1. Module 2: Basic analyses

2. Module 2: Learning Objectives  Identify approaches for setting targets  Understand common analyses that calculate program coverage and retention  Calculate program coverage and retention

3. Terminology  Indicator  Target  Program coverage  Service availability  Service utilization  Program retention

4. Indicator  Program element that needs tracking  Measures an aspect of a program’s performance  Measures changes over a period of time # of new family planning users # of clients currently on ART  Expressed as a number or percentage

5. Target Definition  A specified level of performance for a measure (indicator), at a predetermined point in time (i.e., achieve ‘x’ by ‘y’ date)  Overall target  Annual targets

6. Why Set Targets?  Targets help program staff with:  Planning –Staffing and service delivery –Commodities  Monitoring progress –Break long-term goals into manageable pieces –Check progress on indicators

7. Setting Reasonable Targets  The range of values for a given indicator can be from 0% to 100%. Example: The theoretical range for the Polio indicator is between 0% of children immunized (bad) and 100% immunized (ideal) Is it appropriate to set the Polio indicator target at 100% for a given program? Why/why not?

8. Setting Reasonable Targets  Example: In Somalia, the national CPR from 2007 to 2009 was15%. The following year, a national target was set for 70%.  Is it appropriate to set the CPR target for Somalia at 70%? Why/why not?

9. Overall Target Setting Approaches  There are three approaches to set a target :  Established long-term goals by contacting that national program  Past performance (of your program, increasing by no more than 10%)  Local high performer (a stellar program nearby)  Consider the number of clients your program can realistically expect to serve during a given period of time

10. Annual Target Setting  Determine the increase your program needs to gain to reach your overall target  Divide that number by the number of years in which you would like to achieve the target  Add the number to your baseline indicator for each year

11. Considerations for Target Setting  Ensure you have an agreed-upon and realistic definition of target population  Set a realistic target to achieve in the long term and short term

12. Importance of Defining the Target Population: Case Example  Target was 372 children to be immunized  Actual was 488 children immunized  To calculate the % target achieved, use (Actual/Target) * 100  488/372 = 1.31*100 = 131%  How could the clinic have surpassed its target by so much?

13. Implications of Incorrect Target Setting: Case Example  You don’t really know to what extent you’re fully immunizing the children in your setting  If your program purchases commodities (e.g., vaccines) based on the target set, supply could run out  If you set your target too low, you may not have enough vaccines, leading to disease outbreaks

14. Common Analyses  Program Coverage  Extent to which a program reaches its intended target population, institution, or geographic area  Compare current performance to prior year/quarter  Compare performance between sites  Program Retention  Extent to which the range of services is being delivered as initially intended so that client drop- outs are minimal

15. 15 Why do we need to measure coverage?  To understand program progress  To determine if the target is reached  Clients, commodities, adherence…  To determine if one target is reached more effectively than another Are there underserved area/regions, subpopulations?

16. Program coverage  Extent to which a program reaches its intended target population, institution, or geographic area  Utilization:  Is the target population utilizing services, accessing commodities, being reached with services?  Availability:  Are the services available where there is a need?

17. Utilization calculation Percentage of the target population utilizing services # of individuals in target population using a service ------------------------------------------- X 100 # of individuals in target population

18. Utilization calculation: Example  No. of persons educated as of 6/12/09 = 300  Goal for 12/31/09 = 900 300 900  You have reached 33% of your target group with education messages = 0.33 x 100 = 33%

19. Comparison of time periods  Compare percentage achieved toward target for different time periods, different sites, etc.  Rate of increase  As of January, 70 people educated; by June, 300 people  300 – 70 = 230 increase in people educated  230/6 = 38.3 new people educated per month over the 6 months

20. Sought prenatal care (600) All pregnant women (2,000) PMTCT Target (1,000) Utilization = Service users Target population Counseled & Tested for HIV (500) Utilization of PMTCT Programs Utilization = 600/1,000 = 0.6 0.6 x 100 = 60%

21. Program coverage  Extent to which a program reaches its intended target population, institution, or geographic area  Utilization:  Is the target population utilizing services, accessing commodities, being reached with services?  Availability:  Are the services available where there is a need?

22. Availability calculation  Number of service outlets available per target population  # of clinics with PMTCT per # of pregnant women  Expressed as a ratio

23. PMTCT clinic availability  There are 8 clinics offering PMTCT & 100,000 pregnant women in region X.  Ratio of clinics to pregnant women 8:100,000  Reduce to (1:12,500) pregnant women  The standard recommendation is 1 clinic with PMTCT services per 10,000 pregnant women  Clinic availability is not reaching the target

24. Availability + Utilization = Coverage  Service availability is 1:12,500  Service availability target is 1:10,000  PMTCT service utilization is 25% off the target  What can we conclude?  Service availability and utilization are too low; the program is not meeting the needs of pregnant women.

25. 25 Program retention  Measures if the range of services are being delivered as initially intended  Determines program retention, i.e., is the project keeping clients through entire package of services? Important in clinical programs where drug adherence is an issue (TB, HIV/AIDS, immunization) and there are multiple steps (PMTCT)

26. Utilization Retention example: Immunization Enter service Polio dose 1 Polio dose 2 Polio dose 3 Completion

27. Tested for HIV (500) Sought prenatal care (600) All pregnant women (2,000 women) PMTCT Target (1,000) 40 received prophylaxis 350 received HIV- result or no result 100 received HIV+ result PMTCT Program Retention

28. Tested for HIV Sought prenatal care All pregnant women (2,000 women) 40 received prophylaxis 350 received HIV- result 100 received HIV+ result 1,000 500 PMTCT Program Retention

29. Tested for HIV (500) Sought prenatal care (600) All pregnant women (2,000 women) PMTCT Target (1,000) 40 received prophylaxis 350 received HIV- result 100 received HIV+ result PMTCT Program Retention

30. Tested for HIV (500) Sought prenatal care (600) All pregnant women (2,000 women) PMTCT Target (1,000) 40 received prophylaxis 350 received HIV- result or no result 100 received HIV+ result PMTCT Program Retention

31. Tested for HIV (500) Sought prenatal care (600) All pregnant women (2,000 women) PMTCT Target (1,000) 40 received prophylaxis 350 received HIV- result or no result 100 received HIV+ result PMTCT Program Retention

32. Key messages  Target Setting – A specified level of performance for a measure (indicator) at a predetermined point in time. Both overall and annual targets are set  Coverage – extent to which a program reaches its intended target population, institution, or geographic area  Retention – the extent to which the range of services are being delivered as initially intended, with clients retained throughout the full package of services