What Ethiopia Taught Us about the Contraceptives Market

By Danielle Garfinkel, FPwatch Communications Fellow, PSI

How do you get contraceptives into the hands of 6.2 million women and girls? Since committing to reach this goal in 2012 as part of the FP2020 initiative, Ethiopia has made significant progress, with 1.5 million additional contraceptive users as of 2015.

As we pass the half-way point of this ambitious eight-year goal, it is critical to understand the current landscape of contraceptive access and identify areas that need strengthening. The FPwatch project, PSI’s multi-country research initiative funded by the Bill and Melinda Gates Foundation (BMGF) and the Three Millennium Development Goal (3MDG) Fund, aims to fill evidence gaps by looking at the family planning (FP) markets in Ethiopia, Nigeria, the Democratic Republic of Congo, Myanmar, and India.

Results from FPwatch’s 2015 outlet survey in Ethiopia are providing key market data on family planning indicators. In the context of PSI’s Market Development Approach, data from FPwatch provides a crucial snapshot on market performance. The survey – which was administered in 2015 to more than 2,000 public and private facilities and outlets in four regions of Ethiopia – collected comprehensive data on family planning product availability, market share, cost, method diversity and service availability.

The study findings were extensive, but several key points emerged:

  1. Long-acting reversible contraceptives (LARCs) distributed by public sector outlets account for the majority of market share in couple years of protection (CYPs) – a measurement of the protection from pregnancy provided by contraceptive methods during a one-year period – in Ethiopia. Just 17.5% of contraceptives are distributed by private sector outlets, and most of these are short-acting.
  1. While there is little price variability among private outlet types, the most commonly used method, injectables, are three times the cost of implants and four times the cost of IUDs per CYP (contraceptives distributed by public outlets are typically free).
  1. Findings showed generally high diversity in contraceptives available with nearly 100% of public outlets and 75% of private outlets with three or more methods available. Findings suggest a strong potential for public/private collaboration to increase contraceptive access and choice.

Ethiopia’s family planning community has begun interpreting these results into actionable strategies towards the country’s FP2020 goal. On June 28, 2016, thirty-five stakeholders from 22 leading governmental, nonprofit, academic and private institutions gathered in Addis Ababa to review the FPwatch findings and discuss Ethiopia’s family planning approach moving forward. The Director of the Maternal and Child Health Directorate at the Federal Ministry of Health, Dr. Ephrem Tekle Lemango, acknowledged the role of the private sector and how the public sector already covers the lion share of the FP commodities supply, and applauded the role of health extension workers (HEWs) in FP coverage.  Dr. Lemango also urged alignment of goals and programs with Ethiopia’s five-year Health Sector Transformation Plan, which calls for reducing the national unmet need for family planning, increasing the CYP, and addressing the reproductive needs of adolescents.

With this in mind, event participants considered action items as they relate to three of the Reproductive Health Supplies Coalition’s strategic pillars: availability, quality, and choice. Together, they identified the following action items based on FPwatch Ethiopia findings:

Availability

  • There are opportunities to leverage the private sector, particularly for the provision of LARCs.
  • Careful attention should be paid to market segmentation when assessing willingness-to-pay and determining subsidy levels and equitable implementation of subsidies.
  • The high cost of emergency contraception should be explored and addressed.
  • Expanding the capacity of Health Extension Workers to provide IUD services would broaden contraceptive access. Task-sharing for pharmacies should also be explored.

Quality

  • More information is needed on where and why failures occur along the supply chain.
  • Surveillance and monitoring data can strengthen the supply chain. Incentives for government data forecasting should be identified.
  • There is a need for strategies and mechanisms that encourage private sector data reporting and collection.

Choice

  • Few differences between geographic areas were observed. Those that did exist were primarily related to higher method availability and diversity in urban versus rural regions. Initiatives to expand method availability should focus on rural areas.
  • There is a need to address barriers to market entry, such as regulation policies, to expand choice and address the apparent low product diversity.

If widely shared with decision-makers, these action items can help achieve Ethiopia’s FP2020 goals. How can you help to encourage evidence-based action and market driven progress for family planning in Ethiopia?

  1. Spread the word! Share this blog or one of the many materials available about Ethiopia’s FPwatch results.
  2. Email us to get more information or to collaborate.
  3. Visit our website to learn about the FPwatch program in Ethiopia and our other study countries. You can also take a look at PSI’s Adolescents 360 initiative to see how our other efforts continue to grow the market for FP and work to reduce unmet need specifically for adolescents.