JSI Research & Training Institute, Inc. successfully implemented the Together for Health for the U.S. Agency for International Development from 2005 to 2011. For further information on project activites, visit the TfH page on jsi.com.
Improving the Availability, Affordability, and Accessibility of Contraceptives
Pharmaceutical companies in Ukraine reported that more than 85 percent of contraceptives came from pharmacies in 2005. Yet the range of methods available in pharmacies is limited and high-end contraceptives are much more actively promoted than lower-cost brands. Building partnerships between the public and private sectors is key to improving the availability of modern contraceptive methods. Major activities include:
Pharmaceutical training participants.
- Working with pharmaceutical companies to create a range of contraceptive methods available in pharmacies, including the availability of modern methods at prices to suit every pocketbook.
- Managing USAID's donation of free condoms and working with USAID and private pharmaceutical companies to provide free oral contraceptives to vulnerable populations in 2009 and 2010.
- Training pharmacy staff on contraception and basic counseling skills to help them advise clients about the methods of contraception available.
- Using marketing techniques to promote this range of available contraceptives, including the widely-recognized TfH logo awarded to pharmacies that have the full range in stock and to health facilities with providers trained in family planning.
Together for Health Public-Private Partnership
Together for Health launched a groundbreaking Public-Private Partnership on December 7, 2006, between the project, the Ministry of Health of Ukraine, seven manufacturers and distributors of contraceptives, and a market research firm. The core of the partnership is to improve the availability of quality family planning services and supplies by increasing access to accurate contraceptive information and making a broad range of modern contraceptive methods available through pharmacies at affordable prices.
Launch of Together for Health Public-Private Partnership.
The Public-Private Partnership is at the core of TfH's strategy to address a major challenge: ensuring the availability of a range of contraceptives at affordable prices. There are no donated contraceptives in Ukraine; currently the Ministry of Health doesn't procure any. Those available in pharmacies are pricey, at about $6-10 per cycle of oral contraceptives—in a country where the average monthly salary is only $200. It is estimated that 55% of the need for high-priced oral contraceptives is met, but only 25% of the need for mid- and low-priced brands. Moreover, even though pharmacies are widespread nationwide, in both urban and rural areas, there is very little choice of method. Less than one percent of pharmacies have a range of methods in stock (COCs, POPs, injectables, IUDs, condoms and emergency contraception) and most have just COCs and condoms.
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TfH wants to improve this situation using a fully sustainable Total Market Approach, appropriate to a middle-income country aspiring to European living standards (see diagram). This approach recognizes that there are three population categories or tiers:
- A Tier: People who can afford the high-priced, latest generation contraceptives that are readily available—Comprises mostly women from wealthy urban areas.
- B Tier: People with low to medium incomes—The largest market segment and almost equally distributed in urban and rural areas.
- C Tier: People who cannot afford contraceptives and/or have limited access—Includes most significantly women from rural areas with low or no income and decreased access to pharmacies.
The pharmaceutical companies currently target mostly the A tier as this group has the education and the income to obtain the currently available contraceptives. Availability isn't a major challenge for this group.
The middle section of the pyramid, the B tier, is the project's major priority, even though all three tiers of the pyramid should benefit from TfH's work. The Public-Private Partnership plans to increase the availability of a broader range of affordable contraceptives for the B tier by actively promoting a wide range of low- to mid-priced methods produced by the project's commercial partners—at a minimum COCs, POPs, injectables, IUDs, condoms and emergency contraception—that are already available on the market, but often not actively promoted by the pharmaceutical companies.
To reach the population from the C tier, the project is working to encourage the government to procure contraceptives for the poor and disadvantaged. It has been supporting the Ministry of Health to include a budget line item for contraceptive procurement in the new Reproductive Health of the Nation Program 2006-2015, which was approved by the Cabinet of Ministers of Ukraine. TfH also conducted a competition between the regions in the country to participate in the project and awarded extra points to oblasts submitting proposals that committed to local contraceptive procurement. TfH is working with regions that plan to allocate funds—albeit limited funds—to mobilize the money and prepare for procurement.
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