See the 2,456 pharmacies on the National E-Pharmacy Platform
Use of private sector approaches and ICT as a scale-up strategy for family planning:
1. Use of private sector approaches and ICT as a
scale-up strategy for family planning:
Focus on India
Priya Jha, Katherine Lavoie, Victoria Jennings,
Meredith Puleio, Rebecka Lundgren
APHA–2009
3. Scaling up requires a multi-sectoral
approach
• Public sector
• NGOs
• Private sector (includes social
marketing and private sales)
• Communication technologies
4. Private sector is primary source of
health care
• Free services of national health program
inadequate due to underfunding, poor quality
and lack of reach
• 65% of households report primary source of
health care as private sector
The main provider of care among private
providers is a private doctor or clinic
5. Private sector is most common source of
temporary family planning methods
Pill IUD Injectable Condoms
(%) (%) (%) (%)
Public medical 15.3 45.6 11.2 13.3
sector
NGO <1 1.0 <1 <1
Private medical 63.7 51.8 82.7 45.8
sector
Other (shop, 20.2 <1 4.7 40.4
spouse, friend,
etc.)
Source: NFHS-3
6. What do we mean by private sector?
• Private medical sector – includes formal
(registered) and informal (unregistered) sector
– Private hospital/clinic
– Private doctor – OB/GYN, General Practitioner, other
– Ayurvedic practitioners / homeopaths
– Traditional healers
– Pharmacy/drugstore
– Dai (traditional birth attendant)
• Other private sector
– Retail shops, online sales, etc.
7. CycleBeads: Significant private
sector potential
• Low cost
• Available in large
quantities through
manufacturer
• Visual appeal
• Supported by simple
explanatory materials
• Promising results in
other countries
8. Other experiences worldwide
• Private sector nurse midwives
in Peru
• Pharmacy sales in DR Congo,
Rwanda, Mali, Ecuador
• Philippines: A growing market
– Licensed local distributor
– Initiation of marketing through
pharmacy chain
– Sold by private nurse midwives
and NGOs
• U.S.A.: Internet and retail sales
(Whole Foods, etc.)
9. Be advised when working with the private
sector…
Characteristics of Marketing considerations:
private medical • Profit potential
sector: • Demand
• Heterogeneous • Willingness to pay
• Variable quality • Potential to affect
• Limited regulation condom sales
• Sustainability • How to position the
concerns after product
training • How to market the
product
11. Strategic selection of local
CycleBeads manufacturer
• Largest contraceptive manufacturer in
country
• Offer a range of family planning products and
other health care products
• A “Government of India enterprise” with
distribution networks across country
• Product lines for free distribution, social
marketing, and private sector retail
• Internet sales for condoms
12. Engaging private doctors and
medical professional associations
• Participate & present
at scientific meetings
• Train OB/GYNs and
medical practitioners
at project sites
• Involve private
doctors and leaders
of associations in
partners meetings,
stakeholder
interviews, etc.
13. Preparing for sales through
Abt Associates’ “Saathiya”
Youth-Friendly Network
• Trained pharmacists and private
doctors
• Trained helpline counselors
• Developed promotional
materials
• Conducted willingness-to-pay
study
• Hosted outreach activities to
build awareness and generate
demand
14. Plans are being developed for:
• Social franchising through
“Merrygold” –branded
network of private clinics
• Voucher program to
obtain family planning
products from private
clinics
• Social marketing pilot
project
• Advertisements and
editorial columns in
magazines
• Internet sales
16. Mobile phones
• 4.1 billion users worldwide; 2/3 of this in developing
countries
• Majority of subscribers men and women ages 15-49
• 3 billion use SMS
• India has fastest growing telecom market in the
world – more than 492 million cell phone users by
end of 2009
17. “mHealth”
• Limited resources and fragile health systems in many
developing countries are not adequate to meet the
needs of people for health information.
• Uses of SMS technology for health have been
successful at reaching people with the information
they need.
– Information about opportunities for free exams or treatment
(e.g., One World’s Mobile4Good in Kenya)
– Reminders for people to take medicines at regular intervals
(e.g., SIMpill® Medication Adherence System in South Africa
and Botswana).
18. CycleTel™
• mHealth solution
• Based on the Standard
Days Method (SDM)
• Woman sends the
date of her menses
• User receives text
messages with fertility
status
• Additional messages
support correct use,
info on other RH issues
19. Proof-of-concept testing:
Lucknow, Uttar Pradesh
Phase Objectives
1) Focus group • Understand phone use patterns
discussions • Determine potential interest among
target audience
• Explore appropriate messaging and
preferences for the service
2) Cognitive Verify comprehension of messages
interviews
3) Manual testing • Assess feasibility of use, satisfaction
with ~30 couples with service, and correct use
• Troubleshoot problems
• Determine how to improve the
service
20. Preliminary results:
54 focus group participants
• Need and demand for CycleTel exists
• Messages should be precise, non-technical
• Men interested in receiving messages
• People are willing to pay for the service (15-35
rupees/month)
“This is an idea that can
change your life.”
-Male participant
21. Next steps…
• Completion of proof-of-concept testing
• Software development
• Pilot testing
• Scale up within India; replication of
process in other countries
22. Conclusions
• Private sector and information technology
approaches show potential to maximize
diffusion and reach the tipping point quickly. ,
These approaches should form part of the
scale-up plan
• Apply the guiding principles of the ExpandNet
model during scale up: participatory, systems
approach, evidence based, quality,
sustainability, and rights-oriented
23. References
• Holtz, C. Global health care: issues and policies. Sudbury, MA: Jones
and Bartlett, 2008.
• India To Have 492 Million Mobile Phone User By End-2009.
5/17/09 http://www.thebestdigital.com/india-to-have-492-million-
mobile-phone-user-by-end-2009.html
• International Institute for Population Sciences (IIPS) and Macro
International. 2007. National Family Health Survey (NFHS-3), 2005–
06. India: Volume II. Mumbai: IIPS.
• Jordans, F. World’s Poor Drive Growth in Global Cell Phone Use.
http://abcnews.go.com/Technology/wireStory?id=6986939
• Out-of-pocket spending on health care high: Report.
http://www.thehindubusinessline.com/2008/12/10/stories/200812
1051490600.htm
• Waters H, Hatt L, Peters D. Working with the private sector for child
health. Health Policy and Planning 2003; 18(2): 127-137
Hinweis der Redaktion
My colleague Rebecka described a scaling up strategy that thus far has focused primarily on the first of these two groups, so I will focus on the next two - the private sector, and communication technologies. The latter is not strictly speaking a &quot;sector&quot;, but the growing use of several communication technologies suggests that it holds great potential to support scaling up of health innovations. The particular innovation that was the subject of Rebecka's presentation - the Standard Days Method - is alo the subject of mine, so I will not spend time describing the innovation per se, although you will see in the second part of my presentation - on communcation technologies - the innovation may undergo significant change.
National Health Programs (NHP) is that services being provided under them are free for all – but underfunded inadequate provisioning of critical inputs like drugs, equipment, and facilities Does not reach all the population 71 percent of the health budget is contributed by the private sector, of which households alone spend 68.8 percent. This is because the government’s health sector policies encourage the growth of the private healthcare sector, especially for curative services, by investing resources in medical education, providing subsidies and tax exemptions, and offering soft loans to set up hospitals.
% who access private sector is even higher in urban areas.
Family planning services and supplies in India are provided primarily through a network of government hospitals and urban family welfare centres in urban areas and Primary Health Centres (PHC) and sub-centres in rural areas. Family planning services are also provided by private hospitals and clinics and nongovernmental organizations (NGO). From time to time, sterilization camps are organized to provide sterilization services. Pills and condoms are also available in pharmacies, and condoms are also available in shops.
Initiative by Abt Associates to get private sector engaged in providing quality reproductive health services to young people. Network members include pharmacies and private doctors.
Merrygold network: Franchising of private clinics Xxx clinics in xx districts Standardization of quality services and products District and block levels with referrals (“Merry Silver” Run by HLL’s Trust with USAID support Plans to include SDM/CycleBeads are under development
6 in 10 people around the world now have a cell phone subscription. Two-thirds of the world’s 4.1 billion cell phone users live in developing countries! SMS represents a way to transmit timely, personalized health messages directly to a person’s cell phone. A cellular industry body Wednesday said it expects India to have some 492 million mobile phone users by the year-end, compared with 392 million at the end of March. TheCellular Operators Association of India – which represents more than a dozen telecommunications companies offering GSM services – expects the industry’s mobile subscriber base to reach close to 900 million by 2012. GSM is short for global system for mobile communications technology, and three of four of India’s 391.76 million users are on this platform http://www.thebestdigital.com/india-to-have-492-million-mobile-phone-user-by-end-2009.html Going by the recent data compiled by industry watchdog Telecom Regulatory Authority of India (TRAI), the growth is being powered with equal fervor by rural areas, once regarded as low-end, low-volume markets with modest purchasing power. http://abcnews.go.com/Technology/wireStory?id=6986939 http://www.tradingmarkets.com/.site/news/Stock%20News/2141955/
There is significant potential to help them avoid unplanned pregnancy and improve their reproductive health by providing them with timely, actionable, personalized Mobile4Good sends text messages to personal cell-phones to inform individuals about opportunities for free exams or treatment. It also provides a question-and-answer service that allows individuals to ask sensitive health questions in private. This has proven especially effective among young people.
CycleTel is an mHealth solution that will pioneer supplying a modern family planning method directly to a user’s mobile phone.
54 participants interviewed: 4 groups of women (n=32) 2 groups of men (n=16) 1 group of couples (n=6) All focus group participants: Were married and between the ages of 18-28 Owned a mobile phone of their own Had a need for family planning