Recommendation to Donors
Dear Mr. Roijmans:
Thank you for your interesting and informative interview. I would like to ask you to expand a bit on your recommendation to donors in question 6: “we would support donors who are withdrawing from the public segment to create a safety net enabling women continued access to contraception at affordable prices. This would also help local governments to direct scarce resources to women who cannot afford to pay for contraception. The same applies globally: it will enable donors to redirect funds to those countries where the unmet need is most important, like in the Sub Sahara region.”
My understanding is that in appropriate countries donors should stop providing free contraceptives to the public sector but fund subsidized access to products, or some type of means-tested alternative to free contraceptives. A big challenge for both governments and NGOs is deciding who is eligible for free or subsidized commodities. The administrative burden that this represents can often overwhelm public employees or force them to make arbitrary decisions. Do you know of a good model for this type of market segmentation?
Thank you,Susan Wright
Private Sector Team Leader
GH/PRH/SDI
USAID Washington DC
Answers
Dear Ms. Wright,
Thank you very much for this both interesting and challanging question.
The point I wanted to make is that in countries where considerable socio-economic progress has been made resulting in both high awareness of the need for family planning which has been translated in a high Contraceptive Prevelance Rate, and at the same time ability to pay, room to manouver could be available to alleviate the public burden of financing family planning programs. In such countries implementation of concerted strategies can transform government and donor supported family planning programs into private market development. The focus changes from ability to pay to willingness to pay. In countries where contraceptive prevelance is low, combined with a high poverty rate, free contraception is still very important because it takes away a barrier to improve fertility rates and increase contraceptive use. For countries that float between these two extremes it becomes more complicated. Who is eligible for free or subsidized contraception and who should pay for their contraception?
The key to develop the use of contraceptives that are subsidized or entirely paid by women, is to my opinion to enlarge and differentiate the products that are offered in these segments as compared to free contraceptives and to choose/develop different market- and service delivery outlets. A different value offering should then draw women to these new segments. Involvement of the private sector is needed to accomplish this. In countries where sufficient opportunities exist, co-operation between Ministries of Health, donors, development organisations and the pharmaceutical industry would be an excellent start. Sit down together and analyse the environment to come up with appropriate strategies that are complementary to develop segments where contraceptives are paid for. Also the co-operation with universities and societies like OB/GY, GP's and pharmacies etc., including the media, is in my opinion important to develop a market of contraceptives that are worth paying for.
Kind regards,Frank Roijmans
