Johannesburg, South Africa 2007

Measuring Access & Performance (MAP)

Coverage, Quality of Coverage and Access of LP/Trust in South Africa

P r o j e c t M A P

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CIA

L M

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TIN

G R

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H S

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Research Division

Population Services International 1120 Nineteenth Street NW, Suite 600

Washington, D.C. 20036

Project MAP Coverage and Quality of coverage of Lovers Plus and Trust condoms in

Cape Town, Johannesburg, and Durban

PSI Research Division 2007

© Population Services International, 2005

Contact Information: Sibongile Vilakazi, Researcher SFH South Africa Metro Park, 2nd Floor, 8 Hillside Road, Johannesburg, 2193 South Africa Phone: (011) 484 5320 Fax: (011) 484 5308 Email: Sibongile@sfh.co.za

Navendu Shekhar Regional Researcher Southern Africa Metro Park, 2nd Floor, 8 Hillside Road, Johannesburg, 2193 South Africa

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Acknowledgements This study was made possible through the grant support provided by the Dutch Embassy.

Opinions expressed in this report are those of the author and do no reflect the opinions of the

Dutch embassy.

Thanks to Nontokozo Dlani for the coordination of fieldwork, for training fieldworkers on how to

operate PDAs and for generating the maps of areas that were visited. The fieldwork for this study

was carried out by the Youth Aids volunteers. Appreciation goes to Bram Piot and Navendu

Shekhar for their assistance in the data analysis.

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Table of contents

ACKNOWLEDGEMENTS........................................................................................ 2 LIST OF MAPS AND FIGURES............................................................................... 5

GLOSSARY ............................................................................................................... 6 1. EXECUTIVE SUMMARY .................................................................................... 7

Objective:.................................................................................................................... 7

Methodology:.............................................................................................................. 7

Findings: ..................................................................................................................... 7

Programmatic Recommendations: .............................................................................. 9

2. BACKGROUND .................................................................................................... 9

3. METHODOLOGY ............................................................................................... 10

Sub Places ................................................................................................................. 10

Retail audit ................................................................................................................ 13

4. RESULTS ............................................................................................................ 13

Quality of coverage................................................................................................... 15

Access ....................................................................................................................... 17

Penetration ................................................................................................................ 17

Other findings from the audit.................................................................................... 18

Intention to stock LP................................................................................................. 18

5. LIMITATIONS..................................................................................................... 20

6. CONCLUSION AND PROGRAMMATIC IMPLICATIONS ............................ 21

Programmatic Recommendations ............................................................................. 21

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List of Maps and figures Map 1.1 Sampled EAs in Cape Town............................................................................... 11 Map 1.2 Sampled EAs in Johannesburg ........................................................................... 12 Map 1.3 Sampled EAs in Durban ..................................................................................... 13 Table 1 coverage by High Transmission Areas (HTAs) and non-HTAs.......................... 14 Table 2 Quality of coverage by HTA ............................................................................... 17 Table 3 Penetration by HTAs and non-HTAs.................................................................. 18 Table 4 Types of outlets which stock LP/Trust………………………………………….17 Table 5 Intention to stock Lover’s plus ............................................................................ 19 Figure 1: penetration breakdown of other condom brands………………………………19

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Glossary and minimum standards Coverage is defined as the proportion of geographically defined areas in which a

minimum level of product or service availability is present.

The first minimum coverage standard is that there should be at least one outlet

with Society for Family Health (SFH) condoms (LP or Trust) in a sub place

(SP). Coverage is calculated separately for SPs in high transmission areas

(HTAs) and for SPs in non-HTA. Alternatively,

The second minimum standard is the proportion of Sub Places (SPs) where at

least 30% of outlets stock SFH condoms.

Quality of coverage is the proportion of geographically defined areas in which the

product or service delivery system conforms to minimum standards of adherence to

recommended prices, promotion visibility, inventory and other standards as set by the

program. For this study quality of coverage is based on a combination of additional

minimum standards (besides product availability). In this study, quality of coverage

relates to the presence of promotional items, the visibility of condoms, and adherence to

the recommended price. The following minimum standards are used:

At least 50% of the SPs should display the promotional items for either LP or

for Trust condoms.

At least 60% of the SPs should stock condoms in a place where it is visible

and easy to point out, without having to ask for it by name.

At least 60% of the SPs should sell condoms at (or below) the recommended

price.

At least 60% of the SPs should report no stock out in the last month.

Access is defined as the proportion of a target population that is within the catchments

area of a product/service delivery point. However, a simplified definition of access in this

study is used, where access is defined as the proportion of people who reside in areas

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where SFH condoms are available (as per the minimum coverage standards). It is not

practical to use catchments areas around condom outlets, because the detailed distribution

of residents within a sub place is not known and because the catchments area of condom

outlets is supposed to be very small (e.g. 200 meter radius). Given the small size of sub

places, we assume that when there is coverage in a SP, then all residents also have access

to condoms.

1. Executive summary

Objective: Project MAP (Measuring Access and Performance) aims to increase the coverage, quality

of coverage, access and efficiency of social marketing product and service delivery

systems. SFH undertook a project MAP in Johannesburg, Cape Town and Durban. The

main goal of this mapping was to ascertain the coverage, quality of coverage and access

for Trust and Lover’s Plus condoms among the general population and population

residing in high transmission areas. The findings will thus be used to compare the trends

with those of MAP phase I.

Methodology: The three cities (Johannesburg, Cape Town and Durban) where the Dutch government is

funding were a focal for the MAP study. The primary sampling unit was Sub Places

(SPs). Only SPs that are classified as urban or suburban were included. The Lot Quality

Assurance sampling was employed, which allows for sensibly accurate estimates of

coverage and quality of coverage for an entire supervision area. In each city a

representative sample of HTAs and non-HTAs was randomly selected. The same

sampling frame - which was obtained from Statistics South Africa - as that used for MAP

phase I sampling was used to select the sample for MAP phase II.

An audit sheet built onto PDAs was used to collect the data. Each PDA was

synchronized into ACCESS. The data was subsequently exported and processed in

SPSS.

Findings:

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All three cities were able to easily meet the first minimum standard for coverage.

Amongst the HTAs, 75% of the SPs in Johannesburg met the minimum standard and over

90% in Durban met the standard. Similarly, amongst the non-HTAs, 90% of the

Johannesburg and Durban SPs met the minimum standard. Cape Town HTAs plummeted

when compared to MAP 2006. For instance, only 30% HTAs met the minimum standard

compared to 65% in 2006. A slight increase is observed amongst the non-HTAs because

55% met the minimum standard compared to 45% in 2006.

However, as the minimum standards were raised to at least 30% of the outlets in an SP

should stock LP/Trust; all three cities struggled to meet them. For instance, none of the

Cape Town HTAs had at least 30% of the outlets which stock LP/Trust and 20% of the

non-HTAs. In Johannesburg 30% of both the HTAs and non-HTAs met this standard

while in Durban 20% HTAs and 35% non-HTAs met the standard. Overall, in relation to

MAP 2006 findings, coverage in non-HTAs improved more slightly than it did in HTAs.

In terms of quality of coverage, both HTAs and non-HTAs across all three cities met the

minimum standards. Over 70% SPs in HTAs and non-HTAs in Johannesburg and Durban

place LP/Trust in a visible place. The availability of promotional material increased from

60% to 70% in Johannesburg HTAs and from 30% in 2006 to 40% in 2007 in non-HTAs.

In Durban HTAs it increased from 55% to 65% in 2007, while in non-HTAs promotional

materials were available in 5% more SPs than they were available in 2006. As such it can

be deduced that most of the outlets that currently stock LP/Trust have constant supply of

stock because fewer SPs report stock out in the last month. Promotional materials are

displayed, condoms are placed in a visible place and the recommended prices are adhered

to.

The population residing in the SPs that have LP/Trust coverage is assumed to have access

to condoms because the SPs are small. It was not practical to calculate access using

catchment areas around condom outlets in this study because the detailed distribution of

residents within a sub place is not known.

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LP/Trust is currently mostly stocked by garages (44.6%), pharmacies (37.2%), general

dealers (23.6%) and wholesalers (22.6%). These types of outlets are mostly found in non-

HTAs. More night clubs, spaza shops, hair salons, telephone containers and taverns are

found in HTAs and many of them expressed willingness to stock LP/Trust. These outlets

could be supported closely in order to increase penetration since it has generally declined

in relation to MAP 2006. Increased penetration could subsequently increase coverage in

HTAs.

Programmatic Recommendations:

A more aggressive approach to increase coverage needs to be directed at the type

of outlets found in HTAs because the current strategy appears to be favoring

outlets in non-HTAs.

Measures need to be taken to increase penetration in all three cities. This

penetration will subsequently translate into increased coverage. General dealers,

night clubs, spaza shops, hair salons, telephone containers and taverns should be

aggressively targeted and supported more closely since many of them are found in

HTAs and some of them express a willingness to stock LP/Trust.

Cape Town should be a priority in the strategies to increase coverage and

penetration since it has performed worse than it did in 2006.

2. Background

Society for Family Health (SFH) is the South African affiliate of Population Services

International (PSI), an international NGO network operational in over 70 countries. SFH

in South Africa concentrates on issues of HIV/ AIDS. As part of their HIV/AIDS control

efforts, SFH is using social marketing to motivate behavior change with respect to

consistent condom use, HIV testing and other safer behaviors.

SFH promotes consistent condom use and its efforts target both general population and

key high risk groups in order to positively influence the underlying barriers to increased

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condom use and ensure that condoms are widely available to protect against HIV/AIDS.

SFH promotes consistent condom use through its own two condom brands: Lovers Plus

and Trust.

Project MAP aims to increase health impact among the vulnerable and underprivileged

by improving social marketing performance. It strives to produce meaningful increases in

the opportunity for people to behave by providing continuous feedback to social

marketing managers and strategists in terms of delivery systems coverage, quality, equity

of access and efficiency. In essence, project MAP is designed to measure the

performance of both product and service delivery systems.1

In 2007 SFH undertook mapping in Johannesburg, Cape Town and Durban. The main

goal of this mapping was to ascertain the coverage, quality of coverage and access for

Trust and Lover’s Plus condoms among the general population and population residing in

high transmission areas. Comparisons with the 2006 MAP findings were subsequently

made in order to observe trends. The specific objectives of the study are as follows:

1) Assess geographical coverage and quality of coverage of Lovers Plus and

Trust condoms in Cape Town, Durban, and Johannesburg.

2) Calculate access to condoms among the general population.

3) Calculate access in the HIV high transmission areas (HTAs) and in non-

HTAs, in Cape Town, Durban, and Johannesburg.

Measures of penetration (by outlet type) and the availability of other condom brands,

especially of free government condoms (Choice) will be estimated.

3. Methodology Sub Places The three cities, Johannesburg, Durban and Cape Town, where SFH is funded by the

Dutch were a focal point for the study. The primary geographical unit of sampling was a

1 PSI Research division. (2003). Project MAP: measuring Access and Performance (concept paper).

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“sub place”. Only sub places that were classified as urban and suburban were selected.

However, those sub places that are located in urban areas but where no people live, such

as; parks, nature reserves and mining areas were not included in the sample. Moreover, in

each city the study included a representative sample of HTAs and non-HTAs.

Map 1.1 Sampled EAs in Cape Town

High Transmission Area (HTA)

Non-High Transmission Area (non-HTA)

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Map 1.2 Sampled EAs in Johannesburg

High Transmission Area (HTA)

Non-High Transmission Area (non-HTA)

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Map 1.3 Sampled SPs in Durban

High Transmission Area (HTA)

Non-High Transmission Area (non-HTA)

Retail audit All outlets in all selected sub areas in each city were audited. The PDA form (Appendix

A) contained questions related to quality of coverage, such as adherence to the

recommended price, willingness to stock Lover’s plus and or Trust, presence of

promotional items and the visibility of condoms.

4. Results of Lover’s plus and or Trust The findings from the study will be presented mainly in tables. The following tables

(table 1, table 2, table 3, table 4 and table 5) indicate coverage of Lover’s Plus and or

Trust condoms by High transmission areas, quality of Coverage, penetration, types of

outlets which stock SFH brands and intention to stock LP in all three cities (Cape Town,

Johannesburg and Durban).

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Table 1.1 LP and Trust coverage for MAP Phase I and MAP Phase II by SP_Type City SP_Type Proportion of areas where Trust

is usually available in at least 1 outlet

Proportion of areas where LP is usually available in at least 1 outlet

2006 2007 2006 2007

HTA 13 (80%) 12 (75%) 14 (85%) 11 (70%) Johannesburg

Non-HTA 10 (65%) 15 (90%) 13 (80%) 14 (85%)

HTA 10(65%) 3 (30%) 11 (70%) 2 (25%) Cape Town Non-HTA 6 (45%) 8 (55%) 10 (65%) 7 (50%)

HTA 14 (85%) 17 (>95%) 12 (75%) 11 (70%) Durban Non-HTA 14 (85%) 15 (90%) 14 (85%) 16 (95%)

Table 1.2 LP or Trust coverage for MAP Phase I and MAP Phase II by SP_Type City SP_Type Proportion of areas where LP or

Trust are usually available in at least 1 outlet

Proportion of areas where LP or Trust are available in at least 30% of outlets

2006 2007 2006 2007

HTA 14 (85%) 12 (75%) 3 (30%) 3 (30%) Johannesburg

Non-HTA 13 (80%) 14 (85%) 3 (30%) 3 (30%)

HTA 11 (70%) 3 (30%) 2 (25%) 0 Cape Town Non-HTA 10 (65%) 8 (55%) 4 (35%) 1 (20%)

HTA 15 (90%) 17 (>95%) 4 (35%) 1 (20%) Durban Non-HTA 14 (85%) 17 (>95%) 6 (45%) 4 (35%)

The data presented in table 1.1 indicate that the minimum standard of coverage was met

across all three cities (Johannesburg, Cape Town and Durban). Lovers plus (LP) and or

Trust is available in at least one outlet in all three cities. However, Cape Town has the

lowest proportion of areas where LP and or Trust are available in at least one outlet

(Trust: 30% HTA and 55% Non-HTA; LP: 25% HTA and 50% non-HTA).

All three cities had difficulty in meeting the second minimum standard for coverage. The

proportions of areas where LP or Trust are available in at least 30% of outlets ranged

from 0 in Cape Town HTAs to 35% in Durban non-HTAs (see table 1.2).

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Overall, the current findings indicate that the trend observed during MAP Phase I in

Johannesburg and Durban has been maintained. Durban is still leading in terms of

meeting the minimum standards followed by Johannesburg. Although Cape Town has

seen a dramatic dive since MAP Phase I.

In both Johannesburg and Durban a slight increase of LP and Trust availability in non-

high transmission areas (non-HTAs) is observed. In Johannesburg a slight decrease in

High Transmission Areas (HTAs) for both LP and Trust is observed. For instance, in

MAP Phase I, 80% of the HTAs had at least one outlet which stock Trust compared to

75% of the HTAs in MAP Phase II. Similarly, 85% of HTAs stocked LP in 2006

compared to 70% of HTAs in 2007. In Durban HTAs the proportion of areas where Trust

is usually available in at least one outlet has increased from 85% to beyond 95%.

Regarding the second minimum standard, in Johannesburg no changes are observed in

both HTAs and non-HTAs. While in Durban a slight decrease is observed, from 35% of

HTAs to 20% of HTAs that have 30% of the outlets that stock LP/Trust. Similarly, in

Durban non-HTAs there has been a decrease from 45% of the areas that have 30% of

outlets that stock LP/Trust to 35% of the areas in 2007.

In Cape Town there has been a slight increase of Trust availability in non-HTAs from

45% to 55% non-HTAs that have at least one outlet that stock Trust. However, a dramatic

decrease in HTAs for both minimum standards in comparison to the 2006 MAP findings

is observed

Quality of coverage Four factors were used to determine the quality of coverage. They are: 1).The visibility of

LP or Trust at the store. 2). the availability of LP promotional materials. 3). Percentage of

areas where they had no LP stock out in the last month. 4). LP/Trust sold at recommended

prices. The program minimum standards that were used were the following:

At least 50% of the SPs should display promotional items for either LP or for

Trust condoms.

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At least 60% of the SPs should stock condoms in a place where it is visible

and easy to point out, without having to ask for it by name.

At least 60% of the SPs should sell condoms at (or below) the recommended

price.

The findings in table 2 indicate that nearly all the SPs that stock LP/Trust place them in a

visible and easy to point out place. Both Durban and Johannesburg SPs achieved beyond

the minimum standard of 60%, while Cape Town is not meeting the minimum standard.

The MAP Phase I and Phase II findings on the availability of promotional materials and

reports of stock out in the last month indicate an increasing trend in Johannesburg and

Durban SPs, while Cape Town has generally declined. It appears that more SPs (both

HTAs and non-HTAs) that stock LP/Trust display promotional materials more than it was

the case in MAP Phase I. Similarly, lesser SPs have experienced stock out in the last

month (see table 2 below).

This suggests that for those SPs where LP/Trust is available, there is public awareness of

such availability since promotional materials are displayed. Moreover, those SPs have a

constant supply of stock since fewer of them report stock out in the last month.

The adherence to recommended prices has also increased in comparison to MAP Phase I.

For instance in Johannesburg, over 95% of the non-HTAs adhere to the recommended

prices of LP/Trust, and 75% of the HTAs. Similarly, over 95% of both HTAs and non-

HTAs in Durban adhere to the recommended selling prices of LP/Trust.

Even though Cape Town has been performing poorly in terms of coverage, all those SPs

that are covered or that stock LP/Trust meets all the minimum standards for quality of

coverage.

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Table 2 Quality of coverage for MAP Phase I and MAP Phase II by HTA type

City SP_Type

LP/Trust are stored in a visible place

SFH promotional materials available

% of areas where had no SFH stock out in last month

LP/Trust sold at recommended price

2006 2007 2006 2007 2006 2007 2006 2007

HTA 12/75% 11(70%) 4 / 35% 9 (60%) 9/ 60% 11(70%) 9 / 60%

12 (75%)

Joburg

Non-HTA

12/ 75% 13(80%) 3 / 30% 5 (40%) 10/ 65% 15 (90%) 12 /75%

17 (>95%)

HTA 10/ 65% 3 (35%) 9 / 60% 12(75%) 10/ 65% 3 (30%) 3 / 30%

3 (30%) Cape Town

Non-HTA

7 /50% 8(55%) 3 / 30% 7 (50%) 7/ 50% 8 (55%) 5 / 40%

8 (55%)

HTA 13/80% 13(80%) 8 / 55% 10(65%) 9/ 60% 13(80%) 9 / 60%

17 (>95%)

Durban Non-

HTA 14/ 85% 16 (95%) 10/ 65% 11 (70%) 10/ 65% 16 (95%) 13

/80% 17 (>95%)

Access

A simplified definition of access in this study is used, where access is defined as the

proportion of people who reside in areas where SFH condoms are available (as per the

minimum coverage standards). It is not practical to use catchments areas around condom

outlets, because the detailed distribution of residents within a sub place is not known and

because the catchments area of condom outlets is supposed to be very small (e.g. 200

meter radius). Given the small size of sub places, we assume that when there is coverage

in an SP, then all residents also have access to the condoms.

Penetration Penetration is the number of outlets that stock either Trust or LP in the area. Table 3

indicates that penetration in all three cities decreased tremendously since the MAP 2006

study. For instance, penetration in all HTAs has decreased from 11.8% to 3.9% in 2007,

while in non-HTAs it has decreased from 15.6% to 3.7% in 2007. Similarly, in late

closing outlets penetration has moved from 15.7% in HTAs to 6.3% and from 17.7% in

non-HTAs to 7.7%. In total however, there are only 8.8% outlets that open late at night in

all the audited outlets in the three cities combined. Such a small penetration limits the

analysis of condom availability in such outlets.

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Table 3 penetration of LP/Trust by HTAs and non-HTAs

Other findings from

the audit Intention to stock LP/Trust

A majority of SFH brands are sold at petrol stations/garages (44.6%), pharmacies

(37.2%), general dealers (23.6) and wholesalers (22.6%). These outlets are largely found

in non-HTAs. Although more telephone containers, hair salons and taverns, which are

largely found in HTAs, express willingness to stock. Such outlets need to be exploited

and supported in order to widen the accessibility of SFH condoms.

Table 4 Types of outlets which stock LP/Trust Type of outlet no % (no) yes % (yes) Total missing 2 100 0 0 2 pharmacy 44 62.8 26 37.2 70 garage 41 55.4 33 44.6 74 general dealer 210 76.4 65 23.6 275 clinic 6 75.0 2 25.0 8 retailer 20 83.3 4 16.7 24 wholesaler 24 77.4 7 22.6 31 other traditional 69 95.8 3 4.2 72 brothel 1 100 0 0 1 hotel/guesthouse 1 50.0 1 50.0 2 tavern 205 96.7 7 3.3 212 night club 25 100 0 0 25 bottle store 82 91.1 8 8.9 90 Telephone container 442 99.1 4 0.9 446 hair salon 372 98.4 6 1.6 378 food outlet 172 93.9 11 6.1 183

City SP_Type All outlets Late closing outlets

2006 2007 2006 2007

HTA 8.9% 2.2% 12.1% 2.9% Johannesburg

Non-HTA 8.6% 1.5% 6.4% 3.3%

HTA 11.7% 0.3% 14.3% 2.2% Cape Town

Non-HTA 12.2% 0.4% 6.1% 0.7%

HTA 19.4% 1.4% 26.3% 1.1% Durban Non-HTA 29.5% 1.8% 45.5% 3.7%

HTA 11.8%

3.9% 15.7% 6.3% Total

Non-HTA 15.6% 3.7% 17.7% 7.7%

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delivery service 7 87.5 1 12.5 8 hawker 28 96.6 1 3.4 29 truck shop 119 95.9 5 4.1 124 spaza/tuckshop 722 95.5 34 4.5 756 Other nontraditional 64 100 0 0 64 Total 2656 92.4 218 7.6 2874

Table 5 Intention to stock LP/Trust

Type of outlet no % (no) yes % (yes) Total Missing 2 100 0 0 2 pharmacy 41 93.1 3 6.9 44 garage 35 85.4 6 14.6 41 general dealer 178 84.8 32 15.2 210 clinic 5 83.3 1 16.7 6 retailer 20 100 0 0 20 wholesaler 18 75.0 6 25.0 24 other traditional 64 92.7 5 7.2 69 brothel 1 100 0 0 1 hotel/guest house 1 100 0 0 1 tavern 173 84.4 32 15.6 205 night club 19 76.0 6 24.0 25 bottle store 69 84.1 13 15.9 82 telephone container 378 85.5 64 14.5 442 hair salon 331 88.9 41 11.1 372 food outlet 169 98.2 3 1.8 172 delivery service 6 85.7 1 14.3 7 hawker 28 100 0 0 28 truck shop 110 92.4 9 7.6 119 spaza/tuckshop 655 90.7 67 9.3 722 other nontraditional 61 95.3 3 4.7 64 Total 2364 89.0 292 11.0 2656

Penetration of Other condom brands

The government condom – Choice- are available in many (21.1%) of the outlets audited

followed by LP/Trust (7.6%). This suggests that there is limited overlap in terms of the

condom availability of commercial brands, Choice and socially marketed brands.

Figure 1: penetration breakdown of other condom brands

19

931 47

580

7 12

218

0

100

200

300

400

500

600

700

Care Durex Contempo Choice Unbranded other brands LP/Trust

5. Limitation PDAs were used for the first time in this study and they made the data collection process

very efficient and effective. However, South Africa has high incidences of cell phone

mugging. Since the PDAs look the same as a cell phone to ordinary persons, there was a

constant fear that fieldworkers would be mugged. Two fieldworkers were in fact attacked

in Durban and a PDA was stolen from them. As a result areas which posed a threat for

similar incidences were avoided and replaced with areas with a lesser threat. This had

implications to the sample method, especially in Durban where the incidence was highest

and thus two areas were replaced.

Moreover, in South Africa there have been a number of changes of street names and area

names. Some of these names have not yet been updated on the maps obtained from

Statistics South Africa. Consequently, some sampled areas could not be found because

they would be labeled differently on the map while they would be given another name

locally. Such areas were replaced with an area closest to the sampled one.

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In addition, fieldworkers were asked to audit all outlets that they came across in a

selected SP. This was done in order to prevent fieldworkers having to make a judgment

of potential condom outlets. The idea was to enter all outlet data and then remove all non-

potential condom outlets from the final data base during data analysis. However, a few

outlets that are traditionally not regarded as potential condom outlets, such as clothing

shops, fridge and car repair workshops, also carried condoms. Such outlets were not

removed from the data but were classified as “other”. This poses a challenge to the

traditional definition of “potential condom outlet” and the definition may have to be

refined in future to include other outlets that do not seem to be potential condom outlets

but actually stock condoms.

There was a total of 8.8% outlets that open late at night (after 22:00) in all the SPs

audited. This limited the analysis of coverage for LP/Trust in late night opening outlets.

6. Conclusion and Programmatic Implications In terms of the minimum standards set by SFH, a similar pattern observed during MAP

Phase I is observed in MAP phase II. Durban is leading followed by Johannesburg, while

Cape Town has plummeted. For instance,

The minimum coverage of LP and or Trust was easily met across all three cities.

However, more efforts have to be directed at increasing the number of outlets in

each SP that sell condoms because as the standards were raised to at least 30%

outlets to carry LP/Trust, each city struggled to meet them.

All three cities met the minimum standards for quality of coverage. There is

overall improvement when compared to the MAP 2006.

Penetration has generally plummeted in relation to the MAP 2006.

The willingness to stock LP/Trust amongst outlets that are not currently stocking

indicates that there is distribution potential amongst these outlets.

Programmatic Recommendations

The measures implemented since MAP 2006 appear to have mostly benefited the

types of outlets that are found in non-HTAs. A different approach or more

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Penetration for LP and or Trust needs to be increased in both HTAs and non-

HTAs across all three cities so that higher minimum standards for coverage may

be met. The outlets that are currently indicating willingness (i.e. wholesalers,

nightclubs, telephone containers, hair salons and taverns) to stock could be

prioritized and supported more closely.

The efforts directed at increasing the quality of coverage have been successful in

both HTAs and non-HTAs across all three cities. SFH is commended in this

regard.

Special attention has to be directed in Cape Town in order to improve the

situation there.