1. A TOTAL MARKET APPROACH TO IUD PROVISION IN THREE STATES OF INDIA: ISSUES AND LESSONS LEARNED KALI PROSAD ROY PUSPITA DATTA GARY MUNDY NAYANJEET CHAUDHURY 9 th World Congress on Health Economics Correspondence author kaliprosad@psi.org.in

2. TMA means all sectors, i.e. public, commercial, and socially marketed will 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 page 2 What is TMA?

3. Inefficiency in IUD market with wealthier segments of the population benefiting from free product Key message page 3

4. page 4  IUD use in India is stagnant for 15 years at less than 5%  Government of India provides free IUDs through public health facilities and SMOs provide IUDs through private providers  PSI India is promoting IUDs in in three states Background  This paper describes initial efforts to track IUD market composition; source of IUD use and trends across wealth quintiles

5.  Data from IUD insertions reported by private clinics and public health facilities used to estimate size and composition of the market.  One cross sectional survey among women of reproductive age conducted in 2012 (N=6500)  Wealth quintiles created using household assets and assigned weights as per the national standard provided in DHS (NFHS, 2005)  Government of India Health Management Information System data has been used for insertion reported from public sector while a combination of PSI MIS and panel survey data for private sector IUD insertion Methodology page 5

6.  Annually there were approximately 470,000 IUD insertions across the three project areas.  Around three quarters of insertions are through public health facilities page 6 Findings

7. page 7 * CPR without sterilization CPR and IUD use among wealth quintiles Findings  IUD use increasing as the wealth quintile increases

8. Source of IUD supply among wealth quintiles  50 % of IUDs among the highest wealth quintile are obtained for free  61% of IUDs among the lowest wealth quintile are obtained for free Findings

9.  The market composition in programme areas indicates a high burden of IUD supply on government, very little market share for private sector and SMOs.  Among the poorest two wealth quintiles, >55% women obtained free IUD from government. The same is true among the two wealthiest quintiles.  SMOs should work in collaboration with the government and commercial sector to meet the IUD needs of women according to their ability to pay: poorer segments should benefit from subsidized product, wealthier segments should obtain IUDs from the commercial sector.  Continuing evaluation through TMA approach and strengthening the market metrics should be a central part of these efforts. Conclusion page 9