Developing a Costed Implementation Plan (CIP) requires many inputs—either collected through qualitative approaches like interviews and document review or through more standardized procedures and calculations. A variety of commonly used tools can inform inputs for the following CIP tasks:
- Conduct a situational analysis
- Assess the impact of family planning (FP) strategies
- Conduct a cost-benefit analysis
- Make demographic projections
- Conduct forecasting
- Plan for implementation
Information and links to many of these commonly used tools are presented here (organized by task). However, each CIP team will decide which tools best support its efforts considering the country’s specific context. Additional tools are described in theCrosswalk of Family Planning Tools: A Guide to Costing, Planning, and Impact Analysis Tools, from which some of the material below is drawn.
Conduct a Situational Analysis
Preparation of a situational analysis is an important early step in the CIP development process and is typically led by the expert Technical Support Team (TST). The analysis, complemented by partner interviews, compiles information about the country’s current FP situation, policies, programs, and financing. The information is then used to prioritize intervention areas and key activities. Various tools may be applied during the landscape analysis and each yields slightly different information.
OneHealth: OneHealth, which is included in the Spectrum System of Policy Models, is designed to strengthen the development of national strategic health plans by facilitating health system analysis, costing, and financing scenarios. Its primary purpose is to assess public health investment needs in low- and middle-income countries. OneHealth offers planners a single framework for planning, costing, impact analysis, and budgeting and financing of strategies for all major diseases and health system components. It includes modules to support health activities related to the Millennium Development Goals (MDGs), as well as planning and costing components for the supply side of health systems (human resources, infrastructure, and logistics). The tool also includes a financial space analysis and health impact prediction for the MDGs.
SEED: The Supply-Enabling Environment-Demand (SEED)™ Assessment Guide for Family Planning Programming can be used to help program managers and staff determine strengths and weaknesses in family planning programs. It identifies programmatic gaps that require further investment or more in-depth assessment prior to (re)designing programmatic interventions. It is grounded in EngenderHealth’s SEED Programming Model™, a holistic programming framework based on the principle that sexual and reproductive health programs will be more successful, sustainable, and accountable to the communities they serve if they comprehensively address the three interdependent and mutually supportive components of sexual and reproductive health programs: supply, the enabling environment, and demand.
SPARHCS: The Strategic Pathway to Reproductive Health Commodity Security (SPARHCS) is a tool to help a country identify and prioritize key commodity security issues; assess current capacity for commodity security among country or regional programs, systems, and policies; and shape commodity security strategic plans. SPARHCS identifies relatively strong and weak elements of a family planning program in multiple areas: capital, coordination, capacity, commitment, and context. SPARHCS has three models that can be adapted to local settings and implemented over periods from 3 to 18 months.
Assess the Impact of Family Planning Strategies
One purpose of a CIP is to estimate the demographic, health, and economic impacts of the family planning program.
ImpactNow: 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 for these comparisons to be presented in advocacy materials. It can help estimate the impacts of many “what if” questions about policy options. ImpactNow is designed to analyze a two- to seven-year time horizon; for example, it could be used to estimate the impacts of meeting FP2020 commitments. It can be used to model the impacts of three types of goals: contraceptive prevalence rate (CPR), unmet need for family planning, or family planning budgeting. ImpactNow automatically compares the outcomes of up to three scenarios at once. The outcomes are focused on reproductive health metrics, as well as economic metrics, such as cost-benefit ratios and incremental cost-effectiveness ratios.
Conduct a Cost-benefit Analysis
Conducting a cost-benefit analysis can help clarify country strategies for a CIP. Proposed activities can be analyzed in terms of their value in achieving national objectives relative to their cost.
Family Planning Impact Model: Track20 has developed an impact model that links specific family planning interventions (e.g., community-based distribution; training; information, education, and communications efforts, etc.) with changes in contraceptive prevalence. The estimated impact of interventions is based on an extensive review of the FP impact literature. The model serves as a planning tool to assist countries in developing strategies that best leverage their existing health systems for rapid increases in contraceptive prevalence. This model can answer questions, such as “What should we do to increase modern contraceptive prevalence rates (mCPRs)? What CPR can we reach in a specific period of time based on our current efforts? If we invest in a specific strategy (such as community-based distribution), what level of prevalence could we achieve by a specified year? How much would it cost to reach a particular mCPR target? Can we achieve a better result by re-allocating funding?”
Make Demographic Projections
Updated demographic projections are important to estimate the impact and costs of CIP activities. In developing a CIP and planning its implementation, it is important to know how many people the family planning program will need to serve over time.
Spectrum System of Policy Models: Two modules included in Spectrum, titled FamPlan and DemProj, can be applied together to project the family planning requirements needed to reach national goals for increasing contraceptive use, addressing unmet need, or achieving desired fertility. These projections can be used to set realistic goals, plan for the service expansion required to meet program objectives, and evaluate alternative methods of achieving goals. The models use assumptions about the proximate determinants of fertility and the characteristics of the family planning program (e.g., method mix, source mix, etc.) to calculate the cost and the number of users and acceptors of different methods by source.
Invest-FP Calculator: The Invest-FP Calculator is an Excel-based tool that uses readily available data to model the financial and programmatic impacts of different rural, public sector FP service delivery strategies. Unlike other tools, the Invest-FP Calculator focuses on community-based strategies for delivering FP services. It allows users to explore the financial and human resource requirements of different community health worker deployment options through modeling based on country-specific data. The tool is designed to help decisionmakers explore various strategies for expanding rural, public sector FP programs to achieve their country’s contraceptive prevalence goals. The tool is currently available for Kenya, Nigeria, Uganda, and Zambia.
Reality √: This tool helps users plan based on informed estimates of contraceptive need by examining the relationship between widely available demographic data (contraceptive prevalence and population) and numbers of family planning users, adopters, and commodities and caseload. It can be used for advocacy—helping users set realistic family planning goals by illustrating the resources required as well as the potential impact (e.g., averted unintended pregnancies, induced abortions, and maternal, infant, and child deaths) of realizing these goals. The tool requires minimal data inputs and can be used at the national and subnational levels of the health system. Reality √ is best used as a strategic planning and advocacy tool; donors, program managers, and planners can use the tool to set evidence-based family planning goals, estimate the potential impact of realizing these goals, (e.g. averted unintended pregnancies, induced abortions, and maternal, infant and child deaths) of realizing these goals and anticipate the inputs necessary to reach them.
Conduct Forecasting
Forecasting builds sequentially on demographic projections, translating the number of people who will be served by a family planning program into the quantity of commodities and other program supplies that will be required to meet the program’s goals.
PipeLine: PipeLine is a desktop software tool designed to help program managers plan optimal procurement and delivery schedules for health commodities and monitors their orders throughout the supply chain. Policymakers, product suppliers, and donors can generate reports, estimate future product needs, and use the software as a key tool in program planning.
CastCost: The Contraceptive Forecast and Cost Estimate (CastCost) Excel spreadsheet is used to estimate the quantity and cost of contraceptives needed in a country for five years. These estimates are based on data from the country’s Reproductive Health Survey or Demographic and Health Survey. CastCost can provide estimates of contraceptive needs for the country as a whole, for the public or private sector alone, or for individual service provider organizations. Although CastCost provides an estimate of the quantity of contraceptives needed and their cost, the decision of exactly what quantities of contraceptives to procure should be based primarily on logistics (usage) data. CastCost estimates can be helpful in validating the quantities suggested by a logistics-based forecast. CastCost can also be used to test different scenarios, such as projecting the cost if injectable contraceptives were to increase substantially in the next five years or the differences in cost of a particular contraceptive if it is procured from different sources or to see the financial implications of different method mixes.
Contraceptive Forecasting Handbook for Family Planning and HIV/AIDS Prevention Programs: The Contraceptive Forecasting Handbook for Family Planning and HIV/AIDS Prevention Programs is designed as a reference book for forecasting commodity needs for family planning and HIV/AIDS prevention programs. The Forecasting Handbook follows the sequence of steps required to produce and validate a complete forecast, and then to estimate procurement requirements and monitor progress and performance over time.
A Forecasting Guide for New and Underused Methods of Family Planning: This guide provides direction to programs that want to forecast for new and underused methods (NUMs) of family planning. It supports program managers and others involved in forecasting as they plan to (1) introduce a contraceptive technology for the first time in a country and/or (2) position an underused method for scale-up. The guide recognizes that accurate forecasts take into account the larger system into which the NUM will be introduced and scaled, and it offers a framework for building rational assumptions to support accurate forecasting for NUMs or any family planning method where future demand is inherently difficult to predict. It also identifies common pitfalls in NUMs forecasting and recommends strategies to avoid them.
Procurement Planning and Monitoring Report: This tool, updated monthly, identifies the stock status of commonly used contraceptives in the public sector in more than 30 countries.
Plan for Implementation
Ensuring Human Rights in the Provision of Contraceptive Information and Services: This document provides guidance for policymakers, managers, providers, and other stakeholders in the health sector on some of the priority actions needed to ensure that different human rights dimensions are systematically and clearly integrated into the provision of contraceptive information and services. These guidelines provide specific recommendations for how programs can ensure human rights are respected, protected, and fulfilled in the provision of contraceptive information and services. This guidance is complementary to existing WHO (World Health Organization) recommendations for sexual and reproductive health programs, including guidance on maternal and newborn health, sexuality education, safe abortion, and core competencies for primary health care.
Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights: A Conceptual Framework: This framework has been designed to serve as a pathway to fulfilling both the FP2020 goal and governments’ commitments to the provision of voluntary family planning programs that respect, protect, and fulfill human rights. The framework answers the key question, “How can we ensure public health programs oriented toward increasing voluntary family planning access and use respect, protect, and fulfill human rights in the way they are designed, implemented, and evaluated?” The framework defines what such a program looks like, taking into consideration the broad context in which programs operate, as well as the essential programmatic elements at the policy, service, community, and individual levels.
