Date Published: March 18, 2019
Publisher: Public Library of Science
Author(s): Emmanuel Njeuhmeli, Melissa Schnure, Andrea Vazzano, Elizabeth Gold, Peter Stegman, Katharine Kripke, Michel Tchuenche, Lori Bollinger, Steven Forsythe, Catherine Hankins, David P. Wilson.
Modeling contributes to health program planning by allowing users to estimate future outcomes that are otherwise difficult to evaluate. However, modeling results are often not easily translated into practical policies. This paper examines the barriers and enabling factors that can allow models to better inform health decision-making.
The Decision Makers’ Program Planning Tool (DMPPT) and its successor, DMPPT 2, are illustrative examples of modeling tools that have been used to inform health policy. Their use underpinned Voluntary Medical Male Circumcision (VMMC) scale-up for HIV prevention in southern and eastern Africa. Both examine the impact and cost-effectiveness of VMMC scale-up, with DMPPT used initially in global advocacy and DMPPT 2 then providing VMMC coverage estimates by client age and subnational region for use in country-specific program planning. Their application involved three essential steps: identifying and engaging a wide array of stakeholders from the outset, reaching consensus on key assumptions and analysis plans, and convening data validation meetings with critical stakeholders. The subsequent DMPPT 2 Online is a user-friendly tool for in-country modeling analyses and continuous program planning and monitoring.
Through three iterations of the DMPPT applied to VMMC, a comprehensive framework with six steps was identified: (1) identify a champion, (2) engage stakeholders early and often, (3) encourage consensus, (4) customize analyses, (5), build capacity, and (6) establish a plan for sustainability. This framework could be successfully adapted to other HIV prevention programs to translate modeling results to policy and programming.
Models can be used to mobilize support, strategically plan, and monitor key programmatic elements, but they can also help inform policy environments in which programs are conceptualized and implemented to achieve results. The ways in which modeling has informed VMMC programs and policy may be applicable to an array of other health interventions.
In summary, the three modeling tools (DMPPT, DMPPT 2, and the DMPPT 2 Online) demonstrate a range of uses for modeling in HIV programming—from advocacy to program monitoring. The DMPPT helped to quantify the benefits of VMMC scale-up, providing the push needed for a global commitment from donors and country governments. Countries that implemented the DMPPT 2 then made strategic, evidence-informed decisions on their national targets and VMMC policies. Ongoing use of the DMPPT 2 Online is now helping these countries track the progress and impact of their programs, down to the district level.
In reflecting on the VMMC modeling case study, we have highlighted enablers to the effective use of modeling data to inform decision-making, namely, responding to articulated policy needs, collaborating with stakeholders, considering local context, enumerating assumptions, and spending the necessary time to conduct a thorough analysis.