A TOTAL MARKET APPROACH FOR CONDOMS IN MYANMAR Private Sector in Health Symposium 9 th World Congress on Health Economics 6 July 2013 How the private, socially marketed, and public sectors can work together for a sustainable future for HIV prevention Htat HW 1, Longfield K 1, Mundy G 1, Win Z 1, Montagu D Population Services International 2. Global Health Sciences, University of California, San Francisco

The male condom market in Myanmar has been stagnant due to:  Limited demand for condoms among key populations  A dominance of free and socially marketed condoms on the market  A neglected commercial sector Key Message page 2

page 3  Concerns about appropriate pricing strategies and more than 80% commercial market share of Aphaw-brand subsidized condoms prompted PSI/Myanmar to adopt a total market approach (TMA).  Using TMA means that all sectors - public, commercial, and socially marketed - work together to deliver health choices for all population segments, while ensuring that the needs of the poor and vulnerable are met in a more cost-effective and efficient manner. Background

“The Total Market Approach is arguably central to the future of social marketing.” -Richard Pollard -John Meadley -Mark Wheeler REVIEW OF DFID APPROACH TO SOCIAL MARKETING (2003) Total Market Approach

Desired TMA Effects Commercial Sector Social Marketing Public Sector Increased Impact Reduced risk behavior(behavi or change) Increased Impact market (all sectors) fills greater portion of need Increasing income/WTP Increased Equity poor and vulnerable reached equally well Increased Sustainability growing commercial market role -> reduced subsidy required for greater health impact Commercial Sector

Key metrics for measuring TMA for condoms: i)universe of need (UoN) - the number of condoms needed to reach universal coverage in today’s market ii)demand - the proportion of need that is converted into condom use iii)equity – the degree to which the poor and vulnerable use condoms iv)subsidy – the amount of donor or government funding used to make socially marketed and free condoms available on the market v)sustainability – a decreased reliance on subsidy over time demonstrated by an increase in market volume, value, and the number of brands on the market. Methods page 6 Data Source: Data on condom need, condom use, equity came from PSI/Myanmar's population based surveys. Data on market share, volumes, value, and number of condoms were from PSI/M's quarterly retail audits and UNAIDS’s report.

page 7 Findings: Universe of Need & Demand Total sex acts million (68% unprotected) 98.3 million (54% unprotected)  Number of condoms needed decreased  Unprotected sex acts outnumbered protected sex acts  Increased condom use by FSW

Findings: Market Volume & Share page 8  Influxes of free condoms reduced overall market  Retail price for SM condoms 3x lower than commercial condoms  UNFPA “free” condoms sold to consumers; higher price than SM condoms Brand name Retail Price 2011 Aphaw $0.05 UNFPA $0.07 Quality commercial condoms$ $0.49

page 9 Value of SM condoms Value of Commercial condoms Subsidy for free condoms Subsidy for SM condoms Donor subsidies increased over time due to the large market share of free condoms. Findings: Market Value & Subsidy

 Increase demand for condoms among key populations  Decrease dominance of free and socially marketed condoms  Grow commercial sector - ensure that free and socially marketed condoms aren’t crowding out commercial brands  Improve use of donor subsidies and target those most in need Discussion & Recommendations page 10

page 11 Condom demonstration during Peer Education session © Tamlar Soe

 Building strategic partnerships with the private sector  Promote and sell commercial brands to wealthier consumers  Introduce mid-range condoms to fill the price gap between SM and commercial condoms  Working with UNFPA and other public sector partners to accurately forecast need for free condoms and prevent large influxes of poorly targeted condoms from entering the market Next Steps page 12

 The Myanmar condom market is complex. We must consider the unintended effects of subsides on the market.  A total market approach is needed to grow and sustain the condom market in Myanmar, which requires close coordination between the public, socially marketed and commercial sectors.  The long-term vision should be growing the private sector, especially as the economy improves.  The public and socially marketed sector must better target subsidized condoms. Conclusion page 13

Thank You