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A journey with condoms



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  • 1. A Journey with CondomsASSESSMENT OF CONDOM SOCIAL MARKETING (CSM) IN LAO PDR Roberto A.O. Nebrida, MDM, IMPM, MA CSM International Consultant 06 August 2010
  • 2. TOR: Objectives1. Review existing initiatives2. Describe CSM and its stakeholders3. Review CSM-related policies and plans4. Identify gains, strengths, gaps and weaknesses5. Identify lessons and make recommendations
  • 3. Methodology Review of existing documents Key informant interviews Focus group discussions Ocular visits
  • 4. Limitations Mainly about male condoms Short duration: rapid appraisal Key provinces/cities Purposive respondent selection Language barrier
  • 6. PSI
  • 7. PSI
  • 8. Key Concepts: 4-AsAccessibility = Availability + Adequacy + Acceptability + Affordability
  • 9. Key Concepts: 7-PsMarketing Mix = People + Product + Positioning + Price + Promotion + Place + Policy
  • 10. Key Concepts: What is socialmarketing?1. Role of marketing techniques Customer at the center
  • 11. Key Concepts: What is socialmarketing?2. Focus voluntary behavior change (e.g., use condom, abstinence)
  • 12. Key Concepts: What is socialmarketing?3. Benefit individual > group > population
  • 13. Findings: People (Customer)1. “Where do I belong?”Service/sex workers, MSM, migrants, young people, mobile population, ethnic minorities, married couples, government officials, businessmen, etc…
  • 14. Findings: People (Customer)2. “I am not what you think!”Demographics/Sociographics/“Geographics” Psychographics
  • 15. Findings: People (Stakeholders)1. Program managers & implementers: “How social is social marketing?”
  • 16. Findings: People (Stakeholders)2. Distributors/retailers/frontliners “Oh, so you are…?”
  • 17. Findings: People (Stakeholders)3. Development Partners “Shall I push or pull?” Ventiane Declaration
  • 18. Findings: Product (Condom)1. “I am Number 1… I lead the way!” Male condom very popular; female condom… what? At least 15 different brands Number 1 in 90% of 2,000 pharmacies 47M to 63M distributed??? USAID 70%
  • 19. Findings: Product (Condom)2. “How do I look like? … and smell?” Number 1 = 5 variants (color/scent) Deluxe… pwee! UNFPA unbranded… yuuummmmyyy!
  • 20. Findings: Product (Condom)3. “How many do they want? … Are there enough condoms?” Demand: 6.3M in 2010 (conservative) Supply: 6.4M (39%) Gap: 61%!
  • 21. Findings: Product (Condom)4. “Are they coming in, yet?” 4-5 months stock-out cases Delays, no response from PSI PSI transition under 2010 mktg plan
  • 22. Findings: Product (Condom)5. “Can this small thing really perform?” Condom breakage incidents “partner takes too long…”
  • 23. Findings: Product (Condom)“Keep it going…” Improved variant: Deluxe+ Lube sachet difficult to open Too little lube Lube smudge… “oh, I thought it’s blood”!
  • 24. Incremental Growth Rate of Condom Distribution, PSI
  • 25. Findings: Product (Advice)By peer educators, outreach workers…1. “Let’s talk about what you want” Trainings too disease-focused Fear as motivator? Aspiration as motivator?
  • 26. Findings: Positioning1. Condom in general“Which position is best?” Dual protection HIV/STI emphasis Stigma? Stress benefits!
  • 27. Findings: PositioningNumber 1 condom:2. “Am I the same or different?” Reactive, defensive tagline “space” in the customer mind: BMW = speed; Volvo = safety
  • 28. Findings: Positioning3. “Different strokes for different people” Too many brand extensions (5 variants) Confusing packaging Inadequate labeling Difficult to open PSI new design to be launched soon…
  • 29. Findings: Price“I am not cheap… I am just affordable” Normally 40% cheaper than the cheapest commercial brand Commercial brands: 5K to 25K! New pricing soon…
  • 30. Findings: Price“At least, I earned some money” GFATM 1.25M dollars = 0.2M dollars Total: USAID+GFATM = 0.5M dollars Heavy subsidy… what will happen if no donor?
  • 31. Program Income (LAK) Year USAID GFATM 1999 166,188,000 - 2000 204,460,000 - 2001 274,142,000 - 2002 239,303,000 - 2003 340,893,000 70,800,000 2004 436,184,000 41,116,000 2005 244,959,000 388,192,800 2006 250,542,000 327,012,800 2007 213,491,600 42,822,750 2008 343,267,815 400,441,800 2009 26,221,000 379,752,700 Total 2,739,651,415 1,650,138,850USD 333,291 200,747% Dist 62 38Total, USD 534,038Source: PSI
  • 32. Findings: Promotion1. “How long will I wait?” Long delays--- up to 5 months! Lack of coordination Box on top: rain and sun PSI about to engage a FMCG distribution company
  • 33. Findings: Promotion2. “Wanna try?... (but you have to pay me next time!” “Slow down please”
  • 34. Findings: Promotion3. “Your car… or mine?” 3 parallel systems: PSI, UNFPA, private Condom revolving fund PSI: “we do not intend to stay forever in Lao PDR…”
  • 35. Findings: Promotion4. “How will I make you happy?” Area distributors: “free4all” => “tight network” OHW & Peer Eds: support us better… “we need more gas!”
  • 36. Findings: Place1. High and low penetration 7 provinces: 76%; 98% pharmacies 7 provinces: 25% non-trad (drinkshops, guesthouses, karaoke bars, etc Peer education = no impact on availability of condom in drinkshops?
  • 37. Findings: Place2. “I want another place” Only 25% in non-trad outlets How about remote areas
  • 38. Findings: Place3. Condoms are “hot” MOH-MLC complex big capacity PSI warehouse good location But galva roof too low; poor ventilation (39 deg C during summer => max 40 deg C USAID boxes: good labeling Thai-Nippon: inadequate labeling
  • 39. Findings: Place4. “When will you take me out?” 6.7M condoms in stock since 2008 USAID 3.7 M deluxe; others scented 3.2M condoms expired in the past PCCA complaints on short shelf-life PSI clearing the pipeline: OK but what to do with 6.7M stock with old labels/packs and will expire in 2 years?
  • 40. Findings: Policy1. Role of Gov’t: “Police or Farmer?” Govt sectoral plans + new AIDS law Decree on ass’n establishment: create robust civil society opportunity Regulatory framework for condoms Revolving fund for condoms
  • 41. Findings: Policy2. Directions, Keeping Track“Which way?” Draft 2011-2015 NSAP
  • 42. Findings: Policy3. “How will I know you are there?” PSI TRAC and MAP surveys (with Google) eLIMs Lack of data; unreliable data Lack of transparency
  • 43. Findings: Policy2. “Actually, all of these are yours!” Vientiane declaration: ownership… Transition from PSI National/local capacity: social entrepreneurship and enterprise development and management
  • 44. Conclusions1. Four As = Accessibility Availability = now with 15 brands; non- trad shops and rural areas lacking Adequacy = high unmet need Acceptability = norm in some groups; inconsistent use; stigma is high Affordability = 40% cheaper; equity?
  • 45. Conclusions2. Marketing “mix” = 7Ps Effectiveness = 90% of pharmacies; social norm in certain groups; reduction of STI supply gap; expired condoms; delays; stock-outs
  • 46. Conclusions2. Marketing “mix” = 7Ps Efficiency = business sector potential high subsidy; donor dependency; low cost recovery; low turn-over certain groups; reduction of STI
  • 47. Conclusions2. Marketing “mix” = 7Ps Sustainability = ????????? ?????????
  • 48. Recommendations“Where to from here…?1.Short-term/Immediate (Year 1-2): Bring the system back on track and deliver the goods to where they should be. Correct defects, resolve issues and harmonize selling and free distribution. Address the “bolts-and-nuts” issues identified in this assessment.
  • 49. Recommendations“Where to from here…?2.Medium-term (Year 2-3): Integrate the two parallel systems to make them function as one but with decentralized decision making and operational structures involving all stakeholders down to the village level.
  • 50. Recommendations“Where to from here…?3.Long-term (Year 3-5): Develop the capacity of national and local structures (government, local NGOs, and private sector) to undertake specific roles in the integrated national health social marketing (HSM) system. Disassemble the grant-driven project silos and integrate them into the HSM, which will then become an important cog of the country’s public health system.
  • 51. Recommendations: Details (1) Review the marketing plan and transform it into a detailed business plan: Pay attention to product availability, adequacy, acceptability, and affordability and cost effectiveness hinged on equity. Re-organize and re-energize the distribution system: Engage a reliable logistics outfit. Identify key area distributors with their respective sub-network. Build their capacity to perform their roles. Re/launch the condom brand: Conduct a detailed psychographic survey in each segment and use insights for product development, positioning and promotions. Enhance the BCC service: Link it tightly with the promotion of condom and other healthy behaviors. Improve content and delivery system. Use new media.
  • 52. Recommendations: Details (2) Organize a condom programming committee and capacitate them in the area of social entrepreneurship and enterprise development with emphasis on social marketing. Set-up a national condom quality assurance system. Set-up a modular yet linked telephone/internet- based logistics management system by enhancing the existing eLIMS. In tandem with the provincial-level condom distribution network above, organize and capacitate health stakeholders at the local level through the PCCAs and DCCAs.
  • 53. Recommendations: Details (3) Develop national and local ownership of the social marketing system to include not only condoms but other much-needed health commodities and services as well. Develop civil society. Encourage development-oriented Lao citizens to be involved not only in the HIV response but in other health areas as well. The recent decree on association formation will provide the policy framework on this very important initiative. Make public health system delivery structure more robust and integrated and more capable of engaging local civil society and the business sector in the area of HIV and STI prevention. Link with international development organizations (multi/bilateral, INGOs, etc) and encourage them to develop customized local health solutions built on the strengths of Lao society (e.g., indigenous leadership, close family ties, etc) with emphasis on HIV and STI.
  • 54. Thank you! … and Good Luckin your CONDOM journey!