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