Sayana Press Introduction Project: Global Monitoring Guide

Publication date: 2017

SAYANA PRESS P ROJECT Sayana Press Pilot Introduction Project | Global Monitoring Guide In collaboration with ministries of health and key partners, PATH coordinated pilot introduction of the subcutaneous injectable contraceptive Sayana®Press (DMPA-SC) in Burkina Faso, Niger, Senegal, and Uganda from July 2014 through June 2016. PATH worked in partnership with local and global stakeholders to build consensus on a set of global indicators across the four countries. Indicators were selected based on key interests of national stakeholders and donors to inform decisions regarding scale-up and future investments in Sayana Press. In addition to tracking volumes of doses administered, PATH’s approach to monitoring Sayana Press pilot introduction measured indicators related to new family planning users, adolescent girls and young women, and switching to Sayana Press from other methods, especially DMPA-IM (intramuscular depot medroxyprogesterone acetate). During the design of the monitoring system, PATH paid careful attention to defining indicators consistently within each country, as well as globally. Harmonizing indicator definitions across countries was essential to allow for cross-country analysis of monitoring data, which provided rich information on the outcomes of different training and introduction approaches. This guide summarizes the global indicators for pilot introduction, their definitions, and suggested data sources and measurement levels. These can be modified for various country settings or program needs. No. Indicator Definition and data requirements Purpose Periodicity, reporting, and measurement level Data source(s) Training *Select programmatic considerations in italics 1.1 Number of provider trainings held on provision of Sayana Press The number of training events held on administration of Sayana Press (and other family planning methods, as relevant)  Documents the number of trainings held; can help ensure training is progressing as expected  Collected on a rolling basis as training is implemented (monthly)  Reported quarterly  Disaggregated by district, sector, and facility level or provider type (depending on country context)  Training records of MOH or NGO partner(s) responsible for provider training 1.2 Number of providers trained on the The number of health workers who attended a full training (including theory and practical  Documents the number of health workers trained in the provision of Sayana Press; can help ensure  Collected on a rolling basis as training is  Training records of MOH or NGO partner(s)  Sayana Press is a registered trademark of Pfizer Inc. 2 provision of Sayana Press sessions) on administration of Sayana Press (and other family planning methods, as relevant) training is progressing as expected  Denominator for indicator 1.4 implemented (monthly)  Reported quarterly  Disaggregated by district, sector, and facility level or provider type (depending on country context) responsible for provider training 1.3 Number of trained providers who attained competency in injectable delivery (Sayana Press and/or DMPA-IM) The number of providers trained who successfully completed theory and practicum and are certified to provide Sayana Press (and/or DMPA-IM) Note: Competency standards, including both theory and injection practice, are country- specific and depend on the local context.  Documents the number of health workers certified and potentially active in the provision of Sayana Press  Can help contextualize consumption data (e.g., higher volumes of Sayana Press administered are typically seen where more health workers have been trained)  Numerator for indicator 1.4  Collected on a rolling basis as training is implemented (monthly)  Reported quarterly  Disaggregated by district, sector, and facility level or provider type (depending on country context)  Provider observation checklists and post-training evaluation data  Training records of MOH or NGO partner(s) responsible for provider training 1.4 Percentage of trained providers attaining competency in injectable delivery (Sayana Press and/or DMPA-IM) Out of the total number of providers trained, the percentage that were deemed competent in the provision of Sayana Press Numerator: 1.3 Denominator: 1.2  Provides insight into the effectiveness of training and health workforce capacity to safely and effectively provide injectables  Reported quarterly  Disaggregated by district, sector, and facility level or provider type (depending on country context)  Data for indicators 1.2 and 1.3 Service delivery / consumption 2.1 Number of Sayana Press doses administered to clients The number of Sayana Press doses injected into clients during the month Note: This indicator only represents the number of doses administered to women. It is not equal to the number of Sayana Press users at a point in time.  Determines consumption volumes of Sayana Press  Provides information on the level and location of demand for Sayana Press  May help identify where additional provider training and support may be needed  Collected monthly  Reported quarterly  Disaggregated by district, sector, and facility type or distribution channel (if relevant)  Family planning client register 3 Monitoring data are unable to track individual use over time.  Consider behavior change communication and social marketing activities to help explain consumption patterns  Denominator for indicators 2.3, 2.7, and 2.9 2.2 Number of Sayana Press doses administered to new users The number of Sayana Press doses injected into new users during the month Note: A new user is defined as a woman who has elected to use a modern method of contraception for the very first time. Clients can be counted as a new user only once, so the total number of doses administered to new users is equal to the number of new users.  Indicates the total number of new users of modern contraception who selected Sayana Press  Compared with data on new users who select other methods (if collected), will help determine which methods are most popular among new users  Helps track progress toward global commitments (e.g., FP2020)  Numerator for indicator 2.3  Collected monthly  Reported quarterly  Disaggregated by district, sector, and facility type or distribution channel (if relevant)  Family planning client register 2.3 Percentage of Sayana Press doses administered to new users The proportion of doses of Sayana Press injected into first- time users of modern contraception Note: Modern methods consist of barrier, hormonal, and permanent methods such as male and female condoms, pills, injectables, implants, IUDs, diaphragms, spermicide foam/gel, male and female sterilization, lactational amenorrhea method, and emergency contraception. Numerator: 2.2  Documents the extent to which Sayana Press doses are administered to first-time users of modern contraception  May indicate whether Sayana Press is an attractive method choice for first-time users of modern contraception  Advanced monitoring: Programs that specifically track whether clients are new to family planning (vs. previously used any modern method) at initial offer of Sayana Press may choose to use the total number of doses administered to clients initiating Sayana Press as the denominator, eliminating  Reported quarterly  Disaggregated by district, sector, and facility type or distribution channel (if relevant)  Data for indicators 2.1 and 2.2 4 Denominator: 2.1 Note: The percentage of doses administered to new users will decrease over time as more women return for reinjections, thus increasing the denominator (2.1). For this reason, it is also important to monitor the number of doses administered to new users. See next column for advanced monitoring tip. reinjections from the equation. Since a method can be initiated only once, this indicator would serve as a proxy for the percentage of Sayana Press adopters new to family planning. This alternate indicator would be the percentage of clients initiating Sayana Press that were new users of modern contraception. 2.4 Number of Sayana Press doses administered to women by age group: a. Under age 20 b. Ages 20–24 c. Age 25 and older The number of Sayana Press doses injected in women under age 20, women ages 20–24, and women age 25 and older Note: Age category preferences may vary from country to country. These categories were selected due to alignment with the Demographic and Health Survey (DHS).  Numerator for indicator 2.5  Collected monthly  Reported quarterly  Disaggregated by district, sector, and facility type or distribution channel (if relevant)  Family planning client register 2.5 Percentage of Sayana Press doses administered to women: a. Under age 20 b. Ages 20–24 c. Age 25 and older The percentage of Sayana Press doses injected in women under age 20, women ages 20–24, and women age 25 and older For each age group: Numerators: 2.4a, 2.4b, and 2.4c Denominator: (2.4a + 2.4b + 2.4c) Note: The number of doses administered to women of each age range is divided by the sum of doses administered to women of all three age groups. This  Documents the extent to which Sayana Press doses are administered to adolescents and young women  May indicate whether Sayana Press is an attractive method choice for adolescents and younger women  May highlight areas where additional training on provision of family planning methods (and/or injectables) to youth may be needed  Reported quarterly  Disaggregated by district, sector, and facility type or distribution channel (if relevant)  Data for indicators 2.4a, 2.4b, and 2.4c 5 denominator is used rather than total doses administered, which may not represent the true denominator since the ages of some women may not be documented in the family planning register.  Advanced monitoring: Programs that track initial offer of Sayana Press (vs. previously used any modern method) may choose to only count age of clients at initial offer, which would more closely approximate the ages of Sayana Press adopters. Counting age at every dose administered includes women every time they receive a reinjection. 2.6 Number of Sayana Press doses administered to women who switched from DMPA-IM (and/or other methods) The number of Sayana Press doses administered to women who were actively using DMPA- IM (or another method) and switched to Sayana Press Note: Stakeholders in many country settings may be particularly interested in switching from DMPA-IM to Sayana Press, though some may choose to track switching from other methods as well.  Documents the number of Sayana Press doses administered to clients switching from DMPA-IM (or the number of times clients switch from DMPA-IM to Sayana Press)  Collected monthly  Reported quarterly  Disaggregated by district, sector, and facility type or distribution channel (if relevant)  Family planning client register 2.7 Percentage of Sayana Press doses administered to women who switched from DMPA-IM (and/or other methods) The percentage of Sayana Press doses administered to women who were actively using DMPA- IM (or another method) and switched to Sayana Press Numerator: 2.6 Denominator: 2.1  May indicate whether women and/or health workers prefer Sayana Press to DMPA-IM/other methods  May indicate need to follow up with providers during supervision to ensure Sayana Press is not promoted as a replacement for DMPA-IM  May prompt investigation into DMPA-IM stock levels  Advanced monitoring: Programs that specifically track initial offer of Sayana Press may choose to  Reported quarterly  Disaggregated by district, sector, and facility type or distribution channel (if relevant)  Data for indicator 2.6 6 only count client method switching at initiation of the method (a proxy for counting users rather than doses administered) or choose to also count switching from Sayana Press back to DMPA-IM. Counting unidirectional switching with every dose administered does not account for the fact that women will switch back and forth between methods as stocks fluctuate. Indicator 2.7 may offer a better gauge of product preferences, where both methods are available. 2.8 Number of DMPA-IM doses administered to clients The number of DMPA-IM doses injected into clients during the month Note: This indicator only represents the number of doses administered to women. It is not equal to the number of DMPA- IM users at a point in time. Monitoring data are unable to track individual use over time.  Determines DMPA-IM consumption volumes  Provides information on the level and location of demand for DMPA-IM  Input for numerator and denominator for indicator 2.9  Collected monthly  Reported quarterly  Disaggregated by district, sector, and facility type or distribution channel (if relevant)  Family planning client register 2.9 Relative proportions of DMPA-IM and Sayana Press doses administered The relative shares of DMPA-IM and Sayana Press, where both methods are offered in parallel; the part that each method makes up of the whole (both methods combined) Numerators: 2.1 and 2.8 Denominator: (2.1 + 2.8) The number of Sayana Press (or DMPA-IM) doses administered is  Documents the share of the market comprised of DMPA-IM and comprised of Sayana Press, where health workers are offering both methods  May give an indication of preference for each method, though factors such as level of provider and provider bias should also be taken into consideration  Reported quarterly  Disaggregated by district, sector, and facility type or distribution channel (if relevant)  Data for indicators 2.1 and 2.8 7 divided by the sum of Sayana Press and DMPA-IM doses administered to determine the proportion of each that make up the whole. Note: The relative proportion of each method administered should add up to 1.0 or 100%.  Consider how stockouts of one or more methods may affect overall trends for this indicator. 2.10 Number of facilities active in the provision of Sayana Press that reported this period The total number of health facilities having initiated offer of Sayana Press that reported during the month  Documents the number of facilities that reported on Sayana Press in a given period  Numerator for indicator 2.12  Denominator for indicator 3.3  Collected monthly  Reported quarterly  Disaggregated by district, sector, and facility type or distribution channel (if relevant)  Facility or district reports 2.11 Total number of active facilities The total number of facilities within the family planning program having initiated offer of Sayana Press, regardless of current stockout status Note: A facility may become inactive if it loses trained health providers and its ability to provide contraceptive services.  Denominator for indicator 2.12 Note: Unless facilities are added or removed from the program (common early on in product introduction or scale-up), this indicator will remain constant.  National family planning program or Sayana Press introduction strategy documents 2.12 Percentage of facilities active in provision of Sayana Press that reported this period The percentage of health facilities offering Sayana Press that reported during the period Numerator: 2.10 Denominator: 2.11  Tracks the extent to which facilities active in the offer of Sayana Press are reporting service delivery data  Will help inform how complete service delivery data are  Reported quarterly  Disaggregated by district, sector, and facility type or distribution channel (if relevant)  Data from indicators 2.10 and 2.11 Product distribution and stockouts 3.1 Number of doses of Sayana Press distributed to health facilities The number of Sayana Press doses received into the stock of health facilities that are service delivery points for Sayana Press, or that supply community health  Documents the extent to which Sayana Press units are being delivered and are available for administration to clients  Collected monthly  Reported quarterly  Disaggregated by district, sector, and facility type or  Records of distribution agency  Health facility stock card 8 workers with Sayana Press for community-based distribution  Monitors the functioning of the family planning commodities distribution system distribution channel (if relevant) 3.2 Number of active health facilities with a stockout of Sayana Press The number of health facilities offering Sayana Press that did not have any usable doses of Sayana Press on site (including in the pharmacy and within the clinic) for one or more days during the month Note: A usable dose is a dose that is not damaged or expired.  Identifies locations where the distribution system and/or facility stock management practices may require reinforcement  Numerator for indicator 3.3  Collected monthly  Reported quarterly  Disaggregated by district, sector, and facility type or distribution channel (if relevant)  Records of distribution agency  Health facility stock card 3.3 Percentage of active health facilities with a stockout of Sayana Press Out of the total number of facilities actively offering and reporting on Sayana Press delivery, the percentage that did not have any usable doses of Sayana Press on site (including in the pharmacy and within the clinic) for one or more days during the month Numerator: 3.2 Denominator: 2.10 Note: In many settings, stock data are collected and stored separately from client consumption data, so it is likely some facilities will not report consistently on stockouts. The number of facilities that reported is used as the denominator.  Documents the extent to which the distribution system performs adequately  Contextualizes trends in Sayana Press consumption and in the overall method mix (i.e., if one method is stocked out over a period of time, it may explain increase in consumption of other methods)  Collected monthly  Reported quarterly  Disaggregated by district, sector, and facility type or distribution channel (if relevant)  Records of distribution agency  Health facility stock card January 2017 For more information: http://sites.path.org/rh/?p=292

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