In Re: Armand Izzo Case No.: FEC 16-666 / TO: Armand Izzo ...
Francoise Armand & Barbara O ’ Hanlon PSP- One Project
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Transcript of Francoise Armand & Barbara O ’ Hanlon PSP- One Project
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!