Is International Family Planning Assistance Needed in the 21 st Century? Ed Abel Suneeta Sharma November 9, 2015 Palladium 2015
Total Fertility Rate FP Programs Success of Family Planning Programs Global total fertility has been cut in half since 1960 5 4.98 4.99 4.71 4 3 4.14 3.71 3.54 3.27 2.85 2.64 2.54 2.49 2.46 2 1 0 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2013 Source: World Bank Palladium 2015 2
Contraceptive Prevalence Rate FP Programs Success of Family Planning Programs Contraceptive prevalence among married women of reproductive age increased by nearly 5% between 1990 and 2011 64.0 63.5 63.0 62.0 61.0 60.0 60.2 59.0 58.6 58.0 57.0 56.0 1990 2000 2011 Palladium 2015 Source: World Bank 3
Population Growth Rate FP Programs Population Growth Rate Has Declined The annual growth rate has declined by 40% 2.10 2.05 2.08 1.80 1.87 1.75 1.75 1.73 1.50 1.20 0.90 1.51 1.33 1.25 1.21 1.2 Doubling time has increased from 34 years to 58 years 0.60 0.30 0.00 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2014 Source: World Bank Palladium 2015 4
Total Fertility Rate FP Programs Regional Fertility Trends Total fertility rate (TFR) varies significantly by region 7 6 5 6.9 6 6.6 6 5.4 5.1 4 3 2 1 2.7 2.6 2.2 1.8 0 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2012 ME&NA SSAfrica Sasia Easia LAC Source: World Bank Palladium 2015 5
Contraceptive Prevalence Rate FP Programs Regional CPR Trends Across the globe, the contraceptive prevalence rate (CPR) has been rising, but the rate of change varies by region 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 73.7 75.2 80.6 57.6 63.5 52.9 45.5 43.1 41.3 22.0 23.6 16.0 1990 2000 2011 EAsia & Pacific ME&NA SSAfrica Sasia Palladium 2015 Source: World Bank 6
Total Fertility Rate FP Programs Fertility Varies within Regions TFR varies within regions 7 6 6 5.4 6.1 5 4 4 3.7 3 2.5 2.9 2 1.4 1 0 Nigeria Ghana Afghanistan India Kenya Uganda PhilippinesThailand Source: World Bank Palladium 2015 7
Contraceptive Prevalence Rate FP Programs CPR Varies within Regions CPR varies within regions 80 80 60 56.3 40 39.3 20 14.7 23.5 23.7 0 Nigeria Ghana Kenya Uganda India Thailand Source: World Bank Palladium 2015 8
Total Fertility Rate FP Programs Total Fertility Rates Vary within a Country TFR varies within Indian states 4 3.5 3 3.1 3.4 2.5 2 1.5 1.8 1.6 National Average 2.3 1 0.5 0 Uttar Pradesh Bihar Maharashtra West Bengal Source: Government of India, Ministry of Home Affairs: SRS Statistical Report 2013 Palladium 2015 9
Contraceptive Prevalence Rate FP Programs Contraceptive Prevalence Rates Vary within a Country CPR varies within Indian states 80 71.2 70 66.9 60 50 43.6 National Average 56.3 40 34.1 30 20 10 0 Uttar Pradesh Bihar Maharashtra West Bengal Source: International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS-3), 2005 06: India: Volume I. Palladium 2015 10
Total Fertility Rate FP Programs Egypt: Total Fertility Rate Increase in recent years 6 5 5.3 4.9 4.4 4 3.9 3.6 3.5 3.5 3.1 3 3 2 1 0 1980 1984 1988 1992 1995 2000 2005 2008 2014 Source: Egypt 2014 Demographic and Health Survey Palladium 2015 11
Age-Specific Fertility Rate FP Programs Egypt: Age-specific Fertility Rate 20 24-year-old fertility has increased significantly 250 200 150 213 169 200 185 134 2008 2014 100 50 0 122 69 56 50 59 17 4 17 2 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Source: Egypt 2014 Demographic and Health Survey Palladium 2015 12
Total Fertility Rate FP Programs Egypt: TFR by Regions Significant increase in TFR between 2008 2014 6 5 4 3 2 5.4 4.5 3 5.2 4.7 4.2 3.7 4.1 3.9 3.2 3.2 2.7 2.8 2.9 3.7 3.8 3.9 3.4 3.3 2.9 2.9 3.2 3.4 2.5 2.6 2.5 Urban Lower Upper Frontier 1 0 1988 1992 1995 2000 2005 2008 2014 Source: Egypt 2014 Demographic and Health Survey Palladium 2015 13
Population Modeling has been an effective way to project population growth in Egypt Palladium 2015 14
Population Fertility Change Scenarios Scenario 1: High fertility recent fertility trend continued TFR increases similar to 2008 2014 trend, reaching a maximum TFR of 5.3 by 2035 Scenario 2: Constant fertility fertility continues at current rate TFR remains constant at 3.5 Scenario 3: Low fertility national fertility goals achieved TFR decreases to 2.4 by 2030 and to 2.1 by 2037 Palladium 2015 15
Births (Millions) Population Egypt: Annual Births Fewer births with lower fertility 6.0 45 million fewer births between 2015 and 2040 5.6 High Fertility 4.0 2.0 2.6 2.6 2.6 4.8 4.1 3.6 3.6 3.1 3.2 2.8 2.9 3.0 2.5 2.3 2.0 2.0 2.0 Constant Fertility Reduced Fertility 0.0 2015 2020 2025 2030 2035 2040 Palladium 2015 16
Total Population (Millions) Population Egypt: Population Size Smaller population with lower fertility 180 130.0 170.0 146.0 High Fertility Constant Fertility 120 88.0 121.0 115.0 127.0 Reduced Fertility 60 0 2015 2020 2025 2030 2035 2040 Palladium 2015 17
Economy Palladium 2015 18 18
Labor Force (Millions) Economy Egypt: Labor Force Size Similar size until 2030 50 40 42.6 39.7 High Fertility 33.2 33.2 Reduced Fertility 30 25.9 20 10 0 2015 2020 2025 2030 2035 2040 * Assumes LF participation rate remains at 45.7% Palladium 2015 19
Labor Force Entrants (Thousands) Economy Egypt: New Jobs Required Fewer jobs needed 1200 1100 900 High Fertility Reduced Fertility 600 480 514 514 526 300 3 million fewer people entering LF between 2015 and 2040 0 2015 2020 2025 2030 2035 2040 * Assumes LF participation rate remains at 45.7% Palladium 2015 20
Economy The models also highlight the need for economic opportunity for a growing population Palladium 2015 21
Photo by: Humphleah s International Limited Themes in the Current Use of Models As modelling has evolved, the focus is changing: models are increasingly used to support the implementation of policy commitments. 1. Connecting population and demography to other development sectors (e.g., RAPID, RAPID/Women, Demographic Dividend, pop/food/climate) 2. Costing and economic models (e.g., ImpactNow, OneHealth) 3. Building capacity of local partners to lead dissemination and advocacy using model results, and to apply and update the models over time First Lady of Tanzania Mama Kikwete presents RAPIDWomen in Swahili to a national audience in August 2012. Photo by Humphleah s International Limited Palladium 2015 22
Photo by: Health Policy Project/Christine Kim Three Representative Models Demographic Dividend (Dem/Div) 2014 ImpactNow OneHealth Palladium 2015 23
Demographic Dividend Model Developed in 2014 to project the potential economic benefits of age structure change the demographic dividend Projects a range of potential economic benefits from a change in population age structure combined with improved human capital and macroeconomic environment (a demographic dividend ) Structure and operation are similar to RAPIDWomen, but with newly estimated statistical equations Three intervention strategies Education Family planning Economic (Global Competitiveness Index) GDP = investment + employment + productivity Palladium 2015 24
What types of questions can DemDiv answer? What will GDP per capita be in 20 40 years if the country invests strongly in family planning, education, and the economic environment? What will GDP per capita be in 20 40 years if the country makes no changes to current policies and programs? How will employment change over time under various scenarios? How do social-sector investments increase the effect of an economiconly focus? Palladium 2015 25
Modeling the Demographic Dividend Palladium 2015 Source: DemDiv Model, 2014 26
Impact Now Making the Case for Investment in Family Planning Healthcare Savings per 200 Naira Spent on Family Planning in Lagos, Nigeria 974 Naira Current Savings (2015) 1,438 Naira Savings if FP Barriers are Addressed (2019) Excel-based model projects the near-term health and economic benefits of FP investments over 2 7 years Relates healthcare costs, access, contraceptive use and method mix, and maternal and newborn health status User sets a policy goal for CPR, unmet need, or FP budget User designs two scenarios for the future, plus a base scenario Palladium 2015 27
What types of questions can ImpactNow answer? How much money do various FP investments save in direct maternal and infant healthcare costs? How do FP goals differ in their health outcomes and program costs? Which one is most cost-effective? What are the benefits of expanding method mix to include more longacting and reversible methods? How many mothers and children s lives are saved by investing in family planning? How does this vary by FP policy goal? Palladium 2015 28
OneHealth Mid-term (3 10 years) strategic planning tool used for whole health sector planning Can also be applied to single sector such as HIV/AIDS or RMNCAH Unified tool for costing, budgeting, impact analysis, and financial space analysis Includes Spectrum Modules Also includes additional health services and systems modules Palladium 2015 29
OneHealth Building Blocks Palladium 2015 Source: Adapted from Stenberg, 2011 30
What types of questions can OneHealth answer? What health system resources would be needed to implement the strategic health plan (e.g., number of nurses and doctors required over the next 5 10 years)? How much would the strategic plan cost, by year and by input? What is the estimated health impact? How do costs compare with estimated available financing? Palladium 2015 31
Photo by: Health Policy Project Using Models Turning Commitments into Concrete Actions Costed Implementation Plans (CIPs) Subnational planning Resource mobilization Engaging stakeholders Palladium 2015 32
Costed Implementation Plans for Family Planning (CIPs) Concrete, specific plans for achieving the goals of a national family planning program over a set number of years Detail the program activities necessary to meet national goals Detail the costs associated with the activities, providing clear program-level information on the resources a country must raise domestically and from partners Palladium 2015 33
Results in Countries with CIPs Burkina Faso Niger Reduced price for contraceptives in the public sector Increased the budget line for FP commodities (to CFA 500 million; $955 thousand) Instituted budget line for FP commodities (CFA 200 million; $383 thousand) Introduced task shifting to allow community health workers to administer injectable contraceptives Mauritania Instituted budget line for FP commodities (15 million ougiyas; $51 thousand) Private sector support for plan Palladium 2015 Zambia Developed sex education curricula and timeline for introduction in public schools Hired additional staff to support the FP program (including one to monitor the implementation of the CIP) Doubled budget for reproductive health supplies ($9.3 million) 34
Palladium 2015