Full Market Impact: Measuring Impact of Private-sector Health Projects AEDs N-MARC Project Nepal Nadra Franklin March 31, 2009.

Full Market Impact: Measuring Impact of Private-sector Health

Projects

AED’s N-MARC ProjectNepal

Nadra FranklinMarch 31, 2009

Goal

Expand the depth, reach, and impact of Family Planning/Reproductive Health, MCH, and HIV/AIDS prevention products and services among low socio-economic populations through sustainable social marketing and social franchising programs

Nepal Social Marketing & Franchising Project: AIDS, Reproductive Health, and Child Survival

2006-2009

A New Model of Private Sector Health Initiative - Full Market Impact™

• Social marketing approach to achieve “total market” development for essential healthcare products and services, coupled with sustainable health impact

• Multiple partners from the private commercial sector, NGOs, public sector and civil society to increase the practice of healthy behaviors and generate/fulfill demand for an affordable and accessible range of “public health” products and services

• Four P’s of marketing, (product/supply, price/affordability, place/distribution, and promotion/demand and appropriate use)

• Three primary outcomes – equity, commercial viability, and sustainable public health impact

• Facilitator and broker, steward of donor investment

N-MARC’s Program Strategy

• Build on 30 years of USAID/Nepal’s investment in social marketing in Nepal

• Conduct generic communication campaigns to build ‘total market’ demand for products

• Enhance independence of social marketing organizations and local ownership

Commercial-Sector Partnerships

• Matching funds

– Joint-risk, joint-reward approach

– 1 to 1 matching ratio (or higher ratio favoring USAID)

– Partners responsible for own product procurement

– Stimulates commercial-sector investment

• Technical assistance

– Sensitization to public health issues in Nepal

– Refining and developing marketing strategies

– Brand rationalization/new products

– Market research (e.g. Household behavioral surveys, GIS mapping)

– Support local partners’ implementation

Key Products and Services

HIV/AIDS Prevention

HIV/AIDS Prevention

Family Planning/

Reproductive Health

Family Planning/

Reproductive Health

Maternal & Child Health

Maternal & Child Health

• Male condoms

• Latex female condom

• Oral contraceptives

• Injectable contraceptives

• Long-term methods (IUD and Norplant)

• Emergency contraceptive pills

• Clean delivery kits

• Oral rehydration salts

• POU chlorine solution

N-MARC invests in subsidized and fully-priced locally owned brands

Evaluation Theory Based on Program Theory: Full Market Impact (FMI)

• Measure the program model– 7 results areas relate to intervention design– 7 results areas associated with specific indicators– FMI outcome is Impact

• Prospective evaluation design– Refers to program model and intervention design– Developed at outset of program– Refined in real-time as program design is refined and

revised

Result Area1: Improved Supply

• Increased production capacity and output• Creating strong links between manufacturers

and distributors– Number and percentage of partners utilizing fully developed

marketing plans, including market segmentation strategy to facilitate development of sustainable business relationships between manufacturers and distributors (brand building, planning etc)

• Providing technical support to expand manufacturing capacity and quality– Number of partners trained in development and implementation

of social marketing communication strategies to increase capacity of local partners to design, implement and manage state-of-the-art social marketing and social franchise programs

– Expansion of the number of outlets Improved stock management and distribution system

Result Area 2: Increased Demand

• Generic demand creation campaigns based on extensive research

• Increased equity to ensure equal demand and access (Household coverage rates as high or higher among low-income and high risk groups)

• Private Market Size per product (Present Sales)• Commercial Market Size per product (Present

Sales)• Percent increase in commercial sector market

share per product or service (difference between baseline and present sales)

Result Area 3: Improved Technologies

• Making cutting-edge technology and new products accessible to all manufacturers

• Bringing new products to the attention of manufacturers and then to consumers– Latex female condom– Zinc treatment for diarrhea

Result Area 4: Increased Distribution

• Franchise opportunities and targeted subsidy via commercial sector, vested party or additional donor– Franchising products through training– Voucher schemes– Coverage and reach

• More outlets and enhanced stock management

Result Area 5: Efficiency

• Maximizing public health impact through efficient investment

• Resources leveraged by N-MARC project

• Number and % of initiatives (e.g. research and communication) that include a minimal level of multi-sectoral representation

• Efficiency ratio of using donor resources

Result Area 6: Access

• Creating a sustainable marketplace for consumers at a variety of price-points

• Coverage per product distributed for target population in geographically-defined populated areas

• Access saturation index - monitor variations on the levels of coverage and access for enhanced program management, with the ultimate goal of increasing both coverage access at smaller geographically-defined areas and distances to maintain the focus on realizing public health impact

Result Area 7: Sustainability

• Creating a sustainable business model among manufacturers, suppliers and their distributors to serve long-term consumer needs

• Increased number of brands, partners, with steadily increasing investment in market development by commercial sector

• Establishment of distribution networks and promotional capacity at the regional and country levels that are not dependant on any donor support beyond project

• Sustainability indicator

Full Market Impact™

Product

Price

Place

Promotion

Supply

Affordability

Distribution

Demand/Use

Coordination

Capacity building Quality Assurance

Market Research

Distribution Support/ Marketing Funds

Financing

Policy/ Advocacy

Demand Creation/ Matching Funds

Targeted SubsidiesVouchers

Sustainable Public Health Impact

Increase Usage of Public Health Products/Services

Sustainable Markets

Equity

PRIVATE PUBLIC

Family Planning/Reproductive Health Results (2007-2008)

Indicator Target Achievement

Private Sector CYP 312,481 369,977

Private sector oral contraceptive market size

781,508 912,699

Number of people trained in FP/RH with USG funds

1,500 1,817

•  Male 900 1,252

•  Female 600 565

Number of people that have seen or heard a specific USG-supported FP/RH messages

55,000 97,380

•  Male 11,000 29,614

•  Female 44,000 67,766

HIV/AIDS Results (2007-2008)

Indicator Target Achievement

Coverage of condom distribution in geographically defined areas

85% 88%

Sales of USG-supported condom brands 21,524,709 21,804,780

Number of targeted condom outlets opened in “hot zones”

700 5,466

Number of individuals reached through community outreach that promotes HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful

3,500 43,785

•  Male 1,750 29,611

•  Female 1,750 14,174

Number of individuals trained to promote HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful

1,600 4,509

Number of franchised health providers trained to provide STI treatment

1,800 1,674

Results: Increased Demand and Access

Aug 06-Jul 07 Aug 07-Jul 08 % Growth

Praxis 1,250,000 2,474,861 97%

Gayatra 3,500,000 4,728,573 35%

Pioneer Launched Dec 07

720,000 N/A

Total 4,750,000 7,923,434 66 %

Prior to intervention

After Intervention

Commercial Partners 20/75 72/75

Individual Sales Performance of commercial partners

Increased Geographic Coverage

Results: Sustainability

17,416,357 17,365,62017,843,361 17,823,990

21,419,289

12,000,000

14,000,000

16,000,000

18,000,000

20,000,000

22,000,000

2003-2004 2004-2006 2005-2006 2006-2007 2007-2008

Source: ACNielsen, Retail Market Audit

Private sector market size has increased by 20% since the intervention was initiated, resulting in greater commercial sector role

Results: Efficiency

AED support ($)

Partner Investment ($)

Ratio

Praxis 51,269 250,035 1:5

Gayatra Store

50,577 147,222 1:3

Pioneer 21,481 45,237 1:2

TOTAL 123,326 442,494 1:4

Increased investment from commercial sector

Period: August 2007-July 2008

Full Market Impact

• Creating a sustainable market for maximum public health impact through improved access, sustainability and consumer-focused efficient use of funds

• Three main outcomes – equity, commercial viability, and public health impact– Calculate FMI Index– Model births averted– Model HIV infections averted

Implications: Replicability

• Key results areas can be applied to multiple interventions beyond private sector partnership development models

• Results derived from multiple methods and approaches applied throughout project performance period

• Translate FMI to non private-sector approaches

Implications: Data Quality

• Triangulation of data from household surveys, retail audits, sales reports, GIS mapping, qualitative inquiry

• Private-sector model results in nation-wide intervention and agnostic “selection” of program areas

• Inability to identify “control” areas because of model’s reach and ethical concerns of not providing the intervention

Is this Impact?

• Apply models to measure public health impact using program data – cases averted

• Define program context that potentially contributed to and stalled program implementation over the three-year project period – attribution and speeding up secular change

• Estimate costs of tracking results to measure impact – making budgetary allocations