I love this thanks so much! I love orgs like yours which are doing super important work in super difficult places. My intuition is that anything which gets more contraception int the hands of women who need it is likely to be highly cost effective. I’d love for our org to get better at providing contraception through our health centers as well, and will think about this going into this year.
A couple of questions
Could you share with me how you calculated your DALYs (maybe in private message). This is purely selfish as I’m keen to calculate for my org as well!
You state the cost is 3$ per woman reached, which means the total cost of your program was only $7200? What about training costs, management costs and other overheads, are those included in the cost-effectiveness analysis?
Why is the state you are working in getting such bad stockouts given that so few people use family planning there? This is very interestng and doesn’t make instinctive sense.
Thank you so much for your kind words! It truly is—family planning is a very important area within global health but sadly still not receiving as much attention or donor funding as other causes. I’d love to hear more about your work at OneDay Health, I’m sure there are many lessons learned to be shared.
1. Of course, here is our DALY calculation—we based some of key health assumptions on the model provided by Marie Stopes International and their methodology. This is the first iteration of our model so I’d be keen to see how this model’s assumption compare to others in the field—let’s talk more!
2. Yes, as you’ll be able to see in the model, out total cost of the pilot was $6256.8 USD to deliver the first 2400 doses. We are currently scaling up our program so hoping to bring this number even lower. The key point here is that both Jefferson and myself have been working on it without compensation. I decided to go full time in October after seeing the results of the pilot and we also just employed our Program Officer, so we will be adding those costs as we incur them.
3. Family planning is still a difficult issue to discuss—both with end users and state officials. Jigawa started work on family planning only in 2002 and for the first 15 years, it was more of an afterthought it seems. Then the Federal Ministry of Health prioritised family planning and released national guidelines to increase the use of modern contraception. So, the states are now building the groundwork for advocacy and distribution, struggling with budgeting for such high needs.
On the user side, the fertility rate is 8 children per family in Jigawa state, which means that this a fast-growing problem. Few people use any contraception in the state but many health facilities receive no contraceptives products at all. Our pilot number of contraception delivered may seem small but FP state coordinator told us that last year they received only 1400 doses of any injectables across 400 health facilities in the state.
This is definitely a fascinating question. It seems like there are numerous push and pull factors for both state provision and user demand for family planning. Many of our users report fear of side effects, fear of infertility, and lack of any education of family planning as the reasons of their previous lack of FP usage. Our model addresses both demand generation as well as providing the products to meet this demand in an accessible and affordable way.
I’m about to post a cost-effectiveness analysis here for OneDay Health, and I might just use your calculator for the family planning aspect if that’s OK. It’s a small part of what we do (average 2-3 injections per month per OneDay Health center) but it would still add something to our analysis. I’ll definitely discount though as I’m sure every dose of family planning that you supply under those difficult conditions in Nigeria has more impact even than in remote rural Uganda due to the higher birthrate there and immense barriers to accessing family planning even more than Uganda.
I LOVE that you are working with real local salaries and with volunteer managers, keeping your costs very low. It almost seems like you have started with a kind of minimum viable product which is absolutely the best way to start. Many top-down projects start with horrendously inflated costs and this causes funders to not believe that organisations such as yours can operate so cheaply.
Unfortunately at OneDay Health we have found our management costs to increase substantially as we scaled (accounting costs, more higher level management and transport needed etc.) while unfortunately we find very few economies of scale—I hope you’ll do better than us there. Still though even if your management costs massively increase I’m sure you will remain super cost effective. I find this very stressful as I always hoped if anything our costs would reduce as we grew where in reality the opposite happens. My only advice here would be to try not to worry if costs increase. You are doing more good even if it is more expensive per dose administered!
I’m surprised though you don’t get at least a lot your contraceptives for free through partners. In Uganda we connect with Marie Stopes and Reproductive Health International to get most family planning supplies at no cost to us. Obviously the cost is still there in reality, but it makes programming easier from our end.
Thank you for your patience with my reply. I’m currently in Nigeria and organising two trainings for 40+ health workers so it’s really busy now.
Of course, feel free to use our calculations, I am happy that it can be useful for your organisation. Also, I’d love to see your own cost-effectiveness analysis for OneDay Health, I’ll be waiting for your post soon. I’ll also post soon forecasted calculations for this year.
My strong belief is you do not need a lot to make a lot of positive impact and it is better to do things on a shoestring budget to avoid unnecessary spending. It is yet another exercise in responsibility for the founder—not only for the effects but also for inputs. One thing we are conscious about are the scaling up costs. The costs may increase temporarily but ultimately we are scaling up our health worker network 3.5 times this month and initial calculations look quite promising! Thank you for your kind words—it is important to remember that some of the new costs are investments for future impact.
It is so interesting to hear about your connection with MSI and RHI -I’d love to hear more about it and just dropped you a message on LinkedIn, let’s chat soon!
Hi Joshua, great question! I’ve been waiting to finish this phase of the training to have a better estimate of the future $/DALY. Once I’m back to the UK, I’ll spend some time to prepare a forecast for the upcoming cost-effectiveness and share a speculative number then! I’m personally quite conservative with future numbers and will make sure to conduct an in-depth analysis before sharing it on the Forum. I’ll remember to reply to this comment once it’s ready :)
I love this thanks so much! I love orgs like yours which are doing super important work in super difficult places. My intuition is that anything which gets more contraception int the hands of women who need it is likely to be highly cost effective. I’d love for our org to get better at providing contraception through our health centers as well, and will think about this going into this year.
A couple of questions
Could you share with me how you calculated your DALYs (maybe in private message). This is purely selfish as I’m keen to calculate for my org as well!
You state the cost is 3$ per woman reached, which means the total cost of your program was only $7200? What about training costs, management costs and other overheads, are those included in the cost-effectiveness analysis?
Why is the state you are working in getting such bad stockouts given that so few people use family planning there? This is very interestng and doesn’t make instinctive sense.
Nice work again and lots of love
Nick.
Hi Nick,
Thank you so much for your kind words! It truly is—family planning is a very important area within global health but sadly still not receiving as much attention or donor funding as other causes. I’d love to hear more about your work at OneDay Health, I’m sure there are many lessons learned to be shared.
1. Of course, here is our DALY calculation—we based some of key health assumptions on the model provided by Marie Stopes International and their methodology. This is the first iteration of our model so I’d be keen to see how this model’s assumption compare to others in the field—let’s talk more!
2. Yes, as you’ll be able to see in the model, out total cost of the pilot was $6256.8 USD to deliver the first 2400 doses. We are currently scaling up our program so hoping to bring this number even lower. The key point here is that both Jefferson and myself have been working on it without compensation. I decided to go full time in October after seeing the results of the pilot and we also just employed our Program Officer, so we will be adding those costs as we incur them.
3. Family planning is still a difficult issue to discuss—both with end users and state officials. Jigawa started work on family planning only in 2002 and for the first 15 years, it was more of an afterthought it seems. Then the Federal Ministry of Health prioritised family planning and released national guidelines to increase the use of modern contraception. So, the states are now building the groundwork for advocacy and distribution, struggling with budgeting for such high needs.
On the user side, the fertility rate is 8 children per family in Jigawa state, which means that this a fast-growing problem. Few people use any contraception in the state but many health facilities receive no contraceptives products at all. Our pilot number of contraception delivered may seem small but FP state coordinator told us that last year they received only 1400 doses of any injectables across 400 health facilities in the state.
This is definitely a fascinating question. It seems like there are numerous push and pull factors for both state provision and user demand for family planning. Many of our users report fear of side effects, fear of infertility, and lack of any education of family planning as the reasons of their previous lack of FP usage. Our model addresses both demand generation as well as providing the products to meet this demand in an accessible and affordable way.
Lots of love from Nigeria,
Klau
Thanks so much for the in-depth reply
I’m about to post a cost-effectiveness analysis here for OneDay Health, and I might just use your calculator for the family planning aspect if that’s OK. It’s a small part of what we do (average 2-3 injections per month per OneDay Health center) but it would still add something to our analysis. I’ll definitely discount though as I’m sure every dose of family planning that you supply under those difficult conditions in Nigeria has more impact even than in remote rural Uganda due to the higher birthrate there and immense barriers to accessing family planning even more than Uganda.
I LOVE that you are working with real local salaries and with volunteer managers, keeping your costs very low. It almost seems like you have started with a kind of minimum viable product which is absolutely the best way to start. Many top-down projects start with horrendously inflated costs and this causes funders to not believe that organisations such as yours can operate so cheaply.
Unfortunately at OneDay Health we have found our management costs to increase substantially as we scaled (accounting costs, more higher level management and transport needed etc.) while unfortunately we find very few economies of scale—I hope you’ll do better than us there. Still though even if your management costs massively increase I’m sure you will remain super cost effective. I find this very stressful as I always hoped if anything our costs would reduce as we grew where in reality the opposite happens. My only advice here would be to try not to worry if costs increase. You are doing more good even if it is more expensive per dose administered!
I’m surprised though you don’t get at least a lot your contraceptives for free through partners. In Uganda we connect with Marie Stopes and Reproductive Health International to get most family planning supplies at no cost to us. Obviously the cost is still there in reality, but it makes programming easier from our end.
Thanks, Nick.
Hi Nick,
Thank you for your patience with my reply. I’m currently in Nigeria and organising two trainings for 40+ health workers so it’s really busy now.
Of course, feel free to use our calculations, I am happy that it can be useful for your organisation. Also, I’d love to see your own cost-effectiveness analysis for OneDay Health, I’ll be waiting for your post soon. I’ll also post soon forecasted calculations for this year.
My strong belief is you do not need a lot to make a lot of positive impact and it is better to do things on a shoestring budget to avoid unnecessary spending. It is yet another exercise in responsibility for the founder—not only for the effects but also for inputs. One thing we are conscious about are the scaling up costs. The costs may increase temporarily but ultimately we are scaling up our health worker network 3.5 times this month and initial calculations look quite promising! Thank you for your kind words—it is important to remember that some of the new costs are investments for future impact.
It is so interesting to hear about your connection with MSI and RHI -I’d love to hear more about it and just dropped you a message on LinkedIn, let’s chat soon!
Sending lots of love still from Nigeria,
Klau
This is great. Would you be willing to put a (speculative, ballpark) number on what your $/DALY will be moving forward?
Hi Joshua, great question! I’ve been waiting to finish this phase of the training to have a better estimate of the future $/DALY. Once I’m back to the UK, I’ll spend some time to prepare a forecast for the upcoming cost-effectiveness and share a speculative number then! I’m personally quite conservative with future numbers and will make sure to conduct an in-depth analysis before sharing it on the Forum. I’ll remember to reply to this comment once it’s ready :)