Francoise Armand & Barbara O ’ Hanlon PSP- One Project

1. 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

2. 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

3. Countries covered in the review * Countries assessed by PSP-One

4. RH trends in the EE region 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)

5. RH trends in the EE region Total abortion rate 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.

6. The “whole” FP market Private sector Public sector Donors Pharma Mfg Pharma Distributors Pharma local representative MOH Distribution Detailing Marketing & PR Detailing Private clinics and hospitals Pharmacies Public clinics and hospitals Public pharmacies Informal relationship Formal relationship

7. 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

8. 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

9. Disparities across the EE region • Widely different SES context • Differences in willingness/ability to pay for FP • Market size and maturity • Urbanization and infrastructure Market disparities = varying levels of attractiveness = Uneven product supply

10. Country “opportunity” ranking Russia Ukraine Kazakhstan Kyrgyzstan Romania Armenia Georgia ADVANCED Azerbaijan Tajikistan Uzbekistan INTERMEDIATE EMERGING

11. 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

12. Contraceptive supply in pharmacies

13. OC supply in pharmacies

14. 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/manufacturers

15. 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

16. Working with the private sector You want me to do what?

17. 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

18. 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

19. Finding common areas of interest Private sector priorities Public health goals Decrease reliance on abortion Sell high margin products W/high growth potential Decrease reliance on abortion Increase use of modern methods Increase use of hormonal methods Target middle income, urban women 18-35 Target all WRA Increase use of hormonal, new methods, star brands Maximize access for all groups Target urban women 18-35 Improve the method mix Increase market share

20. 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

21. Thank you!