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

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Presentation on theme: "Full Market Impact: Measuring Impact of Private-sector Health Projects AEDs N-MARC Project Nepal Nadra Franklin March 31, 2009."— Presentation transcript:

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

2 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

3 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 Ps 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

4 N-MARCs Program Strategy Build on 30 years of USAID/Nepals 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

5 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

6 Key Products and Services HIV/AIDS Prevention Family Planning/ Reproductive 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

7 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

8 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

9 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)

10 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

11 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

12 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

13 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

14 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

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16 Family Planning/Reproductive Health Results ( ) Indicator TargetAchievement Private Sector CYP312,481369,977 Private sector oral contraceptive market size 781,508912,699 Number of people trained in FP/RH with USG funds 1,5001,817 Male9001,252 Female Number of people that have seen or heard a specific USG-supported FP/RH messages 55,00097,380 Male11,00029,614 Female44,00067,766

17 HIV/AIDS Results ( ) Indicator TargetAchievement Coverage of condom distribution in geographically defined areas 85%88% Sales of USG-supported condom brands21,524,70921,804,780 Number of targeted condom outlets opened in hot zones 7005,466 Number of individuals reached through community outreach that promotes HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful 3,50043,785 Male1,75029,611 Female1,75014,174 Number of individuals trained to promote HIV/AIDS prevention through other behavior change beyond abstinence and/or being faithful 1,6004,509 Number of franchised health providers trained to provide STI treatment 1,8001,674

18 Results: Increased Demand and Access Aug 06-Jul 07Aug 07-Jul 08% Growth Praxis1,250,0002,474,86197% Gayatra3,500,0004,728,57335% PioneerLaunched Dec ,000N/A Total4,750,0007,923,43466 % Prior to intervention After Intervention Commercial Partners20/7572/75 Individual Sales Performance of commercial partners Increased Geographic Coverage

19 Results: Sustainability Source: ACNielsen, Retail Market Audit Private sector market size has increased by 20% since the intervention was initiated, resulting in greater commercial sector role

20 Results: Efficiency AED support ($) Partner Investment ($) Ratio Praxis51,269250,0351:5 Gayatra Store 50,577147,2221:3 Pioneer21,48145,2371:2 TOTAL123,326442,4941:4 Increased investment from commercial sector Period: August 2007-July 2008

21 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

22 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

23 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 models reach and ethical concerns of not providing the intervention

24 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

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