3 august 2010
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Contraceptive Market Analysis in Nicaragua A Tool to develop Alliances and Improve Commodity Security. 3 August 2010. ¿What is a Market Analysis?. A tool to analyze access to services and define strategies to segment, focus, and ensure equitable resource allocation: - PowerPoint PPT PresentationTRANSCRIPT
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3 August 2010
Contraceptive Market Analysis in Nicaragua
A Tool to develop Alliances and Improve Commodity Security
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¿What is a Market Analysis?
• A tool to analyze access to services and define strategies to segment, focus, and ensure equitable resource allocation:
– Utilizes each country’s demographic surveys
– Analyzes contraceptive use, demand, and provision in the whole market (public and private).
– Groups clients according to characteristics, needs and/or common preferences.
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Why is a Market Analysis Conducted?
• To better understand clients’ needs
• To better understand coverage and institutional potential to satisfy demand
• To ensure more effective and efficient use of resources assigned to each institution to provide family planning services
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What are the Benefits of a Market Analysis?
• A more complete outlook – Sharing information and data helps stakeholders better understand the market they are working in.
• The supply adapts to demand – When coordinating service provision among all actors to better fulfill clients’ needs, the supply is tailored to demand and gaps to access are reduced.
• Client Satisfaction - Clients can have better access to their method of choice, from a convenient source and at a fair price.
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• CS in our country • FP/SRH indicators• Coverage of the different actors
Let’s see a few examples of …..
Market analysis helps us monitor progress in:
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Geographical Analysis Market Analysis
• Identified departments with wider gapt to FP access, based on ethnic, economic, educational aspects, CPR in women of reproductive age, unmet need for contraceptives and others
• Data are reflected on maps to visualize the distribution of each variable and analyze the areas with wider gaps in access
Methodology
• ENDESA 2001 and ENDESA 2006-07 secondary data analysis
• Each home is classified according to the availability of goods and services – Provides an approximate
indicator of socio-economic level: classification by quintiles
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Quintile Analysis
20% of homes with lowest socio-economic rates
20% of homes with highest socio-economic rates
Q5
Q4
Q3
Q2
Q1
Proxy for socio-economic rate based on having goods and services
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Total Fertility Rate (TFR)
Total Fertility Rate Trends: 1992-2007
4.6
3.93.3
2.7
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
1992-93 1998 2001 2006-07
Total Fertility Rates by Quintile: 2006-07
4.5
3.02.6
1.9 1.8
0
1
2
3
4
5
Q1 Q2 Q3 Q4 Q5
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Contraceptive Prevalence Rate Trends
60
6972
57
6670
2.6 2.5 2.6
66
7175
52
60
70
0
10
20
30
40
50
60
70
80
1998 2001 2006-07
Total
Modern Methods
Traditional Methods
Urban
Rural
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Contraceptive Use by Quintile
2006-07
12.621.9
28.6 28.7 32.412.6
13.6
15.3 13.712.3
32.9
2722.1 19.3 13.5
34.8 30.2 25.3 24.5 21.4
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Q1 TPA 65%
Q2 TPA 70%
Q3 TPA 75%
Q4 TPA 76%
Q5 TPA 79%
Does not use
Traditional Methods
Other modern
Male Condom
Injectable
IUD
Pill
Female Sterilization
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43.533.6
23.2
18.6
15.2
4.7
8.7
32.3
4.3 5.2
0%
20%
40%
60%
80%
100%
1998 2006-07
Traditional Methods
Other modern
Male Condom
Injectable
IUD
Pill
Female Sterilization
Method Mix
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Method Mix by Quintile
2006-07
19.3%31.4%
38.3% 38.0% 41.2%
19.3%
19.5%
20.5% 18.1% 15.6%
50.5%
38.7%29.6% 25.6% 17.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Q1 Q2 Q3 Q4 Q5
Traditional Methods
Other modern
Male Condom
Injectable
IUD
Pill
Female Sterilization
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Method Mix by Residence Area
2006-07
38.627.3
13.1
14
4.9
1.6
24.442.3
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Urban Rural
Traditional Methods
Male Condom
Injectable
IUD
Pill
Female Sterilization
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Unmet Need: Traditional Definition
“women who are not pregnant, do not want to be pregnant, are at reproductive risk and do not
use contraception”
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Prevalence and Unmet Need
2001 2006-2007
Modern Methods69.8%
Do not use16.9%
Need FP10.7%
Traditional Methods2.6%
Modern Methods64.3%
TraditionalMethods
4.3%
Do not use16.8%
Need FP14.6%
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FP Services Need by Quintile
Total Unmet Need: 10.7%
2006-07
65.2 69.8 74.7 75.5 78.6
13.312
11.1 8.9 7.3
0
10
20
30
40
50
60
70
80
90
100
Q1 Q2 Q3 Q4 Q5
% w
om
en i
n u
nio
n
Met Need for FP Unmet Need for FP
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Unmet Need by Geographic Area: 2001 and 2006-07
69.4 71.3
57.568.0
4.0 3.6
4.8
1.5
11.5 10.5
18.710.9
15.1 14.6 19.0 19.6
0
10
20
30
40
50
60
70
80
90
100
Urban 2001 Urban 2006-07 Rural 2001 Rural 2006-07
Do not use
Need for FP
Traditional Methods
Modern Methods
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Contraceptive Source
ENDESA
63.6 67.8
7.1 6.5
3.911.9 9.8
11.4 12.4 14.6
6.2 4.5 2.8
62.0
5.0
0%
20%
40%
60%
80%
100%
1998 2001 2006-07
Other source/Does not know
Other NGOs
Pharmacy/Market
PROFAMILIA
Private Clinic/Hospital/Provider
Community Sector
Previsional Medical Company
Public Sector (MOH)
3.6%
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Contraceptive Source by Quintile
83.2 80.271.1
59.3
41.0
0.21.2
3.5
5.8
8.3
2.3
4.3
12.2
2.74.5
5.2
4.8
7.0
5.0 8.314.4
20.626.0
1.5 2.1 2.6 3.7 4.6
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Q1 Q2 Q3 Q4 Q5
Other source/Does not know
Other NGOs
Pharmacy/Market
PROFAMILIA
Private Clinic/Hospital/Provider
Community Sector
Previsional Medical Company
Public Sector (MOH)
2006-07
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Contraceptive Source by Geographic Area
58.3
79.0
5.7
0.9
5.85.4
4.320.27.5
1.6
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Urban Rural
Other source/Does not know
Other NGOs
Pharmacy/Market
PROFAMILIA
Private Clinic/Hospital/Provider
Community Sector
Previsional Medical Company
Public Sector (MOH)
2006-07
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Source of Oral Contraceptives by Quintile
79.3 74.9
59.1
41.9
24.5
0.01.3
2.7
3.3
6.9
11.5 18.9
35.5
48.958.9
0
10
20
30
40
50
60
70
80
90
100
Q1 Q2 Q3 Q4 Q5
Other source/Does not know
Other NGOs
Pharmacy/Market
PROFAMILIA
Private Clinic/Hospital/Provider
Community Sector
Previsional Medical Company
Public Sector (MOH)
2006-07
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Source of IUDs by Quintile
93.388.6 86.5
76.3
42.5
6.8
3.4
4.1
25.3
5.9
5.0
6.3
13.0
12.5 11.811.0
0
10
20
30
40
50
60
70
80
90
100
Q1 Q2 Q3 Q4 Q5
Other source/Does not know
Other NGOs
Previsional Medical Company
PROFAMILIA
Private Clinic/Hospital/Provider
Public Sector
2006-07
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Source of Injectables by Quintile
87.4 89.584.7
62.3
50.2
5.9
5.1 6.2 9.4
26.9
38.0
3.8
4.14.3
0
10
20
30
40
50
60
70
80
90
100
Q1 Q2 Q3 Q4 Q5
Other source/Does not know
Other NGOs
Pharmacy/Market
PROFAMILIA
Private Clinic/Hospital/Provider
Community Sector
Previsional Medical Company
Public Sector (MOH)
2006-07
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Source of Sterilizations by Quintile
84.179.0
74.968.0
51.4
1.43.3
2.96.2
16.2
12.612.6
13.510.7
12.1
4.68.1
12.5
3.35.4 7.4
0
10
20
30
40
50
60
70
80
90
100
Q1 Q2 Q3 Q4 Q5
Other source/Does not know
Other NGOs
Previsional Medical Company
PROFAMILIA
Private Clinic/Hospital/Provider
Public Sector (MOH)
2006-07
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Source of Condoms by Quintile
90.9
46.7
24.718.8
7.7
7.5
51.1
66.8
77.391.2
5.4
0
10
20
30
40
50
60
70
80
90
100
Q1 Q2 Q3 Q4 Q5
Other source/Does not know
Pharmacy/Market
Previsional Medical Company
PROFAMILIA
Private Clinic/Hospital/Provider
Community Sector
Public Sector (MOH)
2006-07
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Method Mix: Health Insurance Beneficiaries
IUD8.7%
Other0.3%
FemaleSterilization
57.0%
Injectable22.6%
Condom5.5%
Pill18.2%
Vasectomy1.7%
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Distribution of Health Insurance Beneficiaries by Supply Source
45.8 42.8
2.819.9
16.0
8.39.34.2
18.9 20.7
5.6 3.30.71.6
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2001 2006-07
Other source/Does not know
Other NGOs
Pharmacy/Market
PROFAMILIA
Private Clinic/Hospital/Provider
Community Sector
Previsional Medical Companies
Public Sector (MOH)
2001 and 2006-07
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Intention to use FP in Non-Users
2001 2006-07
I nyectable 38%
Condom 3%
Pill 24%
I UD 8%
Female Sterilization 20%
NS 5% Traditional 2%
Injectable42%
IUD6%
FemaleSterilization
22%
Pill22%
Condom2%
Does notknow/NA
5%
Other/traditional1%
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• Meet their demand for services
• Reduce unmet need• Offer them the most
appropriate services
Let’s see some examples
Need to reach adolescents to be able to …
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Concentration of the adolescent population (15 to 19 years) in
union, 2006-07
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Contraceptive Use by Age and Total
0
10
20
30
40
50
60
70
80
90
100
15-19 20-24 25-29 30-34 35-39 40-44 45-49
CPR all methods
CPR modern methods
Female Sterilization
Pill
IUD
Injectable
Male Condom
Does not Use
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Contraceptive Source by Age: 2006-07
69.8 72.7 68.1 68.263.0 61.9
68.8
3.8 10.2 12.4
10.022.217.1 19.7 13.7 11.2 8.4 5.4
0.50.1 1.3
0%
20%
40%
60%
80%
100%
15-19 20-24 25-29 30-34 35-39 40-44 45-49
Other source/Does not know
Other NGOs
Pharmacy/Market
Previsional Medical Company
PROFAMILIA
Private Clinic/Hospital/Provider
Community Sector
Public Sector
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Contraceptive Prevalence Rate By Age: 2006-07
82% 81%
59%
74%71%
61%
0%10%
20%30%40%
50%60%70%
80%90%
15-19 20-24 25-29
Sexually Active - Not inUnion
Currently in Union
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Client Method Preference: 2006-07 (15-19)
Other, 4.5%
Female Sterilization,
3.6%
Pills, 21.4%
Copper T or IUD, 8.9%
Injectable, 61.6%
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Non-User Method Preference: 2006-07 (15-19)
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Progress
• The use of modern methods has increased, mainly in quintile 1
• Gap in CPR between rural and urban area has been closed
• Unmet need for FP and TFR has decreased, but % of non-use is the same
• The use of traditional methods methods has remained the same between 1998 and 2006-07, with a slight increase in the urban area
• Previsional medical companies (part of the national
insurance scheme) began to offer more FP services
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• Method mix shows a great disparity between rural and urban area
• Difference in CPR and TFR betweenntre Q1 and Q5 is still significant
• The public sector is the main provider of contraceptives, but provides services to an important % of quintiles 4 and 5
• The NGO sector has shrunk, reflecting a slight increase in pharmacies
• An important % of quintiles 1 and 2 obtain their methods from pharmacies and NGOs
• Clients with private insurance go mainly to MOH sites
To Analyze…(1)
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• Intention of future use among women of reproductive age is concentrated in injectables, followed by sterilization
• Use and future preference for the IUD, being a cost-effective and innocuous method, has decreased
• The higher maternal mortality rates are concentrated in the departments with higher TFRs and lower long term and permanent methods
• 54% of women between 15-24 years prefer the injectable and 26% the pill
• 79% of adolescents want to use contraceptives in the future
To Analyze…(2)
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Challenges (1)
Can the MOH continue fulfilling the needs of every sector of the population?
¿Does it have the financial resources to do this?
¿Where should it focus its efforts, considering budget limits and the global financial crisis?
Are the institutions and services prepared to fulfill the current market, and especially, the future market?
How can FP services be increased in previsional medical clinics and social security institute sites and have cost-effective methods?
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Challenges (2)
How can access to long term methods be improved in rural areas?
How can we ensure access to modern methods for adolescents?
What strategies must the public sector develop for people who have the capacity to pay to go to private services?
What changes must be considered in form and content to provide appropriate reproductive health counseling?
What does the private sector need to improve access to FP in quintiles with the capacity to pay?
What role should NGOs play in the supply of FP methods and services? How can we ensure sustainability in this endeavor?
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¿How can Countries and Institutions Improve?….
¿How can we create inter-institutional synergies to reduce disparities and unmet need for
Family Planning services?
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¡Without Products…¡Without Products…
…There is No …There is No Program!Program!