Bill & Melinda Gates Institute
for Population and Reproductive Health
PMA2020: Overview
PFRH Center Presentations, Wednesday Noon Seminar Series
September 10, 2014
PMA 2020 Overview
• Responds to:
• Need for more frequent data to mark progress
• Evolution of smart-phone technology & cell provider reach
• Objectives:
• Monitor progress against the goals and principles of FP2020
• Establish rapid data collection to produce annual estimates
• Create feedback loop to prompt program action
• Build sustainable country capacity for continuous monitoring
• 2 linked mobile-assisted, sentinel surveys
• Household & Female Survey – measuring demand and use
• Service Delivery Point Survey – measuring supply and access
10 countries:
Ghana, DR Congo, Ethiopia, Uganda, Kenya, Burkina Faso, Nigeria, Indonesia, India, Niger
BILL & MELINDA GATES INSTITUTE FOR POPULATION AND REPRODUCTIVE HEALTH
PMA2020 Survey Features
• Innovative mobile technology
• Annual (or semi-annual) indicators
• Provides consistency with DHS measures…
• …and introduces new indicators of quality, choice, access
• Creates a community feedback loop to prompt program improvement
• Establishes a platform that is expandable to other health sectors
• Strengthens local capacity
•
Network of partner universities/research institutions
•
Network of resident enumerators
BILL & MELINDA GATES INSTITUTE FOR POPULATION AND REPRODUCTIVE HEALTH
How does PMA2020 work?
Data
validation
& analyses
Central server:
data aggregation
& database
Data management
Key indicators and
visuals can also be
transferred via GPRS
back to the community
…and transfers
these data via
GPRS networks.
In real-time, data are
validated, aggregated
and prepared in tables,
graphs, and maps…
…which are pushed out for
use by community and
other stakeholders
Sentinel Enumerator
…uses a mobile
phone to collect data
in her community
Service
Delivery
Points
Households
BILL & MELINDA GATES INSTITUTE FOR POPULATION AND REPRODUCTIVE HEALTH
Advantages of utilizing mobile technology
Paper-mode
shortcomings
BILL & MELINDA GATES INSTITUTE FOR POPULATION AND REPRODUCTIVE HEALTH
Mobile-assisted
data collection advances
Open Data Kit (ODK) Screen shots
BILL & MELINDA GATES INSTITUTE FOR POPULATION AND REPRODUCTIVE HEALTH
The use of mobile devices lends itself to the
collection of new types of data…
• GPS coordinates
• Date/Time Stamp
• Photos
• Bar Code
…and payment for resident enumerators.
BILL & MELINDA GATES INSTITUTE FOR POPULATION AND REPRODUCTIVE HEALTH
Measuring access, equity, quality, choice
Female Survey (51 questions/31 on FP)
• All indicators can be disaggregated by age, marital status, wealth quintile, education,
region, urban/rural
• For Users (…most recent visit)
• Did you obtain the method you wanted? If not, why not?
• Who made the final decision on the method you received?
• Did you pay anything for the services received? If yes, how much?
• Were you told of other methods?
• Were you told of side effects of your method? What to do if you experienced side effects?
• Would you return to this provider? Refer relative/friend to provider?
• If sterilized, were you told that this method was permanent?
• For Discontinued Users
• What was your method? When did you stop using? Why did you stop using?
• For Women with Unmet Need
• Reason for not using a method?
BILL & MELINDA GATES INSTITUTE FOR POPULATION AND REPRODUCTIVE HEALTH
Measuring access, equity, quality, choice
SDP Survey (56 questions/42 on FP)
• Service Accessibility
• How many days a week is FP offered? Are services offered today?
• What methods are counseled? Provided? Referred? Charged?
• Have any methods been out of stock in the last 12 months? Which methods?
• If implants provided, are there trained personnel to insert? Remove? Are key supplies in place?
(repeated for IUDs)
• Are unmarried adolescents counseled, offered, referred for contraceptive methods?
• Are CHWs supported from facility? If so, how many? What FP services do they offer?
• Has mobile outreach team worked from facility? How many times in last year?
• Does facility charge fees for FP services? How much by method?
• Service Quality
• Does facility have system for client feedback? Ask to see. Has there been change?
• When was the last time a supervisor from outside this facility came here to visit?
• Integrated services
• If delivery/maternity: Is FP counseled during the post-partum visit? Are services offered/referred?
(repeated for post-abortion, HIV-related services)
BILL & MELINDA GATES INSTITUTE FOR POPULATION AND REPRODUCTIVE HEALTH
Survey status
Enum.
Areas
Country
Implementing Partner
Ghana
KNUST + UDS
100
Round 1 & 2 complete
DR Congo*
Univ. of Kinshasa
60
Round 1 complete/Round 2 underway
Ethiopia
Addis Ababa Univ. +
200
Round 1 complete
Uganda
Makerere Univ.
110
Round 1 complete
Kenya
ICRH +
120
Round 1 complete
Nigeria
U Ibadan, Ife & Bayero
200+ Enumerator training underway
Burkina Faso
ISSP, U Ouagadougou
Indonesia
BKKBN +
India & Niger
tbd
53
Status
Supervisor training complete
300+ Survey preparations underway
tbd
Assessment visits complete
* DR Congo survey is managed by Tulane University and initially is implemented in Kinshasa only.
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Resident Enumerator Profile
35+
Two or more
< 24
Married
No children
30-34
Single
25-29
•
•
•
two-thirds in their 20s
youngest in Ghana
oldest in Kenya
•
•
•
just under half are single
about 70% single in Ghana
about 70% married in Kenya
BILL & MELINDA GATES INSTITUTE FOR POPULATION AND REPRODUCTIVE HEALTH
One child
•
•
•
half have no children
over 70% childless in Ghana
under 25% childless in Kenya
Resident Enumerator Profile, cont’d
Secondary
Unemployed
In EA
Far
Full-time
Tertiary
Near EA
Part-time
•
•
•
two-thirds less than full-time
about 50% full-time in Kenya
just 20% full-time in Uganda
•
•
•
nearly 70% w/ advanced educ
over 90% in Uganda
under 50% in Ghana
BILL & MELINDA GATES INSTITUTE FOR POPULATION AND REPRODUCTIVE HEALTH
•
•
•
less than 20% live in EA
90% live in/near in Ghana
over 50% live far in Kaduna
A few topline observations
REs: the backbone of PMA2020
“Recruit, train, support, reward, retain”
“No phones, no program”
“The right phones, in the right place, at the right time”
Govt interest in sub-national detail/added modules
Need to first build the platform/prove the concept
BILL & MELINDA GATES INSTITUTE FOR POPULATION AND REPRODUCTIVE HEALTH
What we are learning
Learning:
 REs can be trained to conduct mobile-assisted surveys, with support
 Survey rounds can be completed in 4-6 weeks
 “Cascade” training is highly effective
 ODK performs well and can aggregate data instantly
 Monitoring data as it comes in is important for identifying problems early
 Indicators are in line with those of recent surveys
Surprises:
 More front-end training than envisioned
 Greater number of supervisors/support team required
 Elevated level of effort needed for mapping/listing phase
 Few smart phones meet our requirements/special shipments needed
Yet to learn:
 Resilience of resident enumerator network
 Feasibility of using this network for community feedback
BILL & MELINDA GATES INSTITUTE FOR POPULATION AND REPRODUCTIVE HEALTH
Key Indicators Brief*
* supplemented by detailed indicator report.
BILL & MELINDA GATES INSTITUTE FOR POPULATION AND REPRODUCTIVE HEALTH
Bill & Melinda Gates Institute
for Population and Reproductive Health
Thank you!
Find PMA2020 on the web:
www.pma2020.org
www.facebook.com/GATES.PMA2020
www.twitter.com/PMA2020JHU