Scaling up an Innovation: Experience with the

Standard Days Method® of Family Planning

Institute for Reproductive Health Georgetown University

DRC Guatemala India/Jharkhand Mali Rwanda

Scaling up the Standard Days Method: 5-year prospective case study in

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.

Scaling-up Strategy

Inputs

•Staff

•Partners

•Funds

•CycleBeads

Scale-up Logic Model

Problem: Gap in availability & access to SDM services

Impact: increased availability of SDM

• Norms & procedures

• Training curricula• Supervision• HIS• Procurement &

distribution• Budget lines

• Provider training

• Availability of CycleBeads

• Supportive supervision

• IEC: new method as part of FP mix

Scale-up: NOT just MORE of the SAME

Defining success in scale up

Research questions: Scale-up outcomes

Client • What is the experience of women and men with SDM when scaled-up? (Knowledge, attitudes and use)

Service provision

• 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?

Data sourcesEvaluation

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

Source for statistics: NFHS-3 (2005-2006)

Program goal: Scale Up SDM to full coverage in 11 out of 24 districts

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 In process

Commodities in logistics & procurement systems

Partially

SDM in IE&C materials 4/9

SDM in HMIS In process

Proportion of SDPs with FAM in method mix

22%

FAM in surveys (DHS) No

Funds leveraged for FAM $246,000

Providers trained 3,100 / 15,000

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 organizations

• Benefits Credibility Efficiency Quality Resource

leveraging Consistency

• Challenges Vertical

programming Competition for

resources Donor

constraints

Government of Jharkhand

User Organization

• Benefits Financial

resources (MOU, PIP)

Capacity Integration into

training, IEC, procurement, supervision

• Challenges Involve central,

district, block Transitioning to

member of resource team

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)

The Innovation

• Supervision with structured tool

• Monthly/semi annual/ annual report

• Shared quarterly with stakeholders

Data sources

• Process tracking tools

• MOH service statistics

• Training reports• Follow-up visits

with users

September 2009

Government of Jharkhand signs MOU with IRH and commits $211,000 to

SDM and LAM scale up

January 2009

October 2008

February 2009

HLL Lifecare Limited becomes

licensed manufacturer of

CycleBeads

June 2009

Comic books printed and

CHW trainings begin in

Jharkhand (paid by gov't)

Debut of community

radio programs in

Gumla, Jharkhand

March 2009

April 2009 May 2009

SDM/LAM integration project initiated with UPVHA, an NGO in

Allahabad, UP

Filmed counseling

video

Household survey in

Jharkhand scale-up districts conducted

Facility level trainings begin in 3 districts in

Jharkhand (paid by gov’t)

Monitoring

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