1. 3 August 2010 Contraceptive Market Analysis in Nicaragua A Tool to develop Alliances and Improve Commodity Security

2. ¿What is a Market Analysis? A tool to analyze access to services and define strategies to segment, focus, and ensure equitable resource allocation: –Utilizes each country’s demographic surveys –Analyzes contraceptive use, demand, and provision in the whole market (public and private). –Groups clients according to characteristics, needs and/or common preferences.

3. Why is a Market Analysis Conducted? To better understand clients’ needs To better understand coverage and institutional potential to satisfy demand To ensure more effective and efficient use of resources assigned to each institution to provide family planning services

4. What are the Benefits of a Market Analysis? A more complete outlook – Sharing information and data helps stakeholders better understand the market they are working in. The supply adapts to demand – When coordinating service provision among all actors to better fulfill clients’ needs, the supply is tailored to demand and gaps to access are reduced. Client Satisfaction - Clients can have better access to their method of choice, from a convenient source and at a fair price.

5. CS in our country FP/SRH indicators Coverage of the different actors Let’s see a few examples of ….. Market analysis helps us monitor progress in:

6. Geographical Analysis Market Analysis Identified departments with wider gapt to FP access, based on ethnic, economic, educational aspects, CPR in women of reproductive age, unmet need for contraceptives and others Data are reflected on maps to visualize the distribution of each variable and analyze the areas with wider gaps in access Methodology ENDESA 2001 and ENDESA 2006-07 secondary data analysis Each home is classified according to the availability of goods and services –Provides an approximate indicator of socio-economic level: classification by quintiles

7. Quintile Analysis 20% of homes with lowest socio-economic rates 20% of homes with highest socio- economic rates Q5 Q4 Q3 Q2 Q1 Proxy for socio-economic rate based on having goods and services

8. Total Fertility Rate (TFR) Total Fertility Rate Trends: 1992-2007 Total Fertility Rates by Quintile: 2006-07

9. Contraceptive Prevalence Rate Trends

10. Contraceptive Use by Quintile 2006-07

11. Method Mix

12. Method Mix by Quintile 2006-07

13. Method Mix by Residence Area 2006-07

14. Unmet Need: Traditional Definition “women who are not pregnant, do not want to be pregnant, are at reproductive risk and do not use contraception”

15. Prevalence and Unmet Need 2001 2006-2007

16. FP Services Need by Quintile Total Unmet Need: 10.7% 2006-07

17. Unmet Need by Geographic Area: 2001 and 2006-07

18. Contraceptive Source ENDESA 3.6%

19. Contraceptive Source by Quintile 2006-07

20. Contraceptive Source by Geographic Area 2006-07

21. Source of Oral Contraceptives by Quintile 2006-07

22. Source of IUDs by Quintile 2006-07

23. Source of Injectables by Quintile 2006-07

24. Source of Sterilizations by Quintile 2006-07

25. Source of Condoms by Quintile 2006-07

26. Method Mix: Health Insurance Beneficiaries

27. Distribution of Health Insurance Beneficiaries by Supply Source 2001 and 2006-07

28. Intention to use FP in Non-Users 20012006-07

29. Meet their demand for services Reduce unmet need Offer them the most appropriate services Let’s see some examples Need to reach adolescents to be able to …

30. Concentration of the adolescent population (15 to 19 years) in union, 2006-07

31. Contraceptive Use by Age and Total

32. Contraceptive Source by Age: 2006-07

33. Contraceptive Prevalence Rate By Age: 2006-07

34. Client Method Preference: 2006-07 (15-19)

35. Non-User Method Preference: 2006-07 (15-19)

36. Progress The use of modern methods has increased, mainly in quintile 1 Gap in CPR between rural and urban area has been closed Unmet need for FP and TFR has decreased, but % of non-use is the same The use of traditional methods methods has remained the same between 1998 and 2006-07, with a slight increase in the urban area Previsional medical companies (part of the national insurance scheme) began to offer more FP services

37. Method mix shows a great disparity between rural and urban area Difference in CPR and TFR betweenntre Q1 and Q5 is still significant The public sector is the main provider of contraceptives, but provides services to an important % of quintiles 4 and 5 The NGO sector has shrunk, reflecting a slight increase in pharmacies An important % of quintiles 1 and 2 obtain their methods from pharmacies and NGOs Clients with private insurance go mainly to MOH sites To Analyze…(1)

38. Intention of future use among women of reproductive age is concentrated in injectables, followed by sterilization Use and future preference for the IUD, being a cost-effective and innocuous method, has decreased The higher maternal mortality rates are concentrated in the departments with higher TFRs and lower long term and permanent methods 54% of women between 15-24 years prefer the injectable and 26% the pill 79% of adolescents want to use contraceptives in the future To Analyze…(2)

39. Challenges (1) Can the MOH continue fulfilling the needs of every sector of the population? ¿Does it have the financial resources to do this? ¿Where should it focus its efforts, considering budget limits and the global financial crisis? Are the institutions and services prepared to fulfill the current market, and especially, the future market? How can FP services be increased in previsional medical clinics and social security institute sites and have cost-effective methods?

40. Challenges (2) How can access to long term methods be improved in rural areas? How can we ensure access to modern methods for adolescents? What strategies must the public sector develop for people who have the capacity to pay to go to private services? What changes must be considered in form and content to provide appropriate reproductive health counseling? What does the private sector need to improve access to FP in quintiles with the capacity to pay? What role should NGOs play in the supply of FP methods and services? How can we ensure sustainability in this endeavor?

41. ¿How can Countries and Institutions Improve?…. ¿How can we create inter-institutional synergies to reduce disparities and unmet need for Family Planning services?

42. ¡Without Products… …There is No Program! ¡Without Products… …There is No Program!