 live births of unsafe abortions needing PAC Discount Rate for Monetary Costs and Benefits Parameter 204 2020 Comments Source Women ages 15 49 745 089 opt n Prospects 2010 Revision lt MMR 33 Exercise 2 Modifying Inputs Sample B Modifying percentage who received antenatal care Navigate to the Health Care Utilization per Pregnancy input tab Note that the first column of the table shows the percentage of pregnant women who need a specific health service and that the second column shows the percentage of pregnant women in need who actually receive the service Note that the percentage of women who receive antenatal care ANC is 42 percent as per the 2012 Adding It Up report Singh and Darroch 2012 Hypothetically you may know of a more recent source of ANC data which cites the care received at 52 percent You can update this input to ref
34. ated with these goals It should be noted however that estimates produced by these exercises are for training only The ImpactNow tool is populated by a database of default data including demographics incidence prevalence rates and international cost estimates for some reproductive health services In general you should review the default data and make changes as you see fit For this training examples use default data and hypothetical policy goals The policy goals used in the training exercises should therefore not be considered real policy goals Saving and configuring Objective At the end of the exercise you will be able to e Save anew version of the ImpactNow tool to your computer e Enable macros in the tool e Configure ImpactNow to your region population and type of policy goal of interest Task 1 1 Begin by double clicking on the tool You will see the Welcome screen below which denotes the version of ImpactNow you are using xi l i d 2 B P mp ct Now for test 30 Jun Olds Read Onyi Microsoft Excel B dis alin TI Ka gt p Wr t Genera k ya Normal ead Good Neutra Ly i m me E DA ESM BR mman s or Be sonal Formaat Calculation FEE mens n g CU secumty waing Some active content has been disabled Click for more details Al X J ImpactNOW PUSAID Hb ae sores About impactNOW isa product of collaboration between Marie Stopes International MS and Health Policy Project HPP
35. bortions averted Costs avered Cost benefit ratio Matemal deaths Child deaths averted averted DALYs averted 11 ImpactNow Manual Women of reproductive age at nsk for unintended pregnancy The first step is to understand how many women of reproductive age WRA are considered at risk for unintended pregnancies If you select All women of reproductive age on the Configuration page ImpactNow will apply the calculations to all women ages15 49 If you select Only women in union of reproductive age the model will apply the percentage of women in union to the total number of women ages 15 49 Under this scenario only those women will be considered at risk for unintended pregnancy Note that the default method mix is dependent on which group of women is selected Contraceptive prevalence rate ImpactNow requires you to select one of three types of policy goal increasing CPR reducing Unmet Need or increasing total Future Budgets Depending on the national context and advocacy focus select the most relevant option If you select a CPR policy goal the annual CPR calculation is straightforward ImpactNow does a linear interpolation between the base and end year contraceptive prevalence rates If you select an Unmet Need policy goal ImpactNow first does a linear interpolation between the base and end year unmet need Then the model assumes that each percentage point decrease in unmet need is equivalent to a percentage
36. cessary to make assumptions about past use because LAPM use often carries forward from one year to the next Therefore to calculate the number of LAPM users who are new acceptors in any given year of the analysis assumptions must be made about LAPM continuers Once the dummy table has been established it can be scaled up to match numbers of real women using that LAPM To do this you should sum the total users in the dummy table in the base year of the analysis in the example above 2014 then divide the number of users of that LAPM taken from the FP users calculation above by the hypothetical users from the dummy LAPM table In the example there are 40 387 users of the five year IUD Therefore the scale factor for the IUD is 17 447 15 53 1 123 That is each person in the dummy table represents 1 123 IUD users This scale factor is used to create the second table where the numbers represent actual women to project future numbers of acceptors 14 Methodology Table 2 Sample LAPM Acceptors Projection Table Five year IUD 2014 2020 Analysis Year of Analysis rear amatyss S O roscoe 5 262 4 595 4 013 3 504 Cc O a sS uw O pa 09 gt The numbers in this table represent actual women using the IUD The entire table is calibrated around the first year of analysis outlined in bold in this example 2014 That is the sum of all users in 2014 in this table Summing the values in the 2014 column
37. d In this case there are 17 703 users of the five year IUD ImpactNow then calculates the number of acceptors in 2017 as the difference between the number of users and the number of continuers 17 703 13 020 4 683 Acceptors are calculated in this way for all LAPMs Because the annual results are dependent on assumptions made about past acceptors of LAPMs they are presented in the ImpactNow results as an average across all years This reconciles any year to year fluctuations inherent in the calculations For sterilization calculations ImpactNow also takes age into account The method s permanence means that some users will be older than users of other methods It also requires that the model account for survival and aging out of the reproductive years rather than discontinuation Each cohort of sterilization acceptors is assumed to start at the median age at sterilization Each year the cohort moves forward its members age one year and the concomitant survival rates of women of that age are applied Thus each cohort shrinks slightly each year due to mortality of some women in that cohort Once the median cohort age reaches 50 the surviving cohort of sterilization users goes to zero in the calculations For male sterilization the median age at female sterilization is also used with the assumption that it represents the age of the man s partner This is done for two reasons first because the fecundity of women varies with age much more tha
38. d Mix 39 Exercise 3 Setting Policy Goals e Set an ambitious contraceptive use policy goal for Scen2 by entering 64 in the corresponding 2020 yellow data field ImpactNOW Configuration Inputs Set Policy Goals Outputs Previous Forward CPR Policy Goal Unmet Need Yr1 and CPR Unmet Need CPR Base Base Usual Scen2 Scen3 2014 Source Comment 2014 Source Comment 2020 2020 2020 12 80 DHS 2010 2011 58 50 DHS 2010 2011 58 50 64 00 p 12 95 C Method Mix e Finally set the most ambitious contraceptive use policy goal for Scen3 by entering 74 in the corresponding 2020 yellow data field Configuration Set Policy Goals Outputs Previous Forward ImpactNOW CPR Policy Goal Unmet Need Yr1 and CPR Unmet Need CPR Base Base Usual Scen2 or 2014 Source Comment 2014 Source Comment 2020 2020 12 80 DHS 2010 2011 58 50 DHS 2010 2011 58 50 64 00 l 74 00 Method Mix Task 3 4 Entering inputs into the Method Mix policy goal e Navigate away from the first tab of the Set Policy Goals section by clicking Method Mix By doing this you will see the method mix for the baseline year Base as well as the three policy scenarios Usual Scen2 and Scen3 e Ensure the following distribution of contraceptive users by method in the Base case and corresponding yellow fields Male condom 5 3 Injectable 14 2 Pill 70 6 Male sterilization 0 Female sterilizat
39. d here are the cumulative values for the entire time period that is the sum of all the annual values The cost benefit ratio compared here is the average across all years 49 Exercise 4 ImpactNow Output Analysis e Switch back to your new Excel workbook and complete the following steps o Select cell J2 and click Paste Values Now the Scen3 annual and cumulative values are both on one sheet o Incell J1 type Cumulative Values Scen3 to name the column o Incell K1 type Cumulative Values Check o kh cell K2 enter the formula sum B2 H2 and hit enter Compare whether this value matches the value in J2 d Ca e wT Home Insert Page Layout Formulas Data Review View nC e a N e Copy Paste M Conditional Format Calculation Check d J Format Painter BS Eri a a FER P Bi merge acente 9 Be Formatting as Table check Clipboard ra Font gt Alignment la Number a Sty J 1 Indicator 2014 2015 2016 2017 2018 2019 2020 Cumulative Values Scep 2 Unintended pregnancies averted 331203 6 364779 7 400385 5 438073 2 477894 6 519901 8 564146 7 3096385 163 Births averted 229036 4 252255 1 276877 5 302939 6 330477 2 359526 3 390122 9 2141235 076 E _4 Abortions Averted 47384 65 52188 31 57282 37 62674 27 68371 44 74381 33 80711 36 442993 7162 5 Unsafe Abortions Averted 45375 64 49975 63 54853 71 60017 65472 63 71227 71 77289 36 424211 6678 6 Maternal deaths averted
40. de more long acting methods Identify at least one country specific source for demographic data and use this source in your projection 54 For more information contact Health Policy Project Futures Group 1331 Pennsylvania Ave NWV Suite 600 Aeee en DL ur4010 10 Tel 202 775 9680 Fax 202 775 9694 Email policyinto tuturesgroup com www healthpolicyproject com
41. e births averted Live births averted are calculated by subtracting abortions miscarriages and stillbirths from the number of unintended pregnancies averted This equation describes the distribution of how all pregnancies end P LB SB A M M P Pregnancies LB Live births SB Stillbirths per live birth Because the stillbirth rate is standardly expressed in terms of stillbirths per 1 000 total births a small adjustment is made to express the stillbirths in terms of all live births SB stillbirth rate 1 000 stillbirth rate A Abortions per live birth Because the abortion rate is expressed in terms of abortions per 100 live births we divide it by 100 A Abortion rate 100 M Miscarriages that would have led to abortion per live birth M Abortion per live birth miscarriages per abortion Mb Miscarriages that would have led to birth per live birth Mb Miscarriage per pregnancy that reaches 27 weeks total births Where total births live births stillbirths Solving the formula for live births yields a pregnancies to live births converter LB P SB A M M Pregnancies to live births converter P stillbirth rate 1 000 stillbirth rate abortion rate 100 abortion per live birth miscarriages per abortion miscarriage per pregnancy that reaches 27 weeks total births This converter is applied to the number of unintended pregnancies averted yielding the total number of live births averted Live b
42. e scenarios Methodology islargely based on MSI s Impact 2 tool For more information contact A policyinfo futuresgroup com Note you must enable macros to use the ImpactNOW Model This version is a working beta Please contact us to report any bug Please do not distribute The ImpactNow file may be unlocked by copying unlockFG into your clipboard and then clicking the Next arrow on the Welcome page To lock the file again copy lockFG into your clipboard and then click the Next arrow on the Welcome screen Getting Started Navigation You can navigate through the pages of ImpactNow in two ways the navigation bar at the top of each page and the Previous Forward arrows on the upper right of each page Along the top of each page 1s a navigation bar This bar is visible on all pages in the model other than the Welcome page and allows you to go directly to any section or page Your current location is indicated by the button in dark blue Configuration Set Policy Goals Outputs The Previous Forward arrows in the upper right of each page move you through each section in sequential order Previous Forward The page sequence used by the Previous Forward arrows follows the map of all pages in ImpactNow e Configuration e Inputs o Business as usual Scenario Health Indicators Effectiveness of Contraceptives Median Age of Use for Contraceptives Healthcare Utilization per Pregnanc
43. e scenarios that have identical percentages of women in union and ANC coverage inputs but different CPR goals CPR policy goals will be entered in the next exercise e Navigate to the Health Indicators tab of the Inputs page e Note the three scenario tabs below the navigation header Usual Scen2 and Scen3 Click through each tab to observe what they look like e You will also see a yellow bar below these tabs located next to Scenario Name This box allows you to rename the policy scenario in each tab e A best practice is to provide a descriptive name for each of the three policy scenarios such as Base Case Moderate CPR and High CPR For the purposes of this exercise we will keep the default names of Usual Scen2 and Scen3 j Fie _ Home Insert Page Layout Formula Dats Review View cn Calibri eu A a W gt rap Text General F HA Normal Bad Good Neutral A EBM Rik Bmercacentr 2B Condition ran at Calculation Check Cell ipa SC Formatting as Table kaa O lt Configuratior lt gt Previous Forward Health gt ae tadicetors Scenario Name Usual Load Default Data Effectiveness of Contraceptives Comments Source of women that are in union 26 Median Age of Abortion Rate per 100 live births 20 69 nsafe Abortion 2008 a Use for Stillbirth Rate per 1000 live births 20 eee Unsafe abortion ratio per 100 live births os Health Care
44. eathcare Parameter pone 2020 Comments Source oe sil Women ages 15 49 3 745 089 4 622 123 _ UN Population Prospects 2010 Revision MMR 490 00 647 20 Discount Rate for Monetary Costs and Benefits 32 ImpactNow Manual Task 2 3 Modifying inputs ImpactNow can be used without any input modification However it is considered a best practice to check the default data against your local data sources such as your local census or statistical agency the Ministry of Health and recent health surveys Alternatively you may have a data source you prefer to use over the default source This exercise walks through modifying two sample inputs Sample A Modifying of women that are in union Navigate to the Health Indicators input tab Note that the percentage of women that are in union is 57 7 percent as per the 2005 Demographic Health Survey DHS Since a new DHS was released in 2011 you can choose to update this input data Type 2011 DHS into the Comments Source box Type 62 2 into the Input box Both new entries should turn blue indicating that they have been modified from the default z j gt ed ga ie Ld mpact Now for test 30 Jun 2014 xism Read Only Micros ce Home Insert Page Layout Formule Date Review View amp Cut Calibri hh A A gt ay Vv rap Text General F HA Bad Good Neutral a a Copy ao s _ a y Painter B Z Ela A BBB PMH Bimergeacentr SS pn
45. ent Comment Comment USD Comment Delivery are a 100 Assumption SaeiRG OneHealth 4 7 51 Assumption Postpartum Care 100 Assumption 12 R6 OneHealth 4 0 79 Assumption Set policy goals There are three tabs in the Set Policy Goals section the Main Policy Goal the Method Mix and the FP Costs These are inputs that are more closely or frequently aligned with FP policy goals On the first tab enter the CPR Unmet Need and or Future Budgets The inputs on this page depend on which policy goal was selected from the radio buttons on the Configuration page Under some configurations only the first year value is needed under other configurations you will also have to make an assumption about the last year value Assumptions about values in the last year are often based on stated policy goals On the second tab enter the base year method mix as well as the final year method mix for each scenario The method mix for each year should add up to 100 percent On the third tab enter the annual FP cost per user for each method Ideally the cost per user would be comprehensive including indirect costs and commodities However if you prefer you may use commodity costs only If only commodity costs are used make sure to clarify when presenting the results that FP costs do not represent the full programmatic costs Getting Started Outputs Once you have completed the Inputs and Set Policy Goals sections the
46. er modern Method Mix All Traditional Other country specific Total 100 00 100 00 100 00 100 00 Task 3 4 Navigating to page three of the Set Policy Goals section e In order to view the last set of policy inputs navigate away from the second tab of the Set Policy Goals section by clicking FP Costs By doing this you will see the annual FP cost per user for each method of contraception Do not change the default figures ImpactNOW Configuration Inputs Set Policy Goals Outputs Previous Forward CPR Policy Goal FP Costs To Cost Comments Source Method Mix Male condom a Injectable Pill Male sterilization Female sterilization IUD Implant Standard Days Method SDM Other modern All Traditional Other country specific Save the file by clicking File gt Save 43 EXERCISE 4 IMPACTNOW OUTPUT ANALYSIS Objectives The purpose of this exercise is to practice navigating to selecting managing and interpreting the range of ImpactNow results in the Outputs section Specifically the user will learn how to e Navigate throughout the Outputs section e Select and display annual output values for indicators of interest both numerically and graphically by scenario including Unsafe Abortions Averted Maternal and infant health care costs averted Unintended pregnancies averted and Infant deaths averted e Display and compare in depth annual
47. estimate is made because national estimates of unsafe abortion mortality ratios are not available Mortality ratio unsafe abortions MMR subregional unsafe abortion ratio subregional MMR 3 Mortality ratio for miscarriages is assumed to be equal to the national MMR This is a proxy because there are no data available on maternal mortality due to miscarriages Mortality ratio miscarriages MMR 19 ImpactNow Manual 4 Mortality ratio for live births is estimated as a residual between the total number of maternal deaths nationally and those attributed to abortion and miscarriage Mortality ratio live births MMR live births mortality ratio safe abortions safe abortions mortality ratio unsafe abortions unsafe abortions mortality ratio miscarriages miscarriages live births The total number of maternal deaths averted due to FP use is the sum of those averted by each of these four pregnancy outcomes Maternal deaths averted due to FP use mortality ratio safe abortions safe abortions mortality ratio unsafe abortions unsafe abortions mortality ratio miscarriages miscarriages mortality ratio live births live births 100 000 Note that the four mortality ratios may not be added up because each is expressed as a ratio per 100 000 of a specific pregnancy outcome For example the mortality ratio of unsafe abortions is expressed in terms of 100 000 unsafe abortions not in terms of 100 000 live births as i
48. gh the pages Configuration Set Policy Goals Outputs Forward Get Started Configure Country Ghana Start Year 2010 End Year 2019 Select which women you want to include in your analysis Select a policy goal to configure your outputs Set a Goal for CPR All women of reproductive age Set a Goal for Unmet Need Only women in union of reproductive age Set a goal for Future Budgets First you must choose the country and years of your analysis These values can either be selected from the drop down menu or typed in manually The range of possible values for years is 2010 to 2020 Country Start Year End Year The next choice in the Configuration page is whether you will conduct your analysis considering all women ages 15 49 or only those women 15 49 who are in union The group you choose will constitute the population potentially at risk for unintended pregnancy and who may therefore benefit from FP use Make your selection using the radio buttons Select which women you want to include in your analysis O Only women in union of reproductive age Al women of reproductive age ImpactNow Manual The final choice on the Configuration page is the type of policy goal you would like to model There are three choices CPR contraceptive prevalence rate Unmet Need and Future Budgets Select the option that corresponds to the type of goal whose impact you d like to analyze o
49. he percentage of women of reproductive age who use family planning 2 Seta Goal for Unmet Need This type of policy goal will model the impact of decreasing unmet need for family planning 3 Seta Goal for Future Budgets This type of policy goal will model the impact of increasing or decreasing FP budgets 29 Exercise 1 Getting Started For the purposes of this exercise we will choose to look at the CPR e Select Set a Goal for CPR Fie Home Insert Page Layout Formulas Data Rewew View c A at Calibri Ju A Su gt i Wrap Tet General E fs Totals Totals 2 W hrung a Copy t amp Ae i Center 2 A Conditional Format Normal J Format Painter Big A A Sez FER od Merge A Serner sik a 8 Formatting 23 Table Normal oe SR Clipboard P Font Alignment Number tyle U36 7 fe Get Started JA Configure Country Zimbabwe Start Year 20108 EndYear 2020 Select which women you want to include in your analysis Ad women of reproductive age Only women in union of reproductive age e Save the file by clicking File gt Save at the top left of the page 30 EXERCISE 2 MODIFYING INPUTS Modifying select inputs from their default setting Objective At the end of the exercise you will be able to Access the Inputs page Review the input data in each input tab Modify select input data Task 2 1 Navigate to the Inputs page When you
50. icy Goals Outputs Previous Forward CPR Policy Goal Unmet Need Yr1 and CPR Unmet Need Base Base Usual Scen2 Scen3 2014 Source Comment 2014 Source Comment 2020 2020 2020 12 80 DHs 2010 2011 f 31 85 DHS 2009 12 95 12 95 12 95 Method Mix e Adjust the base year contraceptive prevalence estimate by entering 58 5 in the corresponding 2014 yellow data field Change the source information to DHS 2010 2011 ImpactNOW Configuration Inputs Set Policy Goals Outputs Previous Forward CPR Policy Goal Unmet Need Yr1 and CPR Unmet Need Base Base Usual Scen2 Scen3 2014 Source Comment 2014 Source Comment 2020 2020 2020 12 80 DHS 2010 2011 58 50 DHS 2010 2011 12 95 12 95 12 95 Method Mix Task 3 3 Entering inputs into the main CPR policy goal The data inputs for the three policy scenarios Usual Scen2 and Scen3 are found next to the baseline input fields on the first tab of the Set Policy Goals section e First seta CPR policy goal for Usual representing a policy scenario of no additional increases in contraceptive use from the base year by entering 58 5 in the corresponding yellow data field Previous Forward ImpactNOW CPR Policy Goal Unmet Need Yr1 and CPR Unmet Need Base Base Usual Scen2 Scen3 2014 Source Comment 2014 Source Comment 2020 2020 2020 12 80 DHS 2010 2011 58 50 DHS 2010 2011 58 50 12 95 12 95 ko Metho
51. igation default data and automatic scenario comparison The Health Policy Project supported by USAID authored this user manual to help health analysts use the ImpactNow model to estimate the health and economic impacts of FP programs The manual is divided into two main sections Getting Started and Methodology The Getting Started section is written as a quick start guide on the navigation and flow of pages and offers a brief explanation of each page of the model Individual inputs and outputs are not explained in detail The Methodology section serves as a reference for users who want more detail about the calculations and assumptions GEMNG SIARTED Sc enanos The comparison of different scenarios is at the heart of ImpactNow A scenario is defined by a full set of input data and assumptions about the future of various parameters These scenarios are the framework used to answer many What if questions about future FP policy and behavior For example analysts might want to know What are the financial and economic benefits to switching to greater use of long acting and permanent methods LAPMs Alternatively they may ask What impact would reaching our FP2020 commitment have on women s reproductive health in our country Constructing and comparing different scenarios allows them to answer these questions ImpactNow is designed to compare three scenarios at once In the calculations the first scenario serves
52. in need intervention i Cost of treatment intervention i l average cost per live birth n z J of births in NCCO A i Cost of treatment intervention i il If you select Actual Access on the Inputs page then the average cost calculations assume that only the current fraction of women births that actually receive that intervention will receive it in the case of unintended pregnancies averted In this case average cost per pregnancy n D of women in need intervention i el x of women in need who receive ntervention Cost of treatment intervention i average cost per live birth n gt of births in need mtervention i i 1 of births in need who receiveiptervention i Cost of treatment ptervention i Total healthcare costs averted are always a sum of the pregnancy costs averted and the birth costs averted Total healthcare costs averted unintended pregnancies averted average cost per pregnancy live births averted average cost per birth Cost benefit ratio The cost benefit ratio expresses the costs saved for every cost invested in FP Cost benefit ratio total healthcare costs averted total FP costs 22 Methodology Incremental cost effectiveness ratio The incremental cost effectiveness ratio is a way of expressing how much more money would have to be invested to receive more of a specific output The ICER calculation always compares one of the two policy scenarios with the base scenario For the
53. ine 28 Task 1 5 Choosine the population Of Interest crionn a a taeda 29 Task 1 6 Choosing the type of policy goalen asie an a a 29 Exeit iSe 2 MOGI ING INPS iesidsasetavacsectacedaaveddedensthddcaasddduecustadasanducucesscstdduanstecaussusudeseusesusecsccuddcaumecuucuunece 31 Modifying select inputs from their default Setting cccccccccccsssssssseseseseecccccceeeeesseesaaaessssseeeeeeeeees 31 Tk 2 Te Navigate One INO UtS PAs Cesc ck skis ects te cicdeeh co Lust seo nnana saabinudensanduetedouseasanmnacasaabendensaucneneiaolas 31 ill Task 2 2 REViewine the put TADS sinisira d asus Gente acicdd moneda sane tiGantidbacehdgeeacenetieleaete 32 Task Zo Modi MOAN pi eee a E nerds etesser 33 Sample A Modifying percent of women that are in UNION Voiccccccccccssseeecccccccceeaseesesecceeeeeaaaaseeeeeeeeeeas 33 Sample B Modifying percent antenatal care received ccccccccccccssnesececceeeeecaaeeesseeeeseeeaaaaseseeeeeeeaas 34 Task 2 4 Applying input modifications to each policy scenario eeeeeeesessssssssssssseeeerresssssssssssssse 35 EXeIcise 3 Setting Policy GOalS risiini aiaa aA aa aaa aiaa 38 oe D e E E E ENE VC ORO E E A E TE TIA E A TE EAE N EA 38 Task 3 1 Navigating to the Set Policy Goals pateses e E E Sa 38 Task 3 2 Entering new baseline oures oein E EAE a 39 Task 3 3 Entering inputs into the main CPR policy QOal cc ccccccccccssssssseseesseeeceeeeeeeeeeseeeaaeaaeesenees 39 Task 3 4 Entering
54. intended pregnancy CPR method m1ixmethod x If you select a Future Budgets goal ImpactNow takes a different approach to calculating the number of users of each method Like the other two policy goals ImpactNow assumes a linear interpolation of the total Future Budget between the base and end years It first calculates the average cost per user as a weighted average of the method specific cost per user weighted by the method mix Average cost per user 2 CostPerUser MethodMix i l The total Future Budget is then divided by the average cost per user The product tells us how many FP users the FP program can afford given the total budget and the average cost per user Total FP users total Future Budget average cost per user All of the FP users are then distributed across the various methods according to the method mix Usersmethoa x total FP users method mixmethoa x Acceptoss of long acting and permanent methods ImpactNow estimates the annual number of acceptors 1 e people who begin to use each type of LAPM each year Because these methods last more than one year the model must first make assumptions about how many users began LAPM use before the base year of the analysis because they may continue use into your analysis period Our estimate of acceptors is the difference between these continuers and the users of each method which we have previously calculated Acceptors of LAPM are calculated based on LAPM users during
55. ion 1 9 IUD 0 3 Implant 4 6 Standard Days Method 0 Other modern 0 9 All traditional 2 2 Other country specific Empty O O OOO OO tO 40 ImpactNow Manual The method mix should add up to 100 percent ImpactNOW Configuration Inputs Set Policy Goals Outputs CPR Policy Goal Method Mix Previous Forward Base Usual Scen2 Scen3 Comments Source 2014 2020 2020 2020 Male condom S Injectable Pill 4 699 Male sterilization Female sterilization IUD Implant Standard Days Method SDM Other modern All Traditional Other country specific Total e For the Usual scenario representing no additional increasesin contraceptive use over the Base case assume no changes to the method mix from the 2014 baseline Replace all the data inputs with figures identical to the 2014 Base method mix as noted above Ensure that the method mix adds up to 100 percent Configuration Set Policy Goals Outputs ImpactNOW Previous Forward CPR Policy Goal Method Mix Scen2 Scen3 2020 2020 Comments Source Male condom Injectable Pill Male sterilization Female sterilization IUD Implant Standard Days Method SDM Other modern Method Mix All Traditional Other country specific Total 100 00 100 00 100 00 100 00 4 Exercise 3 Setting Policy Goals e For Scen2 the scenario representing an ambitious contraceptive
56. irths averted unintended pregnancies averted pregnancies to live births converter 18 Methodology Abortions averted total and unsafe Abortions are assumed to be averted at the average rate of abortion reported for the country overall Because the abortion rate is reported per 100 live births the total number of abortions averted is Abortions averted abortion rate live births averted 100 Unsafe abortions are calculated in a similar way applying the unsafe abortion rate to every hundred live births averted Unsafe abortions averted unsafe abortion rate live births averted 100 Matemal deaths averted Estimates of maternal deaths averted due to FP use are based on an adjustment made to the national maternal mortality ratio MMR to account for the specific risk distribution of unintended pregnancies Risk of maternal death is estimated separately for four pregnancy outcomes safe abortions unsafe abortions miscarriages and live births 1 Mortality ratio for safe abortions is set at 2 deaths per 100 000 safe abortions Singh and Darroch 2012 Mortality ratio safe abortions 2 deaths per 100 000 safe abortions 2 Mortality ratio for unsafe abortions is scaled based on the national MMR The scale is a ratio of the subregional unsafe abortion mortality WHO 2011 to the subregional MMR WHO 2014 This gives an estimate of the relative riskiness of unsafe abortion compared to the overall risk of maternal death This
57. l 52100 31 9975 63 1194 008 5063 027 506359 1 16606695 0 102167 11360832 1 46176 1479439 69938 39 111909 6 EC EPE 7 2 4920 131 23336 75 77618 07 76139 63 o 13305 95 32525 67 126735 7 38028 47 g 2016 400345 5 27o677 5 57262 37 54353 71 1264 407 SoS T63 595597 9 16227861 0 076333 11371447 L S75246 1598951 103787 7 231200 4 212410 9 10659 20911 11 163082 8 21134 43 D 14369 65 35174 71 128735 2 36078 42 0 2017 428073 2 2933 6 62674 27 60017 1332 934 6111 542 606567 7 199423643 0 0505 11706245 1 7036 76 1723959 131882 5 291698 1 J67151 6 17239 59 33617 71 261173 9 107747 5 0 15515 63 37927 11 120735 2 38078 47 0 2018 ATRIALE 330477 2 60371 44 65472 63 1399 02 6567 089 655034 1 21756547 0 024667 117589096 1 050206 1653766 156334 7 273121 3 pirot 24716 80 35457 39 377606 9 176056 1 0 16683 89 0782 65 128735 2 35028 42 g 2015 719901 8 59926 3 74301 33 71227 71 152074 7293 13 702530 3 23666960 0 00117 11723371 2 016355 1388270 183252 2 299909 4 731010 4 33137 63 39423401 458061 5 L46137 8 D 17994 23 SEER PEE 128735 2 307E 42 g 2070 56 4146 7 320122 3 80711 36 77189 36 1521 479 7870 399 T65702 9 25693246 O 027 11533099 2 215331 2127471 212 747 1 315120 6 636241 2 42549 42 47549 47 636241 2 166970 2 0 19147 74 46604 Se 126735 2 38028 42 0 other charts You can also conduct additional a
58. lect the more recent data Type the new source into the Comments Source box for the purpose of this exercise you may type New data Type 52 into the Input box Both new entries should turn blue indicating that they have been changed from their defaults Home 0 ormuta Data Review View ne oe Se ee eee x A we ad Merge amp Center 2 Conditional Format Inne eee nl inser Frormat Pointer BL Us Be Me Ae EE HR oea centers S 38 22 Conditional Format Calculation TENT input Y2 f ImpactNOW A Inputs Outputs e gt wer Previous Forward a Health Care Utilization per Pregnancy Usual Of the women who of pregnant women needcare the that Associated Costs for a ee for are bth clans to receive eae of Coenen det oralet afena Eee eee umption lasi terrer 0 06 E Health Care Treatment of Severe Anaemia Utilization per Pregnancy Hypertensive Disorders of Pregnancy Malaria Prevention within ANC Utilization per Malaria Treatment within ANC 0 if all women Live Birth recieve ANC Urinary Tract Infection UTI 34 ImpactNow Manual Task 2 4 Applying input modifications to each policy scenano A significant strength of the ImpactNow tool is its ability to observe the impact of multiple policy goals simultaneously As such you will need to apply the input changes you made to each policy scenario This 1S a very important step since you want to compare thre
59. n for men and second because the median age of male sterilization may not be known Pregnancies averted Once the number of users by method is known you can then calculate the unintended pregnancies averted This calculation compares the failure rate of each method with the pregnancy rate of women with unmet need The method failure rate is the complement of the method effectiveness rate The latter serves as a counterfactual that estimates how many of these women might otherwise have had an unintended pregnancy in that year in the absence of contraceptive use Unintended pregnancies averted ethoa x USETSMethoa x pregnancy rate of women with unmet need 1 effectivenesspethoa x The value of the pregnancy rate of women with unmet need depends on your selection in the Inputs section where you selected the Low 23 Medium 31 or High 38 pregnancy rate for women with unmet need the selection is made separately for each scenario This inter quartile plausibility range was estimated using the Adding It Up methodology Singh and Darroch 2012 The national pregnancy rate among women with unmet need was estimated for 148 developing countries Each national estimate was obtained by dividing the estimated number of annual unintended pregnancies by the total number of women with unmet need The Low Medium and High values used in ImpactNow represent the 25th 50th and 75th percentiles of these national estimates That is 25 percent
60. n your analysis You can choose All women of reproductive age or Only women in union of reproductive age women of reproductive age are defined as women ages 15 49 The group you choose will constitute the population for which you are interested in observing FP benefits Generally it is advised that you choose the population of women who align with your country s national FP priorities This exercise will only look at married women of reproductive age e Select Only women in union of reproductive age BQ aa a Impact Now 0968 Zim Training Meros EXC e a Cut 13 5 gt t gt pi 2 Calib 11 f gt Wrap Te General 4 i Totals Totals 2 ty 5 ao AA J ne i5 D z Panes E SE Sa A ESB HE merge amp center b 9 SR Sor pee 2 sa Normal Bad Good y uU3g X fa Get Started diii Configure Country Zimbabwe Start Year 2014 End Year 2020 Select which women you want to include in your analysis Select a policy goal to configure your outputs t al for Urenet Need ta goal for Future Budgets Task 1 6 Choosing the type of policy goal One of the key steps during configuration is selecting a type of policy goal While you will enter a numeric goal later in the process it is important to decide which type of policy you are interested in exploring at this step There are three policy types from which to choose 1 Seta Goal forCPR This type of policy goal will model the impact of increasing t
61. nalysis using your preferred Excel tools and functions Keep this file open for a forthcoming task 48 ImpactNow Manual Task 4 4 Viewing and copying pasting scenano companion tables e From the Summary Tables tab navigate to Scenario Comparison This tab displays a table which provides a comparison of the cumulative rather than annual values of each indicator output across the three scenarios Ee eo Outputs YY Previous Forward CPR Analysis G23 SURFRRSRTRERT SSE 5 5 S 5 5 s 5 s5 21 5 1 5 5 61 6 5 5 5 sS 5 100 10 e View the first three columns of the table which report the cumulative values for each output Select the column marked Scen3 and click Copy Did 9 0 Microsoft Exc Home insert Page Layout Formulas Da Deere dita T hs m Paste Bi i gee ie As lt 22 Conditional Format accens E SIMS Painter u oo a aae Formatting a Table l d writ d Copy Cl O CPR Surmmary S69 Gepy te selection and putt on the Clipboard a IMpavervo ve a Outputs gt Previews Forwrard CPR Analysis Sh sa uve ofeszeeusaveses 15 19 19 18 14 1 13 13 1 7 25 1s 6 17 22 17 5205 a se 1t 100 12432 7 Acceotor results are expressed as The average annual prumer of acce Nes cool he couse of the period of analysis For each output except the cost benefit ratio the values compare
62. ng as Table Tyee srr Tor test 30 Jun 2014m Revd Oniy Home Insert Page Layout Formulas Data Review View e j kt ak O om a R P Format Painter B U E D A BEB HH Bmergeacenters 82g Conditional Format Calculation Explanatory ipt gt inert lipboard Font Alignr 3 Number Al dik diini mm Input Previous Forward Health z ig Scenario Name Scen3 Load Default Data of women that are in union Abortion Rate per 100 live births Stillbirth Rate per 1000 live births Unsafe abortion ratio per 100 live births Are you sure you want to load from another scenario All settings on this page will be replaced with the settings from the chosen scenario of unsafe abortions needing PAC si p n Discount Rate for Monetary Costs and Benefits Ready e At the end of this exercise Usual Scen2 and Scen3 should reflect the same inputs e Save the file by clicking File gt Save 31 EXERCISE 3 SETTING POLICY GOALS Objectives The purpose of this exercise is to practice entering baseline data as well as inputs into three different policy scenarios e Usual scenario which serves as a baseline against which the second and third scenarios are compared and represents a policy scenario of no additional increases in contraceptive use over current levels e Scenario 2 Scen2 representing an ambitious contraceptive use policy goal and visible increases in contr
63. olicy Project incremental cost effectiveness ratio intrauterine device long acting and permanent method maternal mortality ratio Marie Stopes International previous birth interval United States Agency for International Development women of reproductive age years lost to disability years of life lost INTRODUCTION ImpactNow is an Excel based model that estimates the health and economic impacts of family planning FP in the near term It is designed to model the impacts of different policy scenarios and to compare the results of those scenarios in advocacy materials It can help to estimate the impacts of many what if questions about policy options ImpactNow is designed to analyze impacts in the two to seven year time horizon for example it could be used to estimate the impacts of meeting Family Planning 2020 FP2020 commitments The outcomes are focused on reproductive health metrics as well as economic metrics such as cost benefit ratios and incremental cost effectiveness ratios ICER ImpactNow was adapted from Marie Stopes International s MSI Impact 2 as a collaboration between MSI and the Health Policy Project HPP with support from USAID While Impact 2 is more focused on estimating the effectiveness of the FP services provided by one institution ImpactNow is more focused on the impacts from all national and regional level providers Further the ImpactNow model is designed to be user friendly with click through nav
64. otals Va mad aco u lt sr 3 lt 0 Conditional Format normal aa ar a d Biz uy uo 2 a Ee bag Merge amp Center s 8 8 EAn EEDA T a Gon styles Ciipbosrad Fa Fort Copy Otil C ndicator Cegy the selection and putit on ptor results are expressed as the average annual number of acceptors over the course of the period of analysis 47 Exercise 4 ImpactNow Output Analysis e Switch back to your new Excel workbook Select cell Al and click Paste Values a REESE ee insert Fage layout Data o EE Merge amp Canter Hicvine Forthnulas eet eros A Cut lt 2 Copy FF Format Painter Calin il wrap Text Genaral h AA am Ea gt u Aligqnmert Vis Purmer gt Paste Special 7 Infantdes 4620 503 3 3 10 1 12 12 aA ay 16 17 18 19 DALY ave Maternal g j Unmet Ne 46462 7 6 15076316 0 128 Total FP cx 11080880 Cort bene Total user Condom Injectable Pill users Male steri Female st IUD users 20 Implant u 21 22 Standard Other mou 23 All traditi 24 25 26 Male sten Femse st tod iwed 27 Implant ac 28 29 SDM acces Once your data are pasted you can use Excel to create your own column line pie bar area and 1 360751 1162726 T2745 193307 JO2L0C4 2 a 25891 79 4088 177 52695 37 0 1726453 299 79 96 128735 2 S80 28 42 0 c 2015 364779 7 Pe e
65. point increase in CPR For example if the base year CPR is 30 percent the base year unmet need is 20 percent and the end year unmet need is 15 percent then ImpactNow would calculate the end year CPR to be 35 percent The five percentage point decrease in unmet need is assumed to be equivalent to a five percentage point increase in CPR If you select a Future Budgets goal ImpactNow divides the number of users by the number of women at risk for unintended pregnancy to arrive at the CPR CPR total FP users women at risk of unintended pregnancy CPR is only shown as a result when you select an Unmet Need or Future Budgets goal When you select a CPR goal the CPR is simply a linear interpolation between the inputs Unmet need Unmet Need is assumed to have an inverse relationship with CPR that is for each percentage point increase in CPR unmet need is assumed to decrease by one percentage point For example if the base year unmet need is 27 percent the base year CPR is 35 percent and the end year CPR is 39 percent then ImpactNow would calculate the end year unmet need to be 23 percent Under the CPR and Future Budgets goals an unmet need level must be specified for the base year ImpactNow then calculates future levels of unmet need as the inverse of the CPR calculations 12 Methodology Users of family planning The next step is to calculate the number of users of each method The equation is UserSmethoa x Women at risk for un
66. r configurations are complete you may move forward to the Inputs page Click the Forward button at the top right portion of the screen to move into the Inputs page Alternatively you can click directly on the Inputs button in the navigation header After clicking on one of these two buttons a dialog box will appear This box will appear every time you alter the tool s configuration and will alert you that all inputs are restored to their default settings after a configuration change Click Yes to continue s gt d wE nad Merge amp Center 2 8 on ona nat Painter ory y Formatting as Table J U36 fa qm sik cas oe Senne a bam Get Started Configure Country Zimbabwe Start Year 2014 Settings changed here xj End Year 2020 Configuration Country start year end year selection has changed The scenario input screens need to be reset to defaults Would you like to continue Select which women you want to include in your ar All women of reproductive age Only women in union of reproductive age Set goal for Future Budgets 31 Exercise 2 Modifying Inputs Task 2 2 Reviewing the input tabs You should now see the Inputs page captured below As mentioned previously this page is populated by default data from ImpactNow s database The first tab of inputs displayed Health Indicators includes several health indicators such as abortion
67. r the goal you d like to promote in your advocacy messages Select a policy goal to configure your outputs Set a Goal For CPR O Set a Goal For Unmet Need O Set a goal for Future Budgets When you ve finished configuring your analysis you can move on to the Inputs page If you ve changed anything in the Configuration page a dialog box will appear when you click away from it asking if you would like to continue with your new selections changed The scenario input screens need to be reset to i Configuration Country start vear end year selection has defaults Would vou like to continue This dialog box is a warning that the default data will be reset to align with your new selections If you agree with this click Yes If you have inadvertently made changes on the Configuration page that you do not wish to implement click No Getting Started Inputs Inputs are entered separately for each of the three scenarios Within each scenario inputs are organized into five thematic categories When in the Inputs page there is a smaller navigation bar for the three scenarios under the main navigation bar Like the larger navigation bar above it the buttons on this bar can be used to move directly between scenarios The dark blue button shows your current location Scenano names and default data Near the top of the page under the Health Indicator heading is a place to name the scenario You
68. s Outputs Indicator Analysis 5 000 000 eae 4 000 000 Summary j Tables 4 3 000 000 2 000 000 1 000 000 scenario Comparison incremental Cost Outcome Effectiveness Previous CPR Analysis Costs vs Outcomes 1 500 000 2 000 000 9 000 000 3 500 000 Dutoonves Unintended pregnancies averted FP Costs Outcomes Incremental FP Costs Difference in X outcome ICER 3 794 399 2 627 450 3 369 052 2 791 172 180 654 123 722 4 764 948 3 096 385 480 550 468 935 Acceptor results are expressed as the average annual number of acceptors over the course of the period of anal ysis e Like the Indicator Analysis tab this one analyzes one indicator at a time Select Unsafe Abortions Averted from the yellow drop down menu The graph displays the FP costs while the table includes additional information including the incremental cost effectiveness ratio ICER The ICER tells us the amount of additional funds that must be invested in family planning to achieve one more of the selected outcomes ImpactNOW Configuration Inputs Set Policy Goals Indicator Analysis 5 000 000 4 000 000 3 000 000 2 000 000 7 1 000 000 Scenario Comparison a Incremental Cost Effectiveness Previous CPR Analysis Costs vs Outcomes Usual icen Scand Quitters Outcomes Incremental FP Costs Difference in outcome ICER 3 784 398 359 966 3 965 052 376 917 180 654 16 950 11 4 264 9
69. s found atthe end of this exercise Exercise 4 ImpactNow Output Analysis Which scenario prevented the most infant deaths in 2020 Which scenario averted the most unintended pregnancies in 2020 Task 4 3 Viewing and copying pasting summary table results Navigate to the second tab of the Outputs section by clicking Summary Tables You will see one table for each scenario each table provides the annual values for all outputs previously displayed on the Indicator Analysis tab This tab displays all results in one location impactNOW 2014 336 007 232 358 48 072 46 034 1 139 4 688 471 365 15 296 976 12 80 11 080 880 1 38 1 362 726 72 224 193 507 962 084 o 25 892 4 088 62 685 0 12 265 29 980 0 6 152 1 027 20 037 0 215 349 121 241 427 49 948 47 830 1 246 4 871 493 931 15 894 023 12 80 11 513 371 1 38 1 415 913 75 043 201 060 999 635 o 26 902 4 248 65 132 0 12 743 31 150 0 6 152 1 027 20 037 0 46 CPR Analysis 716 362 235 250 496 1 824 49 627 1 359 5 054 16 810 16 491 070 12 60 11 945 862 1 38 1 469 101 77 862 208 612 1 037 185 0 27 913 4 407 67 579 0 13 222 32 320 0 6 152 1 027 20 037 0 2017 375 350 259 565 53 701 51 424 1 476 5 236 540 002 17 088 117 12 80 12 378 354 1 38 1 522 289 80 681 216 165 1 074 736 o 28 923 4 567 70 025 0 13 701 33 490 0 6 152 1 027 20 037 0 2018 388
70. s into a new Excel file for custom graphics or analysis Scenano Companson The third tab in the Outputs section is Scenario Comparison This table shows a quick comparison of the cumulative values of each output across the three scenarios For each output except the cost benefit ratio the values compared here are cumulative for the entire time period that is the sum of all annual values The cost benefit ratio compared here is the average across all years The first part of the table reports the cumulative values for each output The second part of the table compares the second and third scenarios to the first which is assumed to be a baseline scenario The third part of the table states the comparison as a percentage of the first scenario value this has the benefit of expressing the size of the difference in outputs relative to the absolute level of output ImpactNow Manual This table presents the outputs in terms that may be useful for creating advocacy materials Example statements that could be made based on the table below include By reaching our FP2020 commitment we estimate that we would avert more than half a million unintended pregnancies and By shifting to LAPM we estimate a 15 percent reduction in maternal deaths by 2020 Incremental difference Percentage difference compared to Business as compared to Business as Indicator Business as Usual LAPM scenario FP2020 Commitment LAPM scenario FP2020
71. s the case with the MMR This methodology adjusts the national MMR which reflects the national distribution of pregnancy outcomes to account for the fact that unintended pregnancies have a different distribution of outcomes and therefore a different risk profile Child deaths averted Child deaths averted are based on the concept that longer spacing between births results in lower child mortality Previous birth interval PBI coefficients were estimated for each country Weinberger et al 2012 The PBI coefficient represents the number of child deaths estimated to be averted for each live birth averted Thus the total number of child deaths averted is calculated as follows Child deaths avertedcountry x live births avertedcountry x PBI coefficientcountry x 20 Methodology DALYs averted Disability adjusted life years are metrics that estimate years of healthy life lost due to a specific health issue Calculations of DALYs averted due to various health interventions provide one way to compare different types of interventions across different health issues A DALY is the sum of two components YLL years of life lost and YLD years lost to disability YLL for a specific condition are those years lost due to premature mortality YLD are a fraction of those years lived with a disability due to a specific condition In ImpactNow DALYs are averted in two different health areas maternal health and child health For maternal health
72. the analysis period as well as assumptions about acceptors of LAPM in past years Two tables are used to calculate the acceptors of each LAPM The first table is populated by hypothetical numbers which do not represent actual women but are used to calibrate past cohorts of LAPM acceptors The second table is scaled up so that the numbers in each cell represent actual women Each LAPM has its own pair of tables which go back as many years into the past as the years of method effectiveness of that particular method For example the table for a five year intrauterine device IUD goes back in time five years before the start date of the analysis Each dummy table starts with the assumption that there was a linear scale up in the number of acceptors of that method in past years For example for the five year IUD the model assumes that five years before the start date of our analysis one hypothetical woman accepted the IUD four years ago two hypothetical women accepted three years ago three accepted and so forth These hypothetical numbers 13 ImpactNow Manual are then projected forward in time using continuation rates As you can see in the sample table below the Year of Analysis is shown in columns and the Year of Insertion is shown in rows This table corresponds to an analysis conducted with a base year of 2014 the column outlined in bold and an end year of 2020 Table 1 Sample LAPM Hypothetical Acceptors Table Five
73. tors of interest Once you have navigated to the Indicator Analysis tab you can select an indicator of interest from the yellow drop down menu above the graph The results for all three policy scenarios Usual Scen2 and Scen3 are then graphed and annual values for each scenario are displayed in the table format Each scenario represents varied levels of ambition related to FP policy and maternal health e Inthe yellow drop down menu titled Choose Output select the indicator Unsafe Abortions Averted This allows you to view the number of abortions averted annually by policy scenario The graph and corresponding table show that Scen3 the most ambitious contraceptive use policy goal averts the most unsafe abortions annually compared to the other policy scenarios ImpactNOW Configuration Inputs Set Policy Goals Previous Forward CPR Analysis Se Choose Output Unsafe Abortions Averted Analysis 90 000 CPR by Year 80 000 4 Summary 70 000 4 Tables 60 000 50 000 Usual z 40 000 4 Scen2 Scenario shee Comparison i Scen3 20 000 10 000 Incremental o 4 Cost 2014 2015 2016 2017 2018 2019 2020 Effectiveness Indicator 2014 2015 2016 2017 2018 2019 2020 46 034 47 830 a 49 627 1 424 53 220 55 017 56 814 i AA gffnalysis e To view another output indicator select Maternal amp infant health care costs averted from the yellow drop do
74. use policy goal replace all the data inputs with figures identical to the 2014 Base and Usual scenario method mix except Injectable and Pill For Injectable replace the existing value with 28 40 For Pill change the data input to 56 40 Ensure that the method mix adds up to 100 percent ImpactNOW CPR Policy Goal Method Mix Male condom Injectable Pill Male sterilization Female sterilization IUD Implant Standard Days Method SDM Other modern All Traditional Other country specific Total 100 00 10 00 100 0034 10 00 Previous Forward Comments Source e For Scen3 the scenario representing the most ambitious contraceptive use policy goal broaden the method mix entering the following distribution of contraceptive users by method O O O O O OO0OO0OO0OOO Male condom 10 Injectable 15 Pill 30 Male sterilization 2 Female sterilization 2 IUD 30 Implant 7 9 Standard Days Method 0 Other modern 0 9 All traditional 2 2 Other country specific Empty 42 ImpactNow Manual e Ensure that the method mix adds up to 100 percent ImpactNOW Configuration Inputs Set Policy Goals Outputs CPR Policy Goal Method Mix Previous Forward Scen2 Comments Source 2020 Usual 2020 Male condom Injectable Pill Male sterilization Female sterilization IUD Implant Standard Days Method SDM Oth
75. wn menu The graph and corresponding table show that Scen3 the most ambitious contraceptive use policy goal generates the most annual savings across development sectors compared the Usual scenario and Scen2 ImpactNOW Configuration Inputs Set Policy Goals Previous Forward CPR Analysis Choose Output c no n n Maternal amp infant healthcare costs av Analysis 30 000 000 CPR by Year Indicator 25 000 000 4 Summary Tables 20 000 000 15 000 000 4 Scenario Comparison 10 000 000 5 000 000 4 Incremental Cost Effectiveness 2014 2015 2016 2017 2018 2019 2020 15 296 976 15 894 023 16 491 070 17 088 117 17 685 164 18 282 211 18 879 258 15 078 318 15 974 302 16 895 369 17 641 736 18 813 618 19 811 231 20 834 790 15 078 318 16 606 895 18 227 881 19 943 643 21 756 547 23 668 960 25 683 246 Acceptor results are expressed as the average annual number of acceptors over the course of the period of analysis e Next select Unintended pregnancies averted from the yellow drop down menu Below note the number of unintended pregnancies averted by scenario in 2020 45 O O O Usual Scen2 Scen3 Answers found at the end of this exercise Finally select Infant deaths averted from the yellow drop down menu Below note the number of infant deaths prevented by scenario in 2020 O O OO Usual Scen2 Scen3 Answer
76. y Healthcare Utilization per Birth o Scenario 2 Health Indicators Effectiveness of Contraceptives Median Age of Use for Contraceptives Healthcare Utilization per Pregnancy Healthcare Utilization per Birth o Scenario 3 Health Indicators Effectiveness of Contraceptives Median Age of Use for Contraceptives Healthcare Utilization per Pregnancy Healthcare Utilization per Birth e Set Policy Goals o CPR Unmet Need Future Budgets depending on Configuration o Method Mix o FP Costs e Outputs o Indicator Analysis o Summary Tables ImpactNow Manual o Scenario Comparison o Incremental Cost Effectiveness Ratio Throughout the model all cells with values that you can change are shaded in yellow Country Ghana Start Year 2010 End Year 2019 Results are in light blue Choose Output 400 000 350 000 200 000 L 200 000 oo i e7 150 000 ceni 100 000 50 000 Oo 2015 2016 2017 2018 2019 2020 2015 2016 2017 2018 2019 2020 Usual 184 325 191 965 201 906 212 063 222 461 233 102 5cenz 184 325 204 730 223 050 253 063 2a 203 300 193 Scens ias ages 215 401 253 220 207 06 IA p l 360 232 Getting Started Configuration The first page after the Welcome page is the Configuration page where you will make some general decisions about your analysis To the upper left is an arrow that takes you back to the Welcome page the Forward arrow on the upper right can be used to guide you throu

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