Effective Target Setting for Program Success

1. Module 2:Basic analyses

2. Module 2: Learning Objectives • Identify approaches for setting targets • Understand common analyses that calculate program coverage and retention • Calculate program coverage and retention

3. Terminology • Indicator • Target • Program coverage • Service availability • Service utilization • Program retention

4. Indicator • Program element that needs tracking • Measures an aspect of a program’s performance • Measures changes over a period of time • # of new family planning users • # of clients currently on ART • Expressed as a number or percentage

5. Target Definition • A specified level of performance for a measure (indicator), at a predetermined point in time (i.e., achieve ‘x’ by ‘y’ date) • Overall target • Annual targets

6. Why Set Targets? • Targets help program staff with: • Planning • Staffing and service delivery • Commodities • Monitoring progress • Break long-term goals into manageable pieces • Check progress on indicators

7. Setting Reasonable Targets • The range of values for a given indicator can be from 0% to 100%. • Example: The theoretical range for the Polio indicator is between 0% of children immunized (bad) and 100% immunized (ideal) • Is it appropriate to set the Polio indicator target at 100% for a given program? Why/why not?

8. Setting Reasonable Targets • Example: In Somalia, the national CPR from 2007 to 2009 was15%. The following year, a national target was set for 70%. • Is it appropriate to set the CPR target for Somalia at 70%? Why/why not?

9. Overall Target Setting Approaches • There are three approaches to set a target : • Established long-term goals by contacting that national program • Past performance (of your program, increasing by no more than 10%) • Local high performer (a stellar program nearby) • Consider the number of clients your program can realistically expect to serve during a given period of time

10. Annual Target Setting • Determine the increase your program needs to gain to reach your overall target • Divide that number by the number of years in which you would like to achieve the target • Add the number to your baseline indicator for each year

11. Considerations for Target Setting • Ensure you have an agreed-upon and realistic definition of target population • Set a realistic target to achieve in the long term and short term

12. Importance of Defining the Target Population: Case Example • Target was 372 children to be immunized • Actual was 488 children immunized • To calculate the % target achieved, use (Actual/Target) * 100 • 488/372 = 1.31*100 = 131% • How could the clinic have surpassed its target by so much?

13. Implications of Incorrect Target Setting: Case Example • You don’t really know to what extent you’re fully immunizing the children in your setting • If your program purchases commodities (e.g., vaccines) based on the target set, supply could run out • If you set your target too low, you may not have enough vaccines, leading to disease outbreaks

14. Common Analyses • Program Coverage • Extent to which a program reaches its intended target population, institution, or geographic area • Compare current performance to prior year/quarter • Compare performance between sites • Program Retention • Extent to which the range of services is being delivered as initially intended so that client drop-outs are minimal

15. Why do we need to measure coverage? • To understand program progress • To determine if the target is reached • Clients, commodities, adherence… • To determine if one target is reached more effectively than another • Are there underserved area/regions, subpopulations?

16. Program coverage • Extent to which a program reaches its intended target population, institution, or geographic area • Utilization: • Is the target population utilizing services, accessing commodities, being reached with services? • Availability: • Are the services available where there is a need?

17. Utilization calculation Percentage of the target population utilizing services # of individuals in target population using a service ------------------------------------------- X 100 # of individuals in target population

18. Utilization calculation: Example • No. of persons educated as of 6/12/09 = 300 • Goal for 12/31/09 = 900 300 900 • You have reached 33% of your target group with education messages • = 0.33 x 100 = 33%

19. Comparison of time periods • Compare percentage achieved toward target for different time periods, different sites, etc. • Rate of increase • As of January, 70 people educated; by June, 300 people • 300 – 70 = 230 increase in people educated • 230/6 = 38.3 new people educated per month over the 6 months

20. Utilization of PMTCT Programs All pregnant women (2,000) Utilization = Service users Target population PMTCT Target (1,000) Sought prenatal care (600) Utilization = 600/1,000 = 0.6 0.6 x 100 = 60% Counseled & Tested for HIV (500)

21. Program coverage • Extent to which a program reaches its intended target population, institution, or geographic area • Utilization: • Is the target population utilizing services, accessing commodities, being reached with services? • Availability: • Are the services available where there is a need?

22. Availability calculation • Number of service outlets available per target population • # of clinics with PMTCT per # of pregnant women • Expressed as a ratio

23. PMTCT clinic availability • There are 8 clinics offering PMTCT & 100,000 pregnant women in region X. • Ratio of clinics to pregnant women 8:100,000 • Reduce to (1:12,500) pregnant women • The standard recommendation is 1 clinic with PMTCT services per 10,000 pregnant women • Clinic availability is not reaching the target

24. Availability + Utilization = Coverage • Service availability is 1:12,500 • Service availability target is 1:10,000 • PMTCT service utilization is 25% off the target • What can we conclude? • Service availability and utilization are too low; the program is not meeting the needs of pregnant women.

25. Program retention • Measures if the range of services are being delivered as initially intended • Determines program retention, i.e., is the project keeping clients through entire package of services? • Important in clinical programs where drug adherence is an issue (TB, HIV/AIDS, immunization) and there are multiple steps (PMTCT)

26. Retention example: Immunization Utilization Completion

27. PMTCT Program Retention All pregnant women (2,000 women) PMTCT Target (1,000) Sought prenatal care (600) 350 received HIV- result or no result Tested for HIV (500) 100 received HIV+ result 40 received prophylaxis

28. All pregnant women (2,000 women) PMTCT Program Retention 1,000 Sought prenatal care 500 350 received HIV- result Tested for HIV 100 received HIV+ result 40 received prophylaxis

29. All pregnant women (2,000 women) PMTCT Program Retention PMTCT Target (1,000) Sought prenatal care (600) 350 received HIV- result Tested for HIV (500) 100 received HIV+ result 40 received prophylaxis

30. All pregnant women (2,000 women) PMTCT Program Retention PMTCT Target (1,000) Sought prenatal care (600) 350 received HIV- result or no result Tested for HIV (500) 100 received HIV+ result 40 received prophylaxis

31. All pregnant women (2,000 women) PMTCT Program Retention PMTCT Target (1,000) Sought prenatal care (600) 350 received HIV- result or no result Tested for HIV (500) 100 received HIV+ result 40 received prophylaxis

32. Key messages • Target Setting–A specified level of performance for a measure (indicator) at a predetermined point in time. Both overall and annual targets are set • Coverage – extent to which a program reaches its intended target population, institution, or geographic area • Retention– the extent to which the range of services are being delivered as initially intended, with clients retained throughout the full package of services