A journey with condoms

A Journey with Condoms

ASSESSMENT OF CONDOM SOCIAL MARKETING (CSM) IN LAO PDR

Roberto A.O. Nebrida, MDM, IMPM, MA

CSM International Consultant 06 August 2010

TOR: Objectives

1. Review existing initiatives

2. Describe CSM and its stakeholders

3. Review CSM-related policies and plans

4. Identify gains, strengths, gaps and weaknesses

5. Identify lessons and make recommendations

Methodology

Review of existing documents

Key informant interviews

Focus group discussions

Ocular visits

Limitations

Mainly about male condoms

Short duration: rapid appraisal

Key provinces/cities

Purposive respondent selection

Language barrier

Analytical Frameworks

P-3DEMAND

SUPPLY

P-1

P-6

P-5

P-7 P-2

P-4

DEVT CONTEXT

STKHLDRS AGENDA

S-W-O IMPERATIVES

7x7 matrix 4-As

STRATEGIC & OPERATIONALDIRECTIONS

SITU

ATI

ON

SC

AN

FIN

DIN

GS

&

INSI

GH

TSR

ECO

MM

EN-

DA

TIO

NS

PSI

PSI

Key Concepts: 4-As

Accessibility = Availability + Adequacy + Acceptability + Affordability

Key Concepts: 7-Ps

Marketing Mix = People + Product + Positioning + Price + Promotion + Place + Policy

Key Concepts: What is social marketing?

1. Role of marketing techniques

Customer at the center

Key Concepts: What is social marketing?

2. Focus

voluntary behavior change

(e.g., use condom, abstinence)

Key Concepts: What is social marketing?

3. Benefit

individual > group > population

Findings: People (Customer)

1. “Where do I belong?”

Service/sex workers, MSM, migrants, young people, mobile population, ethnic minorities, married couples, government officials, businessmen, etc…

Findings: People (Customer)

2. “I am not what you think!”

Demographics/Sociographics/“Geographics”

Psychographics

Findings: People (Stakeholders)

1. Program managers & implementers:

“How social is social marketing?”

Findings: People (Stakeholders)

2. Distributors/retailers/frontliners

“Oh, so you are…?”

Findings: People (Stakeholders)

3. Development Partners

“Shall I push or pull?”

Ventiane Declaration

Findings: Product (Condom)

1. “I am Number 1… I lead the way!”

Male condom very popular; female condom… what?

At least 15 different brands

Number 1 in 90% of 2,000 pharmacies

47M to 63M distributed??? USAID 70%

Findings: Product (Condom)

2. “How do I look like? … and smell?”

Number 1 = 5 variants (color/scent)

Deluxe… pwee!

UNFPA unbranded… yuuummmmyyy!

Findings: Product (Condom)

3. “How many do they want? … Are there enough condoms?”

Demand: 6.3M in 2010 (conservative)

Supply: 6.4M (39%)

Gap: 61%!

Findings: Product (Condom)

4. “Are they coming in, yet?”

4-5 months stock-out cases

Delays, no response from PSI

PSI transition under 2010 mktg plan

Findings: Product (Condom)

5. “Can this small thing really perform?”

Condom breakage incidents

“partner takes too long…”

Findings: Product (Condom)

“Keep it going…”

Improved variant: Deluxe+

Lube sachet difficult to open

Too little lube

Lube smudge… “oh, I thought it’s blood”!

Incremental Growth Rate of Condom Distribution, PSI

Findings: Product (Advice)

By peer educators, outreach workers…

1. “Let’s talk about what you want”

Trainings too disease-focused

Fear as motivator?

Aspiration as motivator?

Findings: Positioning

1. Condom in general

“Which position is best?”

Dual protection

HIV/STI emphasis

Stigma? Stress benefits!

Findings: Positioning

Number 1 condom:

2. “Am I the same or different?”

Reactive, defensive tagline

“space” in the customer mind: BMW = speed; Volvo = safety

Findings: Positioning

3. “Different strokes for different people”

Too many brand extensions (5 variants)

Confusing packaging

Inadequate labeling

Difficult to open

PSI new design to be launched soon…

Findings: Price

“I am not cheap… I am just affordable”

Normally 40% cheaper than the cheapest commercial brand

Commercial brands: 5K to 25K!

New pricing soon…

Findings: Price

“At least, I earned some money”

GFATM 1.25M dollars = 0.2M dollars

Total: USAID+GFATM = 0.5M dollars

Heavy subsidy… what will happen if no donor?

USAID GFATM

1999             166,188,000                                    -  

2000             204,460,000                                    -  

2001             274,142,000                                    -  

2002             239,303,000                                    -  

2003             340,893,000                   70,800,000

2004             436,184,000                   41,116,000

2005             244,959,000                 388,192,800

2006             250,542,000                 327,012,800

2007             213,491,600                   42,822,750

2008             343,267,815                 400,441,800

2009               26,221,000                 379,752,700

Total         2,739,651,415             1,650,138,850

USD 333,291 200,747

% Dist 62 38

Total, USD 534,038

Source: PSI

Program Income (LAK)Year

Findings: Promotion

1. “How long will I wait?”

Long delays--- up to 5 months!

Lack of coordination

Box on top: rain and sun

PSI about to engage a FMCG distribution company

Findings: Promotion

2. “Wanna try?... (but you have to pay me next time!”

“Slow down

please”

Findings: Promotion

3. “Your car… or mine?”

3 parallel systems: PSI, UNFPA, private

Condom revolving fund

PSI: “we do not intend to stay forever in Lao PDR…”

Findings: Promotion

4. “How will I make you happy?”

Area distributors: “free4all” => “tight network”

OHW & Peer Eds: support us better… “we need more gas!”

Findings: Place

1. High and low penetration

7 provinces: 76%; 98% pharmacies

7 provinces: 25% non-trad (drinkshops, guesthouses, karaoke bars, etc

Peer education = no impact on availability of condom in drinkshops?

Findings: Place

2. “I want another place”

Only 25% in non-trad outlets

How about remote areas

Findings: Place

3. Condoms are “hot”

MOH-MLC complex big capacity PSI warehouse good location But galva roof too low; poor ventilation

(39 deg C during summer => max 40 deg C

USAID boxes: good labeling Thai-Nippon: inadequate labeling

Findings: Place

4. “When will you take me out?” 6.7M condoms in stock since 2008 USAID 3.7 M deluxe; others scented 3.2M condoms expired in the past PCCA complaints on short shelf-life PSI clearing the pipeline: OK but what to

do with 6.7M stock with old labels/packs and will expire in 2 years?

Findings: Policy

1. Role of Gov’t: “Police or Farmer?”

Govt sectoral plans + new AIDS law

Decree on ass’n establishment: create robust civil society opportunity

Regulatory framework for condoms

Revolving fund for condoms

Findings: Policy

2. Directions, Keeping Track

“Which way?”

Draft 2011-2015 NSAP

Findings: Policy

3. “How will I know you are there?”

PSI TRAC and MAP surveys (with Google)

eLIMs

Lack of data; unreliable data

Lack of transparency

Findings: Policy

2. “Actually, all of these are yours!”

Vientiane declaration: ownership…

Transition from PSI

National/local capacity: social entrepreneurship and enterprise development and management

Conclusions

1. Four As = Accessibility

Availability = now with 15 brands; non-trad shops and rural areas lacking

Adequacy = high unmet need

Acceptability = norm in some groups; inconsistent use; stigma is high

Affordability = 40% cheaper; equity?

Conclusions

2. Marketing “mix” = 7Ps Effectiveness =

90% of pharmacies; social norm in certain groups; reduction of STI supply gap; expired condoms; delays; stock-outs

Conclusions

2. Marketing “mix” = 7Ps Efficiency =

business sector potential high subsidy; donor dependency; low cost

recovery; low turn-over certain groups; reduction of STI

Conclusions

2. Marketing “mix” = 7Ps Sustainability =

????????? ?????????

Recommendations “Where to from here…?

1.Short-term/Immediate (Year 1-2): Bring the system back on track and deliver the goods to where they should be. Correct defects, resolve issues and harmonize selling and free distribution. Address the “bolts-and-nuts” issues identified in this assessment.

Recommendations “Where to from here…?

2.Medium-term (Year 2-3): Integrate the two parallel systems to make them function as one but with decentralized decision making and operational structures involving all stakeholders down to the village level.

Recommendations “Where to from here…?

3.Long-term (Year 3-5): Develop the capacity of national and local structures (government, local NGOs, and private sector) to undertake specific roles in the integrated national health social marketing (HSM) system. Disassemble the grant-driven project silos and integrate them into the HSM, which will then become an important cog of the country’s public health system.

Recommendations: Details (1)

Review the marketing plan and transform it into a detailed business plan: Pay attention to product availability, adequacy, acceptability, and affordability and cost effectiveness hinged on equity.

Re-organize and re-energize the distribution system: Engage a reliable logistics outfit. Identify key area distributors with their respective sub-network. Build their capacity to perform their roles.

Re/launch the condom brand: Conduct a detailed psychographic survey in each segment and use insights for product development, positioning and promotions.

Enhance the BCC service: Link it tightly with the promotion of condom and other healthy behaviors. Improve content and delivery system. Use new media.

Recommendations: Details (2)

Organize a condom programming committee and capacitate them in the area of social entrepreneurship and enterprise development with emphasis on social marketing.

Set-up a national condom quality assurance system.

Set-up a modular yet linked telephone/internet-based logistics management system by enhancing the existing eLIMS.

In tandem with the provincial-level condom distribution network above, organize and capacitate health stakeholders at the local level through the PCCAs and DCCAs.

Recommendations: Details (3)

Develop national and local ownership of the social marketing system to include not only condoms but other much-needed health commodities and services as well.

Develop civil society. Encourage development-oriented Lao citizens to be involved not only in the HIV response but in other health areas as well. The recent decree on association formation will provide the policy framework on this very important initiative.

Make public health system delivery structure more robust and integrated and more capable of engaging local civil society and the business sector in the area of HIV and STI prevention.

Link with international development organizations (multi/bilateral, INGOs, etc) and encourage them to develop customized local health solutions built on the strengths of Lao society (e.g., indigenous leadership, close family ties, etc) with emphasis on HIV and STI.

Thank you!

… and Good Luck

in your CONDOM journey!