Avenir Health staff are pioneers in the field of demographic and projection modeling and have produced many of the models currently being used by reproductive health and HIV/AIDS experts around the world. These models are developed in response to direct needs expressed by donors, international development organizations, and national governments and are designed to use available data to produce outputs that are relevant to program policy and planning. Avenir Health takes a uniquely collaborative approach to model development and routinely works with groups of experts such as the UNAIDS Reference Group on Estimates, Models and Projections and the Child Health Epidemiology Reference Group (CHERG). The model development process also includes country applications in order to test the models in real-life uses and generate feedback from intended users. This process results in models that are informed by a variety of experts and establishes a rigorous vetting process.

Avenir Health also specializes in making these complex models user-friendly and accessible to a variety of audiences. This has led to the development of the Spectrum modeling system, which has a simple framework and an easy to navigate layout. Completed models are well documented and generally include manuals, training materials, and default databases. Systematic review keep the models update with a continuous process of use, feedback, review, and update.

Avenir Health performs modeling activities for a variety of clients and includes the application of well established models, such as those included in Spectrum, as well as the development of use specific models that assist organizations and governments to answer critical health related questions. Such as, what is the impact of contraceptive stock-outs on overall contraceptive prevalence and what would be the estimated impact of focusing health interventions on specific population subgroups. Starting in the late 1970s, Avenir Health's president John Stover was involved in the development and implementation of the RAPID tool to engage policy makers in dialogue about the impacts of rapid population growth and high fertility. Similar models have been developed and used to improve the policy environment and planning for HIV/AIDS, adolescent reproductive health, maternal health, child health and TB. Most recently, these tools have been combined into a comprehensive tool that helps health planners develop comprehensive medium range health plans and budgets from both a programmatic and health systems point of view.

The data and information produced by Avenir Health’s models improve data driven health-related decision making processes, through the use of a variety of mechanisms. These include:

• The development and use of models for evidence-based advocacy, policy and planning. Avenir Health has been involved in developing and implementing advocacy models, such as RAPID and AIDS Impact Model (AIM), which use an array of scientific and programmatic data to help policy makers understand the consequences of current health trends and potential solutions. Planning models such as Goals and the Resource Needs Model use available data to estimate the resources and effort required to achieve national goals.
• Facilitation of dialogue. Often, there is a disconnect in the policy planning process, whereby those with access to data sources may not know how to utilize them for in-depth analysis or present them in an efficient manner to policy makers. The Avenir Health works as a conduit to create opportunities for all of stakeholders, (e.g., researchers, analysts, policy makers and community and grass roots leaders) to come together to discuss what the data show, and how they effect key policy questions.

Avenir Health is a sub-contractor to the Futures Group under the Health Policy Project. HPP contributes to improved health outcomes through strengthening the efficiency, effectiveness, and equity of health systems. HPP focuses on the policy aspects of family planning and reproductive health, HIV, and maternal health.

Avenir Health is bringing its costing and modeling expertise to HPP to improve the enabling environment for health in the areas of software development and maintenance and technical assistance to country programmes.

Overall software development and maintenance activities include:

• New Contraceptive technology added to the method mix in FamPlan
• Modifying FamPlan to provide a broader contribution to repositioning FP and contraceptive security in national settings by updating the proximate determinants of fertility framework used as the basis of many the calculations;
• Develop YouTube tutorials for Demproj and FamPlan.
• Further development work on the Goals model, including updating the impact matrix, validating it in two countries, and implementing it in Spectrum;
• Providing training and expertise assistance to countries in the applications of the FI tools, principally Goals and OneHealth;
• Ongoing Spectrum maintenance and updates.
• Build the unit cost database into FI’s Policy tools web site.
• Launched Spectrum user support web site.

The list below provides an illustrative list of FI’s specific activities for HPP on global issues and country programmes:

• Working with USAID, DfID, RHSC, AGI and others to estimate country specific contributions to achieve the HandtoHand campaign goal and to estimate the resources.
• Using the Goals models and running scenarios of resource allocations based on key population coverage and funding available, provided assistance to Ghana prepare and submit Phase 2 of Round 8 Grant to the Global Fund.
• Presenting a crosswalk of family planning, HIV/AIDS and reproductive costing tools to in a financing workshop for State and Local Government Administrations (LGAs) officials in Nigeria.
• Training a group of master trainers on the OneHealth tool in Ethiopia composed of staff from the Planning and Policy Department of the Ministry of Health, the Ethiopia Public Health Association and several academic institutions and universities.
• Developing an expenditure tracking methodology and tool for family planning expenditures.
• Estimating goals, impact and costs of that provided data to the HandtoHand campaign.
• Analyzing how countries health insurance schemes are helping reach universal coverage.

Updates to the AIDS Impact Model (AIM) in Spectrum was completed, incorporating previous modeling work that estimated the cost and impact of the changing WHO guidelines. In that work (published in November 2010), the model tracked the HIV-positive population by CD4 count, placing them in CD4 categories and progressing them to death by different rates depending on whether or not the person receives ART. After consultation with the UNAID reference group on estimates, modeling and projections, this methodology was programmed into Spectrum/AIM.

Supporting Johns Hopkins’ LiST project, Avenir Health was charged with implementing a computer-based tool designed to estimate the impact of different child and maternal intervention packages and coverage levels. LiST has been used to support research and ministry of health personnel for policy decision in developing countries.

In response to requests for an easy-to-use version of the Goals model, we developed a web and mobile based application called “Goals Express.” The methodology extends the single-year (UNAIDS) Modes of Transmission model through 2015 and combines it with the framework of the Goals model to estimate cost per HIV infection averted for up to 17 different interventions. Target coverage rates can be changed, along with the default set of unit costs to examine the impact of alternative resource allocation scenarios. Further, after extensive analysis modeling possible ways to incorporate multiple concurrent partnerships, Goals Express includes an intervention targeting that behavior. Goals Express is available for 16 countries in sub-Saharan Africa using data from a variety of documented sources.

In partnership with the UN Inter-Agency Working Group (IAWG) on Costing, composed of UNICEF, World Bank, WHO, UNFPA, UNDP, and UNAIDS, Avenir Health has been working on the harmonization of costing and impact assessment tools used for health sector planning.

This tool helps health planners to determine the needed programmatic and health systems improvements that are needed to achieve scale up plans set by the LiST. The tool includes sophisticated modules that address directly gaps in Human Resources, Infrastructure and Logistics as well as important programmatic elements such as training, communication and supervision. OneHealth includes a comprehensive module that allows the OneHealth costing framework to be translated into any budget framework needed by a ministry of health. Although the tool is designed to be used in a comprehensive planning exercise, the various modules (human resources, disease programs, infrastructure, HIS, logistics, etc.) can be used modularly to examine particular issues either in a single country or regionally.