Module 7 handout - Population Indicators - M&E of PHE UNC

8/7/2019 Module 7 handout - Population Indicators - M&E of PHE UNC

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4 Pa t Th ee: i cato

Pop at o secto i cato :Family Planning and Reproductive HealthPopulation sector activities within PHE programs aim to improve and

sustain voluntary amily planning and reproductive health services anduse. Population programs need to collect and assess in ormation about twobroad, sometimes overlapping areas: health acilities and relevant popula-tions. Te frst area is important because acility quality and sta train-ing, access, and population use o health acilities all strongly in uencethe overall health o a population. Population programs not only assessa populations physical health, but also that populations attitudes, knowl-edge, and behaviors about a specifc health issue, as well as promote genderequality and male inclusion in discussions about contraception. An areao improving and sustaining voluntary amily planning and reproductivehealth services that is particularly relevant to PHE programs work is a

ocus on providing access to underserved communities.

While the ultimate long-term measurement in population programs is thetotal ertility rate, the indicators in this guide ocus on measuring vari-ables that can be measured or results over a shorter period o time but areequally important. Many o the indicators in this section may be valuable

or population-sector M&E; however, programs that have a ocused natureor that ace limited budgets should concentrate on measuring indicatorsthat best ft their needs.

Tab e 5 Pop at o i catoO tp t

Program-Based O tcome

Population-Based Percent o program sta trained to work withor provide reproductive health services toadolescentsPercentage o women o reproductive age(15-49) who were clients o a community-based contraceptive distributor in the last yearCouple-years o protection (CYP)

Average household distance/time to the near-est health centerPercent o skilled health personnel knowl-edgeable in obstetric warning signs

1.

2.

3.

4.5.

Number o acceptors new to moderncontraceptionContraceptive prevalence ratePercent o deliveries occurring in a healt

acilityPercent o births attended by skilled heapersonnel

Percent o women attended at least onceduring pregnancy or reasons related topregnancy

6.

7.8.

9.

10.


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A G e o Mo to g a E a at g Pop at o Hea th E o me t P og am

P o p u l a t i o n

lEvEl Of MEAsurEMEnT:Output.

dEfiniTiOn:Sta members are considered youth- riendly i they have the ability to proand an environment that targets young audiences. Youth- riendly training generally inhow to create a service environment that will attract and retain a youth clientele. This or rooms dedicated to adolescent reproductive health services; sta who are competentprocedures to ensure privacy and con dentiality; peer educators who stay on-site durin

ed or provision o services to youth, and use o non-judgmental approaches to proyouth and accept drop-in clients. A sta member would need to go through speci c traing with youth to be counted in this indicator. The denominator should include all sta wtarget area during the re erence period (semi-annually or annually), even sta who wo

1 PErCEnT Of PrOGrAM sTAff TrAinEd TO wOrk wiTH Or PrOvidErEPrOduCTivE HEAlTH sErviCEs TO AdOlEsCEnTs

disAGGrEGATE:None.

PurPOsE:Reproductive health services have traditionally been designed or older, marrIncreasing the number o health providers trained to work with youth may increase tyouth will take advantage o the basic reproductive health services they need.

dATA sOurCEs:Project records.

TiME frAME:Semi-annually; annually.

dATA COllECTiOn COnsidErATiOns:Speci c topics related to adolescent reproductive healthsuch as sexual health education and peer dynamics, should be covered in the trainingand post-test will assist in determining the sta s level o understanding.

sTrEnGTHs & liMiTATiOns:This indicator targets the service improvement or an audiencehas a strong, o ten unmet need or reproductive health services. However, training dwhether or not providers give adequate care.

# o program sta trained to work withor provide reproductive health services to adolescents during the re erence period

total # o health service providers in the target area during the re erence period

Ca c at o

x 100


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50

Population

Pa t Th ee: i cato


dEfiniTiOn:This indicator measures how well community-based distribution o cocoverage o amily planning services to an area. In the context o PHE progratribution means that the contraceptives are sold at a point that is not a traditionas a clinic or hospital. Community-based distribution is generally through a losite or an individual at a non-commercial site, as well as other variations that armeasured in this indicator, a client is a woman who receives contraception romdistributor (CBD), but does not include a woman who only talks with the CBmethods. The method o contraception here can include any method modern

disAGGrEGATE:By target community.

PurPOsE:The aims o the CBD program are to increase contraceptive use by incring demand through in ormation, education, and communication (EIC) activicommunity volunteers are usually recruited to be community-based distributgrams especially e ective in rural and isolated communities where demand isalternative methods is low.

dATA sOurCEs:Population-based survey or project records.

TiME frAME:Annually or project records and every three to ve years or survey

dATA COllECTiOn COnsidErATiOns:The questionnaire or surveying women in the tshould include the type o commodities/methods received in the previous tim

sTrEnGTHs & liMiTATiOns:CBDs tend to be low-volume independent distributors insometimes difcult-to-reach areas, creating the need or eld-workers to re-suquently and provide supervision and continuous training in contraceptive meth

2 PErCEnT Of wOMEn Of rEPrOduCTivE AGE (15-4 ) wHO wErE CliEnTsOf A COMMuniTY-BAsEd COnTrACEPTivE disTriBuTOr in THE lAsT YEA

total # o women clientsage 15-49 o community-based distributors in the target area in the last yea

total # o women age 15-49 living in the target area in the last year

Ca c at o

x 100


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P o p u l a t i o n


dEfiniTiOn:Couple-years o protection (CYP) is the estimated protection provided by amservices during a one-year period based upon the volume o all contraceptives sold oclients during that period.

3 COuPlE-YEArs Of PrOTECTiOn

Tab e : Ho to Ca c ate CYPCa c at o :Multiply the quantity o each method distributed to clients by the conversion

below to obtain a CYP per method. Then sum each CYP to obtain a total CYP gure.Metho u t pe CYP Co e o factoOral contraceptives 15 cycles per CYP /Condoms 120 units per CYP /Female condoms 120 units per CYP /Vaginal oaming tablets 120 units per CYP /Depo Provera injectable 4 doses per CYP /Noristerat Injectable 6 doses per CYP /Cyclo em monthly injectable 13 doses per CYP /Emergency contraceptive pills 20 doses per CYP /Copper-T380-A IUD 3.5 CYP per IUD inserted 3.5Norplant implant 3.5 CYP per Implant 3.5Implanon implant 2 CYP per Implant 2

Jadelle implant 3.5 CYP per Implant 3.5Natural amily planning(i.e. standard days method)

2 CYP per trained, con rmedadopter

2

Lactational amenorrhea method(LAM)

4 active users per CYP (or 0.25CYP per user)

0.25

Sterilization (male & emale)AsiaLatin AmericaA ricaNear East/North A rica

10 CYP10 CYP8 CYP8 CYP

101086


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Population

Pa t Th ee: i cato

Example: A facility that distributed the following family planning servicesMethod Quantity Conversion Factor CYPOral contraceptives 4,321 / 288.1Condoms 9,900 / 82.5

IUDs 80 3.5 280.0Total 650.6

disAGGrEGATE:By method.

PurPOsE:CYP is a simple, inexpensive way to measure program activity volumelected data. CYP can monitor progress o contraceptive service delivery at t

levels.dATA sOurCEs:Service statistics.

TiME frAME:Annually.

dATA COllECTiOn COnsidErATiOns:Standardized orms, acility log books and ctracking are necessary or this indicator calculation. Regarding the calculationmost programs credit the entire amount to the calendar year in which the clientFor example, i a amily planning program in Asia per ormed 100 voluntarya given year, it would credit all 1000 CYP (100 procedures x 10 years each) tothough the protection rom those programs would in act be realized over thayears.

sTrEnGTHs & liMiTATiOns:CYP can be obtained rom di erent service delivery However, the value o this indicator can be difcult to understand. CYP data dcontraceptive use rates. The validity o the conversion actors is still debated represented is not evident in this calculation.


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P o p u l a t i o n


dEfiniTiOn:This is the average time or distance rom a respondents place o residence tservice delivery site o ering the measured service. The services included in this measbe determined in advance by the project, depending on the projects objectives.

disAGGrEGATE:By services o ered (i desired).

PurPOsE:Distance to a health acility is o ten a major actor determining whether or nohave access to that acility, especially when transport is not easily available.

dATA sOurCEs:GPS or mapping the routes can calculate the distance between health cencommunities. A less reliable option is using a population-based survey where househoasked their distance or time it takes them to reach the nearest health center that providesservice.

TiME frAME:Every one to two years.

dATA COllECTiOn COnsidErATiOns:This indicator is use ul or demonstrating the e ects o viding health services in remote, underserved areas. These areas may contain relativelythe impact o providing services there may be great because there were no or ew pre-In these instances, the PHE project should compare the distance or traveling time it pretarget population to get to outside health centers with the calculation o the distance oit takes the target population to get to the newly established health center.

sTrEnGTHs & liMiTATiOns:Community members may visit distant health acilities in ordmaintain con dentiality. The expense and e ort required to obtain this indicator may mbe collected every ew years.

4 AvErAGE HOusEHOld disTAnCE/TiME TO THE nEArEsT HEAlTH CEnTEr


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A G e o Mo to g a E a at g Pop at o -Hea th-E o me t P og am

P o p u l a t i o n

lEvEl Of MEAsurEMEnT:Outcome.

dEfiniTiOn:For this indicator, an acceptor is a person using any modern contraceptive method or rst time in his or her li e within the last year. Modern contraceptive methods include IUDs, th

implants, injections, condoms, spermicides, diaphragms, tubal ligation, and vasectomy.

disAGGrEGATE:By method (i desired).

PurPOsE:This indicator measures a programs ability to attract new clients rom an untapped segmo the population.

dATA sOurCEs:Usually service statistics; occasionally rom population-based surveys.

TiME frAME:Annually using service statistics; every two to ve years using a population-based surv

dATA COllECTiOn COnsidErATiOns:Program personnel can disaggregate service statistics by keyvariables (age, sex, place o residence, or other actors deemed relevant in the country o conte

sTrEnGTHs & liMiTATiOns:De ning this indicator in terms o rst-time use in the li e o an indi-vidual removes the ambiguity associated with the more general term new acceptor that can incindividuals who are new to a clinic or a method but not to modern contraceptive use. However,indicator measures absolute numbers, not the proportion o the population. It does not measurelong contraceptive use continues or i methods are used properly.

nuMBEr Of ACCEPTOrs nEw TO MOdErn COnTrACEPTiOn


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Population

Pa t Th ee: i cato


dEfiniTiOn:Contraceptive prevalence rate (CPR) is de ned as the percent o reproductive(ages 15-49 years) who are using a contraceptive method at a particular point in time. Talways reported or women married or in a sexual union. Generally, this includes allmethods, modern and traditional, but it may include modern methods only. The progrshould decide in advance whether any method or just modern methods will be included this indicator. The World Health Organization (WHO) de nes modern contraceptive mmale and male sterilization, injectable and oral hormones, intrauterine devices, diaphragimplants, spermicides, and condoms. Traditional methods include the calendar methodwithdrawal, abstinence, and lactational amenorrhea (LAM).

7 COnTrACEPTivE PrEvAlEnCE rATE

disAGGrEGATE:By modern and traditional methods.

PurPOsE:CPR measures population coverage o contraceptive use, taking all sources o straceptive methods into account.

dATA sOurCEs:Population-based surveys.

TiME frAME:Every two to ve years.

dATA COllECTiOn COnsidErATiOns:In countries with a widespread practice o sexual acoutside marriage or stable sexual unions, a prevalence estimate based on women in unioignore a considerable number o current users o contraception.

sTrEnGTHs & liMiTATiOns:This indicator is widely used. To calculate a true contraceptive denominator should include only women at risk o pregnancy, which is difcult to meadicator does not measure how long women have been using contraceptives or i they acorrectly.

# o partnered women(married or in union) o reproductive age using a contraceptive method

total # o partnered women (married or in union) o reproductive age

Ca c at o

x 100


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0 Part Three: ind cators

Health ind cators:Child Survival and Environmental HealthChild survival and environmental health activities work toward reducingchild morbidity, mortality, and disease incidence. Child health and survivalhas been a ocus or many large-scale international programs, including theMillennium Development Goals, the Integrated Management o Child-hood Illness strategy, the Global Alliance or Vaccines and Immunization,and the Roll Back Malaria initiative.

Many communities served by PHE projects have identifed child healthand survival as a priority. Te indicators in this section have been chosento measure indicators at the input, process, output, and short- to medium-term outcome levels rather than the long-term outcomes o disease in-

cidence and in ant and child mortality. ogether, these indicators covera broad range o environmental and child health activities. Most PHEprograms work on achieving the shorter-term outcomes in a smaller com-munity and contribute to a larger e ort in the area to improve child health.Depending on their ocus and resources, PHE programs can choose theindicators most appropriate or their own work.

Table 7 Health ind catorsOutputs Outcomes

Number o doses o tetanusvaccine distributedNumber o insecti-cide-treated bed netsdistributedNumber o packets o oralrehydration salts distributedNumber o sa e water stor-age vessels distributed

1.

2.

3.

4.

Percent o pregnant womenreceiving at least two doseso tetanus toxoid vaccinePercent o children aged 12-23 months ully immunizedbe ore 12 monthsPercent o households withaccess to an improved sourceo drinking waterTime spent by householdmembers to collect water

5.

6.

7.

8.

Percent o households usingan improved toilet acilityPercent o households usingsoap in last 24 hoursPercent o households stor-ing drinking water sa elyPercent o children underfve years who slept underan insecticide-treated bednet the previous nightOral rehydration therapyuse rate

9.

10.

11.

12.

13.


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Health

Pa t Th ee: i cato


dEfiniTiOn:An improved toilet acility means a ush/pour- ush toilet connected to a psystem, septic tank, or pit; a ventilated-improved-pit latrine; simple pit latrine with slacleaned; or a composting toilet. An unimproved toilet acility includes ush/pour-empty elsewhere without connection to piped sewage systems, septic tanks, pits, or hadrainage; pit latrines without slabs or open pits; bucket latrines (where excreta are manuhanging toilets/latrines; open de ecation in feld or bush or into plastic bags ( ying toiother type o de ecation.

PErCEnT Of HOusEHOlds usinG An iMPrOvEd TOilET fACiliTY

disAGGrEGATE:None.

PurPOsE:Access to a unctioning and improved toilet acility is essential or improvinghygienic situation. This indicator measures access to such acilities.


TiME frAME:Every two to fve years.

dATA COllECTiOn COnsidErATiOns:Household heads or caretakers should be interviewed athe type o toilet acility they use; a terwards interviewers should observe the acilitcessible.

sTrEnGTHs & liMiTATiOns:This indicator does not measure whether toilet acilities are uwhether they are hygienic.

# o households that have working improved toilet acilities within their compound

total # o surveyed households

Ca c at o

x 100


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A G e o Mo to g a E a at g Pop at o -Hea th-E o me t P og am

H e a l t h


dEfiniTiOn:This indicator measures the percent o households where soap is used on a regular basUse o soap at the most critical times (a ter de ecation and be ore cooking or eating) or handcan decrease the risk o diarrheal disease. Although ash, sand, and mud are mentioned in the liteas local alternatives, neither their acceptability as a cleansing agent nor their actual use on a signiscale has been established. The use o soap or washing hands is commonly promoted through pprivate partnerships.

10 PErCEnT Of HOusEHOlds usinG sOAP in lAsT 24 HOurs

disAGGrEGATE:None.

PurPOsE:Washing hands with soap is essential to controlling diarrheal diseases. This indicator reresents actual behavior, not knowledge. Washing hands with soap at two critical times is suggeas a minimum but programs may choose to set higher targets i more requent hand washing sachievable.


TiME frAME:Every two to fve years.

dATA COllECTiOn COnsidErATiOns:Alternatively, the interviewer can observe hand-washingacilities and techniques but this would not measure soap use, only the availability o hand-wa

supplies. The household respondent (o ten the caregiver o the youngest child) is asked aboutuse o soap in the last 24 hours to reduce recall bias. It is important to also ask whether the houshas soap.

sTrEnGTHs & liMiTATiOns:This indicator is easily collected, and observation allows or a reliableassessment o available conditions. However, this indicator does not necessarily measure properstorage, hand washing techniques, or how o ten hands are washed on a regular basis.

# o households reporting washing handswith soap be ore cooking/eating and a ter de ecation over the past 24 hours

total # o households surveyed

Ca c at o

x 100


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Env ronment ind cators:Natural Resource Management,Species Preservation, Income-Generation ActivitiesTe environment indicators in this section ocus both on system health

(species abundance and distribution) and measuring healthy, sustain-able interactions between communities and their environments (area un-der improved management). While this section includes environmentaloutcomes, it also includes indicators that measure inputs, processes, andoutputs. Environment indicator topics include habitat status, improvedpractices/management, natural resource management committees, anden orcement o environment protection laws. Te environment indicatorsbest suited or individual PHE or environment programs will depend onprogram goals and resources.

Environment-related work in PHE programs naturally complements e -orts to improve governance by building capacity o local government bod-

ies, and even communities, to manage shared resources in a sustainablemanner or current and uture revenue generation or livelihood purposes.More than hal o the environment indicators in this guidebook are value-added in the governance, livelihoods, and/or underserved populations sec-tors. Five indicators in this section are value-added or more than one area.Tis refects the multi-sectoral approach o environment-related activitiesin PHE programs.

Table 10 Env ronmental ind catorsProcess/Outputs Outcomes

Percent o communities in target area thathave developed a community-based natural

resource management planNumber o ofcers trained in laws anden orcement procedures and posted to apermanent en orcement positionHours o en orcement patrols loggedArea o legally protected habitatNumber o trees plantedPercent o trees planted that survive

Number o educational sessions on improvedagricultural/marine practices

1.

2.

3.4.5.6.

7.

Percent o community-based natural resourcemanagement plans that are approved by a

government authorityPercent o armers/ shers who adoptimproved agricultural/marine practicesArea o habitat under improved managementArea o secondary orest regeneratedPopulation structure o speciesSpecies richnessSpecies abundance and distribution

8.

9.

10.11.12.13.14.


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Environment

Pa t Th ee: i cato

lEvEl Of MEAsurEMEnT: Outcome.

dEfiniTiOn: NRM is the management o all activities that use, develop, and/or conserve airplants, animals, and ecosystems. NRM committees are organized groups o people whoand attempt to practice natural resource management. A government authority is a pers

or the government and has the power to make legal decisions. Approved means the ofcially adopted as having the e ect o law it is en orceable.

PErCEnT Of COMMuniTY-BAsEd nATurAl rEsOurCE MAnAGEMEnT

PlAns THAT ArE APPrOvEd BY A GOvErnMEnT AuTHOriTY

disAGGrEGATE: None.

PurPOsE: Community control at the local level can result in more sustainable environmenment where locals are likely to bene t rom their choice o land or natural resource usresources are owned and/or controlled by the state or commercial interests, even when lenous people have occupied a territory or many years or generations. When local commlegal right to manage local resources, they begin to value resources leading to ongoing c

dATA sOurCEs: Secondary records.

TiME frAME:Annually.

dATA COllECTiOn COnsidErATiOns: Examining secondary records such as legal documentsbe sensitive in some countries. The project should work with the locally-based NRM cgovernment authorities to receive documentation or this indicator.

sTrEnGTHs & liMiTATiOns: Measurements should be relatively easy and straight- orward tosince the indicator is unambiguous and has been legally de ned. However, changing lawcan be a slow process that may occur over the course o several years, requiring ongoiAlthough a community-based NRM plan may not have been approved by a governmenmay still be in the process o being implemented by the community. This indicator dwhether there is improved management on a local level.

# o government-approved community-based NRM plans

# o community-based NRM plans nished and submittedto a government authority or approval

Ca c at o

x 100


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integrat on ind cators:Partnerships and CommunicationRecent assessments o integrated PHE programs in the Philippines have

ound that integrated programs have several advantages over stand-alonepopulation, child health, or environment programs. Te assessments oundthat integrated programs were cost-e ective compared to the cost o sin-gle-sector population, child health and sa ety, or environment programs.Integrated programs also recruited a greater number o men to amily planning e orts and a greater number o women and adolescents to en-vironment/conservation e orts. Integrated programs also improved theperceived value o amily planning e orts by packaging them with healthinterventions.

One o the main long-term goals o integrated PHE programs is to ensurelocal ownership and sustainability. Tere ore, the outcome indicator num-ber o enabling local ordinances/policies/strategies/doctrines supportingPHE is included in this section. Short-term outcome indicators in thissection measure local PHE awareness (number o policy-makers, media,and scholars knowledgeable about or aware o a specifc PHE issue), orthe diversifcation o PHE e orts.

Process indicators in this section measure linkages between materials(number o linked messages/materials created) and partnerships that in-crease integration (number o new PHE partnerships created that makelinkages among organizations or institutions rom di erent sectors). Out-put indicators in this section measure PHE promotion/education e orts(number and requency o PHE educational sessions provided in the tar-get community).

While any o the indicators in this section may be valuable or the M&Eo integrated programs, programs that have a ocused nature or that acelimited budgets may concentrate on measuring a ew indicators that bestft their needs.


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i n t e g r a t

o n


dEfiniTiOn:This is a number count o policy-makers, media members, and scholars knowledgeababout or aware o a speci c PHE issue. The issue should be chosen by the project in advance the beginning o project implementation or tracking over the li e o the project. This issue svery speci cally de ned to avoid error in counting whether an in uential person has knowledawareness. Choosing a broad and over-arching topic (i.e., the connection between amily planand environment) is not use ul in counting this indicator. Similarly, policy-makers, media, and scshould not already be involved with or active in the PHE issue selected by the project. They snormally be those who are targeted and monitored by the project on the speci c issue selected.

disAGGrEGATE:By issue.

PurPOsE:Persons o interest knowledgeable about the PHE issue is an indication that the prograprojects messages reached those in power or those who are in a position o educating/impactinpublic.

dATA sOurCEs:Secondary sources, key in ormant interviews.

TiME frAME:Semi-annually, annually.

dATA COllECTiOn COnsidErATiOns:Complications in collecting this indicator with accuracy arisewith the de nition o knowledge or awareness. Knowledge and awareness are difcult to measobjectively without the ability to per orm pre and post tests or the persons o in uence. Usiin ormant interviews where targeted policy-makers, media members and scholars are intervie

about their knowledge or awareness o a PHE issue can assist in con rming in ormation or thitor. When possible, using an interview as a baseline and then repeating the interview at a scheduinterval can provide in ormation over time about increased knowledge or committment to as spPHE issue.

sTrEnGTHs & liMiTATiOns:This indicator does not give in ormation on whether the policy-makers,media, or scholars are supportive o the speci c PHE issue. It also does not measure the in upersons level o knowledge or depth o awareness o the issue.

nuMBEr Of POliCY-MAkErs, MEdiA, And sCHOlArs knOwlEdGEABlEABOuT Or AwArE Of A sPECifiC PHE issuE


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112

integraton

Pa t Th ee: i cato


dEfiniTiOn:This is a percentage o the households in the projects target area whose reknowledgeable about or aware o a speci c PHE issue. The issue should be chosen bthe beginning o project implementation or tracking over the li e o the project. Thivery speci cally de ned to avoid error in counting whether the person responding orhas knowledge or awareness. Choosing a broad and over-arching topic (i.e., the connec

amily planning and environment) is not use ul in counting this indicator. The houseshould normally be those who are targeted and monitored by the project on the speci c

or this indicator to be use ul in determining whether the household gained the knowleo the PHE project.

7 PErCEnT Of HOusEHOlds knOwlEdGEABlE ABOuT Or AwArE Of AsPECifiC PHE issuE

disAGGrEGATE:PHE issue covered in survey.

PurPOsE:Household knowledge o a speci c PHE issue may be an indication o the proin communicating the PHE issue or in the increasing awareness o the community to between human health and the natural environment.

dATA sOurCE:Population-based survey.

TiME frAME:Every two to ve years.

dATA COllECTiOn COnsidErATiOns:The speci c PHE issues should be determined in advanmain consistent, and be monitored over time. When collecting in ormation at the housepopulation-based survey, special attention should be made not to bias results by suggest

sTrEnGTHs & liMiTATiOns:This indicator only measures knowledge and does not indicate bchange or where the knowledge was acquired. The questions utilized to measure knowlcare ully worded and pretested to ensure accurate measurement.

# o households surveyed that are knowledgeable about a speci c PHE issue

total # surveyed households

Ca c at o

x 100

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Module 7 handout - Population Indicators - M&E of PHE UNC

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