Abt Associates Inc. in partnership with:Banyan Global Dillon Allman and Partners. LLCFamily Health International Forum One Communications IntraHealth InternationalO’Hanlon ConsultingPopulation Services International Tulane University School of Public Health and Tropical Medicine

MAXIMIZING PRIVATE SECTOR CONTRIBUTION TO FAMILY PLANNING IN THE EUROPE & EURASIA REGION:

Context Analysis & Review Of Strategies

Francoise Armand & Barbara O’Hanlon

PSP-One Project

Why this review?

Concerns about sustaining support for FP Limited donor funds Low priority for governments Uncertain supply (contraceptive security) FP lost in the health sector reform shuffle

Importance of the private sector in the region Poor understanding of what drives this sector Need for leveraging/partnering strategies

Countries covered in the review

AlbaniaArmenia

Azerbaijan*Georgia

Kazakhstan*Kyrgyzstan*

RomaniaRussia*

Tajikistan*Ukraine*

Uzbekistan

* Countries assessed by PSP-One

RH trends in the EE region

Country TFR1 (%) Total CPR1 (%)Total modernmethods1 (%)

Most-usedcontraceptive

method3

Albania 1.9 75 8 …

Armenia 1.7 53 20 Withdrawal

Azerbaijan 2.0 55 15.64 Withdrawal

Georgia 1.6 47 27 Withdrawal

Kazakhstan 2.2 66 53 IUD

Kyrgyzstan 2.6 60 49 IUD

Romania 1.32 64 385 Withdrawal

Russia 1.3 67 49 IUD

Tajikistan 3.8 34 27 …

Ukraine 1.2 68 38 IUD

Uzbekistan 2.7 68 63 IUD

Sources:1Population Reference Bureau (PRB) (2006) 4Measure DHS project (2007)2Centers for Disease Control and Prevention and ORC Macro (2003) 5Romania Reproductive Health

Survey (2004)3PRB (2003)

RH trends in the EE region

Trends in Abortion Rates in Selected Countries

3.2 3.1

2.3

1.6

2

2.5

2.9

1.3

Romania, 1999 Armenia, 2000 Azerbaijan, 2001 Kazakhstan, 1999

6-8 years before survey

0-2 years before survey

Note: The total abortion rate is the number of abortions a woman would have in her lifetime if she experienced current age-specific abortion rates.

Source: Population Reference Bureau Policy Brief. Reproductive Health Trends in Eastern Europe and Eurasia. Washington, DC: 2003.

Total abortion rate

Marketing & PR Detailing

The “whole” FP market

Private sector

Public sector

Formal relationship Informal relationship

Pharma Mfg

Donors

Pharma Distributo

rs

Pharma local representativ

e

Private clinics and hospitals

Public pharmacies

Public clinics and hospitals

Pharmacies

Distribution Detailing

MOH

Cross-cutting findings/FP market

High reliance on abortion but… Growing demand for hormonal/new methods Strong provider bias drives consumer

preferences Very low support for injectables Preference for late-generation OCs

No publicly funded consumer education programs

Some supply issues for vulnerable groups

Cross-cutting findings/policies

Various stages of health sector reform Pro-natalist policies/FP low priority Environment favorable to private sector growth But limited initiatives to increase private sector

provision of FP (exceptions Romania, Georgia)

Dynamic, open environment = private sector opportunity

Disparities across the EE region

Widely different SES contextDifferences in willingness/ability to pay for FP Market size and maturityUrbanization and infrastructure

Market disparities = varying levels of attractiveness = Uneven product supply

Country “opportunity” ranking

ADVANCED

TajikistanUzbekistan

EMERGING

INTERMEDIATE

Kyrgyzstan

Armenia

Georgia

Romania

RussiaUkraine

Kazakhstan

Azerbaijan

Contraceptive supply in the EE region

Wide supply of condoms, spermicides OCs, EC

Low cost, high-quality, easily accessible IUDs

Fast introductions of new hormonal methods

Very low availability of injectables, no implants

Less than optimum contraceptive security for low-income and rural groups

Contraceptive supply in pharmacies

RUSSIA UKRAINE KAZAKH. KYRGYZ. TAJIK. ARMENIA AZERB. GEORGIA

Condoms

OC

ECP

DMPA

IUD

Hormonal IUD

Vaginal ring

Patch

Spermicides

Combined OCs Formulation Manufacturer Minium price per cycle (USD)

RUSSIA KAZAKHSTAN AZERBAIJAN

Microgynon Levonorgestrel 0.15 mg + EE 30mcg Schering 5.50 3.98 N/A

Rigevidon Levonorgestrel 0.15 mg + EE 30 mcg Gideon Richter 1.24 1.35 0.90

Marvelon Desogestrel 0.15 mg + EE 30 mcg Organon 9.39 11.28 4.60

Regulon Desogestrel 0.15 mg + EE 30 mcg Gideon Richter 4.03 2.63 9.00

Mercilon Desogestrel 0.15 mg + EE 20 mcg Organon 10.97 14.29 N/A

Novinette Desogestrel 0.15 mg + EE 20 mcg Gideon Richter 4.82 4.29 3.69

Femoden Gestodene 0.075 mg + EE 30 mcg Schering 11.91 6.24 6.9

Logest Gestodene 0.075 mg + EE 20 mcg Schering 10.37 7.52 5.77

Lindynette20 Gestodene 0.075 mg + EE 20 mcg Gideon Richter 10.00 4.51 N/A

Jeanine Dienogest 2 mg + EE 30 mcg Schering 14.66 9.77 7.60

Yarina Drospirenone 3 mg + EE 30 mcg Schering 16.77 13.53 7.40

Diane 35 Cyproterone acetate 2 mg + EE 35 mcg Schering N/A 8.27 6.00

Triquilar Lev. 0.05/0.075/0.125mg + EE 30/40/30mcg Schering 7.24 3.38

Tri-Regol Lev. 0.05/0.075/0.125 mg + EE 30/40/30mcg Gideon Richter 2.19 1.35 2.00

Trisiston Lev. 0.05/0.075/0.125 mg + EE 30/40/30 mcg Jenapharm 5.47 2.48 N/A

Progestin only OCs

Exluton Lynestrenol 0.5 mg Organon 15.19 12.78 N/A

Cerazette Desogestrel 0.075 mg Organon 16.77 N/A N/A

Microlut Levonorgestrel 0.03 mg Schering 6.97 N/A N/A

OC supply in pharmacies

Key players/manufacturers

Throughout the EE region, manufacturers invest in intensive marketing efforts targeted at providers and consumers Detailing Continuing education Sponsorship programs Brand-specific websites

Key players/distributors and retailers

Most countries have good distribution systems

Existing demand at the retail level drives supply

High demand products always have priority

Pharmacists are primarily service providers, not marketers

Working with the private sector

You want me to do what?

Leveraging the private sector/Stewardship

Good market stewardship means:

Monitoring contraceptive prices and method mix

Creating financial incentives for FP provision Identifying and addressing supply gaps Increasing demand-side efforts Avoiding “crowding-out” effect

Engaging the private sector/Partnerships

Public/private mix varies with each intervention

Partnering implies identifying common goals All stakeholders must bring something to the

table

Finding common areas of interest

Sell high margin productsW/high growth potential

Target middle income, urban women 18-35

Increase market share

Increase use of hormonal, new methods, star brands

Decrease reliance on abortion

Target all WRA

Maximize access for all groups

Improve the method mix

Decrease reliance on abortion

Target urban women 18-35

Increase use of hormonal methods

Private sector priorities

Increase use of modern methods

Public health goals

Parting thoughts

The private sector plays a significant role in contraceptive security – don’t fix what is not broken

The best way to improve supply in the region is to increase demand for FP products and services

Regardless of market maturity, the private sector can always be leveraged to contribute to FP goals

Donors/governments must monitor access, address supply gaps, and ensure unbiased RH/FP counseling

Thank you!