Scaling up an Innovation: Experience with the Standard Days Method® of Family Planning Institute for Reproductive Health Georgetown University Scaling up the Standard Days Method: 5-year prospective case study in DRC Guatemala India/Jharkhand Mali Rwanda using the ExpandNet model for planning, monitoring, research Hypothesis: Applying the systems analysis framework and scaling-up principles articulated in the ExpandNet model to scaling up SDM in existing programs and services will lead to more sustainable, quality SDM services. Scale-up Logic Model Scaling-up Strategy Problem: Gap in availability & access to SDM services Inputs • Staff • Partners • Funds • CycleBeads Process • Conduct trainings • Advocacy • Supervision Outputs • Providers trained • Clinics offering SDM • IEC activities Outcomes • Provider competency • Awareness and use • Availability • Supportive policies Impact: increased availability of SDM Scale-up: NOT just MORE of the SAME • • • • Provider training Availability of CycleBeads Supportive supervision IEC: new method as part of FP mix Systems integration • • • • • • Norms & procedures Training curricula Supervision HIS Procurement & distribution Budget lines Services Integration Defining success in scale up Availability of SDM at national, subnational, organizational level Availability of SDM at SDPs Provider capacity Research questions: Scale-up outcomes Client Service provision • What is the experience of women and men with SDM when scaled-up? (Knowledge, attitudes and use) • Is SDM offered correctly by providers? • How does SDM introduction influence quality, availability and use of overall family planning services? System integration • To what extent has SDM been integrated into training, IEC, procurement and distribution, and HMIS? Is it included in norms, protocols and guidelines? Resource mobilization • What is the level of resources dedicated to SDM? Research questions: Scale-up process Resource team • Do user organizations assume the roles, responsibilities and ownership of the resource team during scale-up process? Advocacy/ Dissemination • What is the role of SDM champions? What strategies work best? Organizational choices • Has SDM been offered outside traditional public sector service delivery? Evaluation Semi annual benchmark monitoring Most Significant Change (MSC) story collection (1-2 times) Data sources Guided discussions with staff (quarterly) Event tracking (timelines) Community surveys & facility assessments (1-2 times) Individual interviews with stakeholders (1-3 times) Scale Up in the state of Jharkhand, India • A new state formed in 2002 • 27 million people with more than 90% in rural areas • TFR = 3.3 • CPR = 36% , spacing methods at 8% • IMR - 49 and MMR - 371 • 54% literacy rate Program goal: Scale Up SDM to full coverage in 11 out of 24 districts Source for statistics: NFHS-3 (2005-2006) Monitoring Performance Benchmarks – India, Jharkhand Selected Indicators (as of 6/09) No. of resource organizations 2/8 SDM included in key policies, norms, protocols 1/2 SDM in pre-service training Commodities in logistics & procurement systems SDM in IE&C materials SDM in HMIS In process Partially 4/9 In process Proportion of SDPs with FAM in method mix 22% FAM in surveys (DHS) No Funds leveraged for FAM Providers trained $246,000 3,100 / 15,000 Environment Dynamic, requires flexibility in programming and M&E • Supportive political environment influenced by results from pilots • Health is a state subject, policy changes influenced by centre • System requires substantial capacity building • Low priority of FP, particularly birth spacing • Naxalite affected areas • Large cadre of community level providers (30,000 ASHAs & 34,000 AWWs) Should include multiple Resource Team organizations • Benefits Credibility Efficiency Quality Resource leveraging Consistency • Challenges Vertical programming Competition for resources Donor constraints User Organization • Benefits Financial resources (MOU, PIP) Capacity Integration into training, IEC, procurement, supervision Government of Jharkhand • Challenges Involve central, district, block Transitioning to member of resource team The Innovation Adapt to scale-up conditions • Simplify/adapt/test training materials • Develop/test approaches to facilitate ownership, sustainability and scalability Community radio Social marketing Distance learning magazine tear-outs mHealth approaches (CycleTel) Monitoring Data sources • • • • Process tracking tools • Supervision with structured tool MOH service statistics • Monthly/semi annual/ annual report Training reports • Shared quarterly with stakeholders Follow-up visits with users Filmed counseling video Government of Jharkhand signs HLL Lifecare MOU with IRH Limited becomes and commits licensed $211,000 to SDM and LAM manufacturer of CycleBeads scale up October 2008 January 2009 SDM/LAM integration project initiated with UPVHA, an NGO in Allahabad, UP Comic books Household printed and Facility level trainings survey in CHW trainings begin in 3 districts in begin in Jharkhand scaleJharkhand Jharkhand (paid up districts (paid by gov’t) by gov't) conducted February 2009 March 2009 April 2009 May 2009 June 2009 Debut of community radio programs in Gumla, Jharkhand September 2009 Lessons Learned: • Using research & evaluation methodologies have enabled IRH to: measure scale-up progress, identify needed adjustments, involve stakeholders, provide evidence for advocacy, and maintain momentum & accountability • Challenges facing scale-up are many (i.e. shifting policy and resource environments, large number of partners involved) ExpandNet framework has contributed to sustainable, strategic and quality scale-up efforts www.irh.org