Assessing the Commercial Viability of Long-Acting and Permanent Contraceptive Methods

This document from the United States Agency for International Development (USAID) PSP-One Project discusses issues of access and sustainable provision of long-acting and permanent methods of contraception (LAPM), particularly in rural or other low-resource settings. Focusing on sub-Saharan Africa, where challenges of health systems infrastructure, lack of adequate funding and trained staff, and fragmented supply chains make it difficult to provide LAPM on a widespread basis, the document cites access problems due to inadequate family planning (FP) funding, dependence on donated LAPM supplies, and religious and political prohibitions.

The document assumes an increased interest in commercial sector provision of LAPM due to a decrease in donor funding in FP, the existence in some countries of a viable commercial sector capability for LAPM distribution with a reach towards geographic and population segments not easily reached by the public sector, sustainability of the commercial sector, and consumer preference for choices offered commercially.

Communication aspects of increasing sustainable LAPM provision include examining the segmented market and tailoring services and promotional messages to, for example, those likely to pay for products and services and those wanting to limit or cease having more children, e.g., as noted here, Jordanian women preferring female intrauterine device (IUD) providers. "Market segmentation strategies require knowledge of the critical determinants affecting a consumer’s choice to adopt LAPM and to utilize the commercial sector....Knowing the key target market’s characteristics is critical to most effectively craft marketing messages to reach them. Literacy, available transportation mechanisms, ability to pay, beliefs about LAPM, perceptions about the private health sector and potential size of the segment must all be considered....".

Segmenting messaging for the population that can pay for services and the population that needs vouchers for services (including transportation to clinics) can maximise the potential of the health system by preserving free and subsidised LAPM services for those without the ability to pay, "while allowing the commercial sector to be sustained by earning the patronage of the clientèle who can pay." This is kind of scheme can be the product of public and private sector collaboration. "If done successfully, segmentation of the market by ability to pay has several advantages. It can improve equity (wealthier women may cross-subsidize the poor, or free up public sector resources to be used on lower income groups); improve the distribution of resources in the health system; and enhance financial sustainability of the public and private sectors. In contrast, universal access to free or reduced-price services may diminish the market for NGO [non-governmental organisation] and commercial sector services and be ultimately unsustainable."

Stimulation of the commercial sector and strategies for doing so are charted on page 24 and include subsidising demand-generation activities, training, establishment of delivery outlets, and products for commercial providers so that they may compete for those willing to pay. For example, "by organizing and promoting campaigns called 'clinic event days', [a Population Services International (PSI)] project concentrates method demand into a one- or two-day period... Community mobilizers conduct targeted communication activities among women leading up to the event day. Because clients know that the LAPM services they want will be readily available at the announced time of the clinic event day, they come from surrounding areas to the network facilities." Subsidising private provider networks in a social franchise model, as stated here, requires further study to examine its reach into various population segments and its ability to increase in scale.