A Model for Managing a Family-Planning System

This paper describes a planning model designed to be used by managers of family-planning systems to improve understanding, forecasting, and planning. The macro-flow model describes the patient movement through post-partum and nonpost-partum programs. The flows model the phenomena of: outreach recruitment, continuance, post-partum checkups, switching methods, referral, migration, contraceptive-use experience, private protection, method effectiveness, advertising response, follow up, abortion, and medical services. Strategic variables can be linked to the flow parameters to produce capacity requirements and budgetary implications. The model output includes benefit measures of total active patients, couple years of protection, “births protected,” and unwanted births prevented. The fertility aspects of births prevented are modeled through a nonstationary Markov process submodel that considers demographic phenomena without burdening the basic flow structure. The input procedures used to process patient-visit, outreach, clinic-survey, and experimental data are discussed and some empirical results are reported. The combination of data-based estimates and subjective judgment is done by “fitting” the model to past observed data. Testing and control are done by “tracking” model performance through conditional prediction, diagnosis, and updating. The model is implemented in an on-line, conversational program that facilitates evolutionary model building by allowing the user to specify his model options. The application and testing of the model in the Atlanta Area Family Planning System are discussed and the experiences of managers in using the model to gain new insights, forecasts, budgets, and plans are reported.