3 August 2010

Contraceptive Market Analysis in Nicaragua

A Tool to develop Alliances and Improve Commodity Security

¿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.

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

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.

• 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:

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

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

Total Fertility Rate (TFR)

Total Fertility Rate Trends: 1992-2007

4.6

3.93.3

2.7

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

1992-93 1998 2001 2006-07

Total Fertility Rates by Quintile: 2006-07

4.5

3.02.6

1.9 1.8

0

1

2

3

4

5

Q1 Q2 Q3 Q4 Q5

Contraceptive Prevalence Rate Trends

60

6972

57

6670

2.6 2.5 2.6

66

7175

52

60

70

0

10

20

30

40

50

60

70

80

1998 2001 2006-07

Total

Modern Methods

Traditional Methods

Urban

Rural

Contraceptive Use by Quintile

2006-07

12.621.9

28.6 28.7 32.412.6

13.6

15.3 13.712.3

32.9

2722.1 19.3 13.5

34.8 30.2 25.3 24.5 21.4

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Q1 TPA 65%

Q2 TPA 70%

Q3 TPA 75%

Q4 TPA 76%

Q5 TPA 79%

Does not use

Traditional Methods

Other modern

Male Condom

Injectable

IUD

Pill

Female Sterilization

43.533.6

23.2

18.6

15.2

4.7

8.7

32.3

4.3 5.2

0%

20%

40%

60%

80%

100%

1998 2006-07

Traditional Methods

Other modern

Male Condom

Injectable

IUD

Pill

Female Sterilization

Method Mix

Method Mix by Quintile

2006-07

19.3%31.4%

38.3% 38.0% 41.2%

19.3%

19.5%

20.5% 18.1% 15.6%

50.5%

38.7%29.6% 25.6% 17.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Q1 Q2 Q3 Q4 Q5

Traditional Methods

Other modern

Male Condom

Injectable

IUD

Pill

Female Sterilization

Method Mix by Residence Area

2006-07

38.627.3

13.1

14

4.9

1.6

24.442.3

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Urban Rural

Traditional Methods

Male Condom

Injectable

IUD

Pill

Female Sterilization

Unmet Need: Traditional Definition

“women who are not pregnant, do not want to be pregnant, are at reproductive risk and do not

use contraception”

Prevalence and Unmet Need

2001 2006-2007

Modern Methods69.8%

Do not use16.9%

Need FP10.7%

Traditional Methods2.6%

Modern Methods64.3%

TraditionalMethods

4.3%

Do not use16.8%

Need FP14.6%

FP Services Need by Quintile

Total Unmet Need: 10.7%

2006-07

65.2 69.8 74.7 75.5 78.6

13.312

11.1 8.9 7.3

0

10

20

30

40

50

60

70

80

90

100

Q1 Q2 Q3 Q4 Q5

% w

om

en i

n u

nio

n

Met Need for FP Unmet Need for FP

Unmet Need by Geographic Area: 2001 and 2006-07

69.4 71.3

57.568.0

4.0 3.6

4.8

1.5

11.5 10.5

18.710.9

15.1 14.6 19.0 19.6

0

10

20

30

40

50

60

70

80

90

100

Urban 2001 Urban 2006-07 Rural 2001 Rural 2006-07

Do not use

Need for FP

Traditional Methods

Modern Methods

Contraceptive Source

ENDESA

63.6 67.8

7.1 6.5

3.911.9 9.8

11.4 12.4 14.6

6.2 4.5 2.8

62.0

5.0

0%

20%

40%

60%

80%

100%

1998 2001 2006-07

Other source/Does not know

Other NGOs

Pharmacy/Market

PROFAMILIA

Private Clinic/Hospital/Provider

Community Sector

Previsional Medical Company

Public Sector (MOH)

3.6%

Contraceptive Source by Quintile

83.2 80.271.1

59.3

41.0

0.21.2

3.5

5.8

8.3

2.3

4.3

12.2

2.74.5

5.2

4.8

7.0

5.0 8.314.4

20.626.0

1.5 2.1 2.6 3.7 4.6

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Q1 Q2 Q3 Q4 Q5

Other source/Does not know

Other NGOs

Pharmacy/Market

PROFAMILIA

Private Clinic/Hospital/Provider

Community Sector

Previsional Medical Company

Public Sector (MOH)

2006-07

Contraceptive Source by Geographic Area

58.3

79.0

5.7

0.9

5.85.4

4.320.27.5

1.6

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Urban Rural

Other source/Does not know

Other NGOs

Pharmacy/Market

PROFAMILIA

Private Clinic/Hospital/Provider

Community Sector

Previsional Medical Company

Public Sector (MOH)

2006-07

Source of Oral Contraceptives by Quintile

79.3 74.9

59.1

41.9

24.5

0.01.3

2.7

3.3

6.9

11.5 18.9

35.5

48.958.9

0

10

20

30

40

50

60

70

80

90

100

Q1 Q2 Q3 Q4 Q5

Other source/Does not know

Other NGOs

Pharmacy/Market

PROFAMILIA

Private Clinic/Hospital/Provider

Community Sector

Previsional Medical Company

Public Sector (MOH)

2006-07

Source of IUDs by Quintile

93.388.6 86.5

76.3

42.5

6.8

3.4

4.1

25.3

5.9

5.0

6.3

13.0

12.5 11.811.0

0

10

20

30

40

50

60

70

80

90

100

Q1 Q2 Q3 Q4 Q5

Other source/Does not know

Other NGOs

Previsional Medical Company

PROFAMILIA

Private Clinic/Hospital/Provider

Public Sector

2006-07

Source of Injectables by Quintile

87.4 89.584.7

62.3

50.2

5.9

5.1 6.2 9.4

26.9

38.0

3.8

4.14.3

0

10

20

30

40

50

60

70

80

90

100

Q1 Q2 Q3 Q4 Q5

Other source/Does not know

Other NGOs

Pharmacy/Market

PROFAMILIA

Private Clinic/Hospital/Provider

Community Sector

Previsional Medical Company

Public Sector (MOH)

2006-07

Source of Sterilizations by Quintile

84.179.0

74.968.0

51.4

1.43.3

2.96.2

16.2

12.612.6

13.510.7

12.1

4.68.1

12.5

3.35.4 7.4

0

10

20

30

40

50

60

70

80

90

100

Q1 Q2 Q3 Q4 Q5

Other source/Does not know

Other NGOs

Previsional Medical Company

PROFAMILIA

Private Clinic/Hospital/Provider

Public Sector (MOH)

2006-07

Source of Condoms by Quintile

90.9

46.7

24.718.8

7.7

7.5

51.1

66.8

77.391.2

5.4

0

10

20

30

40

50

60

70

80

90

100

Q1 Q2 Q3 Q4 Q5

Other source/Does not know

Pharmacy/Market

Previsional Medical Company

PROFAMILIA

Private Clinic/Hospital/Provider

Community Sector

Public Sector (MOH)

2006-07

Method Mix: Health Insurance Beneficiaries

IUD8.7%

Other0.3%

FemaleSterilization

57.0%

Injectable22.6%

Condom5.5%

Pill18.2%

Vasectomy1.7%

Distribution of Health Insurance Beneficiaries by Supply Source

45.8 42.8

2.819.9

16.0

8.39.34.2

18.9 20.7

5.6 3.30.71.6

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2001 2006-07

Other source/Does not know

Other NGOs

Pharmacy/Market

PROFAMILIA

Private Clinic/Hospital/Provider

Community Sector

Previsional Medical Companies

Public Sector (MOH)

2001 and 2006-07

Intention to use FP in Non-Users

2001 2006-07

I nyectable 38%

Condom 3%

Pill 24%

I UD 8%

Female Sterilization 20%

NS 5% Traditional 2%

Injectable42%

IUD6%

FemaleSterilization

22%

Pill22%

Condom2%

Does notknow/NA

5%

Other/traditional1%

• 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 …

Concentration of the adolescent population (15 to 19 years) in

union, 2006-07

Contraceptive Use by Age and Total

0

10

20

30

40

50

60

70

80

90

100

15-19 20-24 25-29 30-34 35-39 40-44 45-49

CPR all methods

CPR modern methods

Female Sterilization

Pill

IUD

Injectable

Male Condom

Does not Use

Contraceptive Source by Age: 2006-07

69.8 72.7 68.1 68.263.0 61.9

68.8

3.8 10.2 12.4

10.022.217.1 19.7 13.7 11.2 8.4 5.4

0.50.1 1.3

0%

20%

40%

60%

80%

100%

15-19 20-24 25-29 30-34 35-39 40-44 45-49

Other source/Does not know

Other NGOs

Pharmacy/Market

Previsional Medical Company

PROFAMILIA

Private Clinic/Hospital/Provider

Community Sector

Public Sector

Contraceptive Prevalence Rate By Age: 2006-07

82% 81%

59%

74%71%

61%

0%10%

20%30%40%

50%60%70%

80%90%

15-19 20-24 25-29

Sexually Active - Not inUnion

Currently in Union

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

Other, 4.5%

Female Sterilization,

3.6%

Pills, 21.4%

Copper T or IUD, 8.9%

Injectable, 61.6%

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

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

• 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)

• 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)

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?

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?

¿How can Countries and Institutions Improve?….

¿How can we create inter-institutional synergies to reduce disparities and unmet need for

Family Planning services?

¡Without Products…¡Without Products…

…There is No …There is No Program!Program!