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!