Use of private sector approaches and ICT as a scale-up strategy for family planning:Presentation Transcript
Use of private sector approaches and ICT as a scale-up strategy for family planning: Focus on India Priya Jha, Katherine Lavoie, Victoria Jennings, Meredith Puleio, Rebecka Lundgren APHA–2009
Presenter’s statementI have no relationships to disclose.
Scaling up requires a multi-sectoral approach• Public sector• NGOs• Private sector (includes social marketing and private sales)• Communication technologies
Private sector is primary source of health care • Free services of national health program inadequate due to underfunding, poor quality and lack of reach • 65% of households report primary source of health care as private sector The main provider of care among private providers is a private doctor or clinic
Private sector is most common source of temporary family planning methods Pill IUD Injectable Condoms (%) (%) (%) (%) Public medical 15.3 45.6 11.2 13.3 sector NGO <1 1.0 <1 <1 Private medical 63.7 51.8 82.7 45.8 sector Other (shop, 20.2 <1 4.7 40.4 spouse, friend, etc.) Source: NFHS-3
What do we mean by private sector?• Private medical sector – includes formal (registered) and informal (unregistered) sector – Private hospital/clinic – Private doctor – OB/GYN, General Practitioner, other – Ayurvedic practitioners / homeopaths – Traditional healers – Pharmacy/drugstore – Dai (traditional birth attendant)• Other private sector – Retail shops, online sales, etc.
CycleBeads: Significant private sector potential• Low cost• Available in large quantities through manufacturer• Visual appeal• Supported by simple explanatory materials• Promising results in other countries
Other experiences worldwide• Private sector nurse midwives in Peru• Pharmacy sales in DR Congo, Rwanda, Mali, Ecuador• Philippines: A growing market – Licensed local distributor – Initiation of marketing through pharmacy chain – Sold by private nurse midwives and NGOs• U.S.A.: Internet and retail sales (Whole Foods, etc.)
Be advised when working with the private sector… Characteristics of Marketing considerations: private medical • Profit potential sector: • Demand • Heterogeneous • Willingness to pay • Variable quality • Potential to affect • Limited regulation condom sales • Sustainability • How to position the concerns after product training • How to market the product
Private sector strategies in India
Strategic selection of local CycleBeads manufacturer• Largest contraceptive manufacturer in country• Offer a range of family planning products and other health care products• A “Government of India enterprise” with distribution networks across country• Product lines for free distribution, social marketing, and private sector retail• Internet sales for condoms
Engaging private doctors and medical professional associations• Participate & present at scientific meetings• Train OB/GYNs and medical practitioners at project sites• Involve private doctors and leaders of associations in partners meetings, stakeholder interviews, etc.
Preparing for sales throughAbt Associates’ “Saathiya” Youth-Friendly Network• Trained pharmacists and private doctors• Trained helpline counselors• Developed promotional materials• Conducted willingness-to-pay study• Hosted outreach activities to build awareness and generate demand
Plans are being developed for: • Social franchising through “Merrygold” –branded network of private clinics • Voucher program to obtain family planning products from private clinics • Social marketing pilot project • Advertisements and editorial columns in magazines • Internet sales
Information and Communication Technology
Mobile phones• 4.1 billion users worldwide; 2/3 of this in developing countries• Majority of subscribers men and women ages 15-49• 3 billion use SMS• India has fastest growing telecom market in the world – more than 492 million cell phone users by end of 2009
“mHealth”• Limited resources and fragile health systems in many developing countries are not adequate to meet the needs of people for health information.• Uses of SMS technology for health have been successful at reaching people with the information they need. – Information about opportunities for free exams or treatment (e.g., One World’s Mobile4Good in Kenya) – Reminders for people to take medicines at regular intervals (e.g., SIMpill® Medication Adherence System in South Africa and Botswana).
CycleTel™• mHealth solution• Based on the Standard Days Method (SDM)• Woman sends the date of her menses• User receives text messages with fertility status• Additional messages support correct use, info on other RH issues
Proof-of-concept testing: Lucknow, Uttar Pradesh Phase Objectives1) Focus group • Understand phone use patterns discussions • Determine potential interest among target audience • Explore appropriate messaging and preferences for the service2) Cognitive Verify comprehension of messages interviews3) Manual testing • Assess feasibility of use, satisfaction with ~30 couples with service, and correct use • Troubleshoot problems • Determine how to improve the service
Preliminary results: 54 focus group participants• Need and demand for CycleTel exists• Messages should be precise, non-technical• Men interested in receiving messages• People are willing to pay for the service (15-35 rupees/month) “This is an idea that can change your life.” -Male participant
Next steps…• Completion of proof-of-concept testing• Software development• Pilot testing• Scale up within India; replication of process in other countries
Conclusions• Private sector and information technology approaches show potential to maximize diffusion and reach the tipping point quickly. , These approaches should form part of the scale-up plan• Apply the guiding principles of the ExpandNet model during scale up: participatory, systems approach, evidence based, quality, sustainability, and rights-oriented
References• Holtz, C. Global health care: issues and policies. Sudbury, MA: Jones and Bartlett, 2008.• India To Have 492 Million Mobile Phone User By End-2009. 5/17/09 http://www.thebestdigital.com/india-to-have-492-million- mobile-phone-user-by-end-2009.html• International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS-3), 2005– 06. India: Volume II. Mumbai: IIPS.• Jordans, F. World’s Poor Drive Growth in Global Cell Phone Use. http://abcnews.go.com/Technology/wireStory?id=6986939• Out-of-pocket spending on health care high: Report. http://www.thehindubusinessline.com/2008/12/10/stories/200812 1051490600.htm• Waters H, Hatt L, Peters D. Working with the private sector for child health. Health Policy and Planning 2003; 18(2): 127-137