Landscaping the male & female condom and lubricant market in Cameroon - usaid
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Landscaping the male & female condom
and lubricant market in Cameroon
Applying a total market approach lens to identify programmatic
gaps and sustainable solutions to support delivery of condoms,
female condoms, & lubricant
October 7, 2016
Chris Jones, chris@jonesglobalinsights.com
Kuyosh Kadirov, kkadirov@usaid.gov
Scope of Work & Purpose 3
Donor Landscape 5
Condom Use & Need: Who is the 7
Condom Market Failing?
Condom Market Structure & Trends 10
How is the Market Failing – 20
Inefficiencies & Weaknesses
The Role of Subsidy in the Condom 24
Market
Readiness to Steward a TMA 28
Recommendations Moving Forward 33
Condom Market Landscape - Cameroon
Information & Data Gaps 36
2Project aim: Document the landscape for male and female condoms, lubricants in
Cameroon, through the lens of a total market approach
Landscaping of the condom market (public, commercial, and NGO/SM) will support the development of strategies supporting
sustainable condom use through equitable access to condoms outlined in the National Strategic Plan /Comprehensive Condom
Programming (NSP/CCP)
Objectives:
1. Analyze existing condom/female condom/lubricant programming environment, capacity & resources in country. Map
donor priorities, funding commitments, and partners’ reach in condom, FC, and lubricant procurement, distribution, & promotion.
2. Determine and assess support in Cameroon for a TMA to sustainable condom/FC/Lubricant delivery, exploring capacity
to implement a TMA, and potential coordinating committee mechanisms to steward a TMA
3. Understand who the condom/FC/lubricant market is failing in Cameroon. Segmented by geography, gender, socio-economic
status, risk profile (i.e., Key Population), quantification will identify total estimated NEED of condoms/FC/lubricants by KP, against
existing use / coverage.
4. Understand how the market is failing vulnerable and key populations. Assess stage of market, analysis of actors on
the core supply & demand function, and supportive market functions to dial in where and how the market is failing
populations, and focus interventions of future
5. Fill existing gaps /activities outlined in the NSP/CCP
6. Cameroon is an opportunity to apply, test, and refine a TMA / Market Development Framework in support of
sustainable delivery of key HIV prevention commodities, informing application in other countries and contexts.
3Scope of Work & Purpose 3
Donor Landscape 5
Condom Use & Need: Who is the 7
Condom Market Failing?
Condom Market Structure & Trends 10
How is the Market Failing – 20
Inefficiencies & Weaknesses
The Role of Subsidy in the Condom 24
Market
Readiness to Steward a TMA 28
Recommendations Moving Forward 33
Condom Market Landscape - Cameroon
Information & Data Gaps 36
4The Donor Landscape supporting Condom, Female Condom, & Lubricant Interventions
Rapid phase out of subsidy for commodities next 2-3 years: KfW phasing out support for commodities by
2019; UNFPA ending support for commodities from 2018.
USAID/USG KfW UNFPA Global Fund
Key Supporting Cascade of HIV prevention through condom social Technical Support and HIV prevention among key
Objectives & Prevention to Treatment marketing. ACMS, a member of the PSI Provision of Key FP & HIV pops. PR and primary
description through CHAMP. DoD support network, implementing partner, managed prevention Commodities. implementing partner is
to military. PEFPAR support through PPSAC (HIV/AIDS prevention project CAMNAFAW, an IPPF affiliate.
(commodities) to CBCHS in Central Africa, regional coordinating body)
(FBO), CAMNAFAW (IPPF
affiliate)
Funding Funding and commitments Designing ‘next and final phase of From 2018 no further New Funding model grant
Timelines & made annually. Majority support, ending 2019: 10 million Euros over support for commodities. running over 15 months.
levels prevention commitment 3 years for region – 7m targeting Cameroon. Cameroon classified as
through 5 year CHAMP Programming funding from summer 2017-19, Category B country and shift
program – ($18.8 m through perhaps a year more. Next phase of budget is to GoC financed, sustainable
mid 2019). limited – no funding for Female Condom. provision of commodities.
ACMS could use PI to support SBCC, or
procure FC.
Commodity Commodities (condom, female 70 million condoms procured and Imported 15.6 m condoms in 5 million condoms through
Commitments condom, lubricant) targeting delivered through Dec 2020. No support for 2015, 14.84 m in 2016; 2.46 quarter 1 2018. Lubricant
specific key populations Female Condom. Condoms for SM running at FC in 2016, 1.835 m FC in support as well.
through implementing ~24-30mm condoms/year, 700k FC / year. 2015.
partners. 2017 plans ~7
million condoms, 1.5 million
FC, lubricants
Priority Pops Key Pops General Pop, Key Pops WRA, General pop, & KP SW, MSM, male clients, youth. 5Scope of Work & Purpose 3
Donor Landscape 5
Condom Use & Need: Who is the 7
Condom Market Failing?
Condom Market Structure & Trends 10
How is the Market Failing – 20
Inefficiencies & Weaknesses
The Role of Subsidy in the Condom 23
Market
Readiness to Steward a TMA 27
Recommendations Moving Forward 32
Condom Market Landscape - Cameroon
Information & Data Gaps 35
6Condom Use and Needs– Who is the market failing?
Total market size based on self reported use is 143 million units/year, against total need of ~250 million condoms / year. An estimated 105
million condoms/year are required to fill the gap between self-reported condom use today, and condoms needed to ensure every high risk sex
act is protected with a condom (Universal coverage).
• Volumes of condom use and
need driven by sex work;
estimated more than 98,000 SW
in Cameroon, many of them high
105 million
frequency SW (pop estimates &
behavior data from JHU risk factors study).
• An estimated 25% of men
reported sex with more than one
partner in last 12 months;
condom use less than 50%. (2014
MICR5)
• The high proportion of WRA that
rely on condoms for FP (33%+ of
those using a modern method)
contributes to total condom use.
(2011 DHS cites 66% condom use in method
mix, downward revision from Contraceptive
quantification wkng group)
7Condom Use – Who is the market failing?
• Condom Use high during Higher Risk Sex:
• 82% of SW report using a condom ‘every time’ or ’almost every
time’ they use condom (JHU) 70 66.5
• Bamenda, Bertoua, Ngaoundere lagging every time use.
• 53% of MSM report condom use every time (Johns Hopkins U) 57.4
60 54.7
• Anecdotally, Sex workers, MSM report increasing rates of use.
50 46.5 46.5
43.0
• Usage gaps & Concerns, driven by: 40.5
Pourcentage
37.3
• Self-reported condom use among all women and men actually 40
declined between 2004 and 2011 - Waiting on 2016 DHS data.
• Clients: For SW, clients often insist sex w/out condom. Offering 30
more for sex w/out condom. SW cite lack of ‘social support’ from 15-49 ans
peer group as client knows he can go to next SW if she refuses. 20
• SW condom use w/‘Boyfriends’ or protectors also low – just 15-24 ans
27.5% use condom ‘every’ or ‘almost’ every time. (JHU) 10
• Newer SW entering to profession reported vulnerable
• MSM report conditional use for partners that look “healthy” or 0
strong. Femmes Hommes Femmes Hommes
• Men w/Multiple Partners: Of those reporting sex with more than
2004 2011
one partner in the 12 last months, just 43% of women and 49.5%
of men reported condom use at last sex. (From 2014 MICS) Pourcentage ayant utilisé un condom au cours des derniers
• DHS (dated) indicates significantly lower condom use by lower rapports sexuels à hauts risques parmi les personnes qui ont
wealth quintiles. eu des rapports sexuels au cours des 12 derniers mois ayant
• FC valued as ‘back up’ method when male clients decline condom précédé l'enquête
use.
• Lubricant’s highly valued by MSM and SW, and would like to see
availability in retail outlets.
8Scope of Work & Purpose 3
Donor Landscape 5
Condom Use & Need: Who is the 7
Condom Market Failing?
Condom Market Structure & Trends 10
How is the Market Failing – 20
Inefficiencies & Weaknesses
The Role of Subsidy in the Condom 24
Market
Readiness to Steward a TMA 28
Recommendations Moving Forward 33
Condom Market Landscape - Cameroon
Information & Data Gaps 36
9Cameroon Male Condom Market Structure - 2016
Manufacturers/
Who pays Importers Distributors/ Wholesalers Providers Consumers
Marketers
Manix Private
Pharma Distributors: Ubipharm, Laborex (60%+ Hospital/Clinics Consumers
Domino market) (prestige
Registered Pharmacies segment)
Commercial/ Campharm & other smaller distributors - < 40% (450-500)
SM - Pharma Innotex
Commercial/
SM - FMCG Sure ~90k outlets 76% mkt
Free (public Drug Shops
& other) Prudence Consumers: Gen
Plus Super Markets / petrol
ACMS (~30m/year + ~4m free?) stations Pop and KP:
Semi- • SW
Kiss Boutique / kiosks
DKT (~2.5 m year, planned growth to 4.5m /year) Wholesalers • MSM
Whole- • Truckers
SM brands Bars/clubs//hotels
KfW Entrepreneurs / Wholesalers salers • Military
(leakage)
• Prisoners
Alex Brothels/hostels
dkt
FMCG Distributors
Other street vender
brands
CAMNAFAW (~5m condoms) CBOs (106 -
GF & 6 KP DIC
Global Fund CHAMP (862k condoms)
Generic CHAPMP) OWs Consumers
Condoms USAID/PEPFAR 24% Free
DOD (400k condoms), CDC/CBCHS (416k)
USAID/USG Mobile units (small fee @
• GF ~5m; UNFPA CNLS (4.87m condoms ) HC)
UNFPA
• UNFPA 14.8m; CENAME Public
• USAID: 4.3m
(3.62 m) FSPS Hospitals
Public Health
10
CentersOverview of Cameroon Condom Market
Market about to become more dynamic w/new entrants, although currently limited choice for lower income populations: Free, Prudence Plus, & Alex.
Public Sector – Free & near free Social Marketing Sector Commercial Market
~31% market ~34% of market ~35% plus of market
ACMS: Prudence Plus largely flat sales over 10 years. Established
the condom market in Cameroon, creating widespread access and
• Commercial market volume doubled in
• GoC has included a budget line item for
acceptability; continued promotion (generic & some branded). size over last 10 years, perhaps more.
contraceptive commodities last few years
Consumer price remained at 100 CFA since launch, although shifted
but never spent on that line item
from 4 to 3 condom pack in 2011 and tightened trade margins.
• Very little to no investment in promotion.
(reallocated)
o PPSAC led qualitative brand research paints picture of • ”Prestige Market’ in sophisticated
• UNFPA, USG, & as of 2016, GF Prudence Plus as aging brand ‘of our father’.
(CAMNAFAW) primary supporters of free
pharmaceutical sector stable – growth to
o Revenues do not currently recover commodity + 2014, steady since, focused on high value
distribution. packaging COGS (78% cost recovery).
• Generally coordinated distribution coupled & multiple SKUs. FMCG (Consumer
o Plans in place to launch regional brand which will also
w/outreach/promotion to KPs – enhance sustainability through improved cost recovery. goods) market highly fractured, large #
o USAID targets 11 districts through 6 Broader sustainability strategy in development. outlets, but effective & efficient at
CBOs, DKT just launched Kiss, a youth focused, regional (Central/West distributing needed products, including
o GF (through CAMNAFAW) 29 districts in Africa) brand promising to shake the market up. Priced at 200 and condoms.
10 regions & 105 CBOs; 250 CFA, with 4 variants (flavored / textured).
o Most UNFPA supplied condoms target o Kiss is currently commodity/packaging cost recoverable, • Continued punctuated presence of low
health centers, . supported by lean operations team. Marketing support, end brands, but…
driven at regional level, rolling out later this year.
o Coordinated distribution in overlapping Revenues don’t cover operating costs. • Alex, recent addition to market, is
districts. Support package consistent o Fiesta, an upscale brand planned for launch next year in a affordable @ 200 CFA, and potentially of
across KP (12 condoms, lube) strategic effort to cross-subsidize brands and reasonable quality . Now widely available.
• Free distribution widely appreciated by KPs programming. Found a niche and exploiting with
PPSAC currently undergoing market research to launch affordable attractive product and margins to retail.
(~150 CFA) regional condom targeting youth
11Cameroon’s Commercial Market Structure
The distribution market works – while the consumer goods (FMCG) market is not sophisticated, it has broad, efficient reach. Qualified as
‘Nascent’ to ’Developing’ market using Abt. Associates market indicators.
A tale of two markets - there is little cross-over between the pharmaceutical and FMCG markets. Larger pharmaceutical distributors don’t sell
products available in the ‘open market’( FMCG)– largely because regulated margins make it difficult for pharma to compete.
Pharmaceutical Sector – Low condom volumes, high FMCG – high condom volumes, lower value/price
value/quality questionable quality
• Sophisticated market driven by larger players: Laborex and Ubifarm • Fragmented, less sophisticated then pharma, but it works in
account for ~60+% of market. Sophisticated import, distribution / supply efficiently and effectively distributing products to nearly 90k
chain systems, from warehousing to fleet of trucks supporting delivery. outlets.
• Tightly regulated and controlled: sell to just ~450-500 registered • Larger players include a few (~3) emergent large distributers that
pharmacies + clinics/hospitals / para pharmacies. Margins establishes by also import, such as Henri & Bros, complimented by smaller
law: distributers connected to international FMCG brands (i.e., Nestle).
• customs clearance tax’ (confirm) – 2% • Most FMCG distribution characterized by many dozens of
• Distributer mandated margin: 25% regionally focused, passive wholesalers and many more semi-
• pharmacy mandated margin – 35%
wholesalers, selling product to more than 90k retailers that pick
• Condoms VAT exempt
up on sight. Credit little deployed.
• The French based pharmaceutical system: Distributors do not ‘promote’
• Margins:
or market specific products, but do focus on importation, distribution,
• Import: 5% value tax on good
logistics, supply chain mgt.
• Wholesaler: 33%
• Non pharma products small part of business: ‘Para-pharmaceuticals’
• Semi-wholesaler: 9-28% (depending on quantity, purchase
(toiletries, feminine care, includes condoms) account for just 10% of
behavior)
market.
• Retail: 40%
• Condoms VAT exempt
12Depth of the Condom market– Total volume / size of the market
40% growth in Condom market in last 10 years, largely driven by commercial sector, and free distribution. SM sales largely flat over 10
year period. Robust commercial market, showing impressive growth, indicates potential.
~31%
~35%
~34%
• The total estimated market size of ~70 million condoms/year
is considerably less than the 143 million estimated as used.
• Likely size of commercial sector is underestimated: Condoms are
Data compliments of ACMS & UNFPA’s RH interchange. Commercial market size imported and not registered at customs. Commercial sector likely
estimated through ACMS retail studies and analysis of customs data. ’Free’ aligned larger than the 24 m estimated.
to procurement in given year, not distribution. 2016 data estimated.
13Market Structure
Breadth of
Breadth of Condom Market – Number of brands and activity on market Market
ACMS has 2 brands at 100 Gap in market w/ potential
PPSAC for affordable, cost
CFA – opportunity to Free / Lover’s youth Kiss (dkt)
segment by price plus recoverable brands
retail condom
Free HC / Prudence ? Fiesta? (dkt)
Free & SM condoms Outreach plus Kiss variants
Private sector condom Intimy, Superlove Alex Sure Inotex Mannix Domino
Consumer Price CFA 0–5 17 100 150 - 200 250 500 650 750 1200+ 2400
Poorest Second Third Fourth Richest
Pharmaceutical Sector
“Open market” (FMCG consumer products) ‘Prestige’ Brands
• FMCG selling lower priced, sometimes lower quality products; not • Registered, tested, recognized international, high quality, high value
registered & unknown testing brands. Multiple brands & SKUs with variants, packet sizes. Driven by
• Brands have a punctuated presence, indicating opportunistic, likes of Manix, Innotex, Domino, Sure. Targeting upper market, from
sporadic purchasing by importers. upwards of 650 CFA packet of 3. Prudence and Kiss present.
• ‘Super Alex’ however, was virtually omnipresent w/Prudence Plus.
• Due to legally mandated margin requirements, pharmaceutical
Alex favored throughout the distribution chain b/c of favorable margins
distributors do not sell condoms also available on the ‘open market’ as
it offered throughout, while still affordable to customers @ 150-200
they can’t compete on price.
CFA.
• Fewer SKUs, generally fewer choices than pharma (1-3 per outlet).
Most outlets invest in no more than 2-3 brands.
• Prudence Plus widely available, generally offered only when Alex
refused.
• Leakage of free condoms at times into retail – particularly around hot
14
spots.Market Structure
Affordability
Are Social Marketed Condoms affordable?
• ACMS has not adjusted consumer price The relative cost of social marketed condoms is decreasing
since launch (did shift from 4 pack to 3
pack in 2010, and recently tightened
margins to trade).
• Both SW and MSM report (anecdotally)
condoms are affordable. Effective price
increase
- ”they can easily afford buying for
themselves, the condoms are everywhere’
msm
- “Prudence is affordable. If we don’t get
free, we will go back to paying for them.”
• Priority: Need for Willingness to pay
study to better understand purchase
behavior in a changing market
15
GNI data per WB; relative cost of CYP determined by 100 condoms @ estimated CFA USD exchange rate relative to GNI/capitaMarket Structure
Breadth of
Breadth of the Market: Condom Access and Availability Market
Condoms widely available in urban areas, both for general population through pharmacies, shops, and KPs in
hotspots (bars, umbrella stalls, etc).
100%
90.40%
90% 80.90%
77.80%
80% 73.50%
70% 66.10%
61.40%
60%
50%
40%
30%
20%
10%
0%
• 86% of SW report it ‘easy’ to find condoms, 34% report easy to
ACMS Coverage of outlets – Condoms **(measured as find Female condom, and 42% easy toit find lube. (JHU)
Prudence Plus in 2 or more outlets in a given geographic
territory) • Significant drop off of coverage in rural areas - which aligns
with lower reported condom use - although access aligns
with prevalence (high prevalence urban areas covered).
• SW more likely to buy then get free, with only 5% relying only
SW condom acquisition by outlet and where purchased on free distribution.
from JHU study. 16The Public Sector (Free) Market
What’s wrong with free condom distribution?
• “Lumpy” binge and purge procurement
leading to inconsistent condom supply -
creating challenges for commercial &
SM to sustain retail interest. 2015 / 16 free
• Free condoms are impacting, to an distribution
3x’s that of
extent, SM and Commercial markets - prior 7 year
popping up at retail around hotspots, average
price of 6 condoms for 100 CFA, or 144
for 1,500.
• Subsidy wasted on those that can, and
are willing to, pay
• Both SW and MSM report (anecdotally)
condoms are affordable.
- Willingness to Pay study required
to confirm
Free distribution data from UNFPA RH Interchange site. Procurement, rather than distribution, presented (distribution
17
presented inappendix).Free Distribution – Recommendations
With imminent reduction in funding available for condoms, need to make the best use of scarce subsidy by
targeting those Cameroonians at risk.
• Coordinate future procurement & distribution of free condoms Is it feasible to integrate CHAMP supported CBOs
through quantification that builds in the contribution of SM and into more sustainable ACMS SM interventions?
commercial market actors through the GTTP/TMA work group. Condom Aim to transition KP back to SM products, build on KP
quantification and forecasting for HIV and FP could include support
from Deliver/GHSC. work of ACMS.
Explore possibility:
• Target free distribution to populations based on need through
segmentation, such as geography (i.e., rural, where condoms are not • Targeted interventions could enlist CBO staff to
as accessible & affordable), ability and willingness to pay, and target outlets with Prudence Plus merchandizing
preferences. Approaches could include: (condom promo materials); identifying and linking
o Revisit standard distribution package (currently at 12 condoms/contact) outlets w/ACMS sales teams at high risk areas;
based on consumer segmentation strategies. e.g., high need (low ability to
pay) segment receive package of 12; medium need 6 condoms, etc. linking KP to target outlets; targeted sales to
Determine if outreach workers can be equipped to segment users by need. specific outlets such as hostels.
o Position free condom distribution as behavior change / motivational tool • Secondary benefit of empowering CBO staff, and
rather than source of ‘free supply.’
o Leverage free consumers as ‘samples,’ linking beneficiaries to commercial
potential of program income to support operations.
access points. • Feasibility would require training required for CBO
• Lubricants: Continue to support targeted distribution of free lubricants. staff, systems required to support targeted SM
While demand was expressed for a commercially available lubricant, efforts, how to link KP strategies to social marketing
unsure whether market would support such an introduction w/out efforts, funding to support. Request concept note
investment – Recommend DKT or ACMS explore market potential
and appetite to launch as variant. from ACMS within year.
• Female Condom: Continue targeted free distribution. USAID to • Depends on ACMS sustainability strategy & future
collaborate with KfW to determine how to support continued provision of pricing decisions– will SM be affordable for KP?
Female Condom in support of social marketing efforts.
18Scope of Work & Purpose 3
Donor Landscape 5
Condom Use & Need: Who is the 7
Condom Market Failing?
Condom Market Structure & Trends 10
How is the Market Failing – 20
Inefficiencies & Weaknesses
The Role of Subsidy in the Condom 24
Market
Readiness to Steward a TMA 28
Recommendations Moving Forward 33
Condom Market Landscape - Cameroon
Information & Data Gaps 36
19A framework to analyze the ‘health’ of the Cameroon Condom market1
While market failure or weakness can often be explained by analyzing actors supporting the Supply & Demand function (from
commercial, SM, NGO, & public sector actors), systemic market failure or weaknesses can be understood by analyzing
supporting functions, rules, and financing functions.
Partnerships The ’Donut’ draws attention to the range of
actors supporting market functions.
Coordination
Subsidies The framework distills the key factors
Commodity forecasting influencing how a market operates into four
R&D categories:
Information
Credit facilities 1. Core supply & demand (the target of most
Quality interventions, such as procurement of
Assurance subsidized commodities, or demand
Core Supply & Demand creation for consumers)
2. Supporting Functions such as government
Cause may Distrib- bodies assuring quality, access to market
Problem we
lie here… uters / retail information, or coordinated efforts
Importers consumers see here
wholesalers between the public and private sector;
Or here… 3. Financing Functions in a market such as
condoms generally boil down to how
subsidy is delivered;
Regulations Informal rules 4. Rules environment include regulations
& norms and how products are licensed.
The Donut helps distinguish underlying root
Taxes Licensing causes of a market’s – why it may not be
serving those in need.
1RefBarbara O’Hanlon, Ohealth
Consulting & Springfield Centre
Rules
20Identified Market Constraints Leveraging PSI’s Production to Use assessment tool
DISTRIBUTORS/
IMPORTERS Retailers CONSUMERS
WHOLESALERS
Lower priced condoms of unknown quality; punctuated presence Consumers still have limited options for affordable product – Free,
PRODUCT
in market. Prudence Plus, and Alex.
CORE SUPPLY & DEMAND FUNCTION
Trade is biased toward higher margin products, sometimes
Provider bias toward higher margin product (Alex). Condoms widely cited
PRICE of dubious quality (such as Alex over Prudence Plus);
as being affordable, including KP (SW, MSM).
Prudence not displayed, and generally not initially offered.
Coverage drops fairly dramatically in rural area. However, condoms widely available in urban, peri-urban areas and at / in hot spots.,
PLACE
aligning w/epidemiology
Little business to business product promotion by importers
No harmonized national Social BCC / Category Promotion strategy to
(distributors/wholesalers to retailers) – Little to no brand
PROMOTION address persistent barriers to consistent condom use – which continues
promotion / merchandising occurring (point of sale
to lag in key populations.
materials, etc)
Insufficient understanding, monitoring, and inter-sectoral coordination of the condom
INFORMATION /
market– sectors are not working in coordinated approach to achieve sustainability goals,
PROCUREMETN
COORDINATION goals are not clear. Private sector not engaged; Little procurement coordination of free,
SM, and commercial sector results in leakag e of free into commercial markets, etc.
Free & SM condoms only condoms consistently tested. Quality
QUALITY
SUPPORT
ASSSURANCE
of condoms in commercial market largely unknown – particularly .
lower end condoms such as Alex.
Inconsistent guidance and understanding on requirements to
GUIDANCE register and test condoms means condoms ‘registered’ at import
but not with DPML–no testing happening.
Low level of common understanding of TMA and how to translate
CAPACITY
concept to reality.
While condoms are on the essential list of medicines, disconnect
between how condoms are registered for importation, and
POLICY AND
REGULATIONS
requirements for registration. Insufficient to no guidelines exist
for either registration or testing. Most commercial condoms
RULES
currently not registered, fewer tested.
Informal Rules Conditional Condom use by male clients driven by pleasure, potentially
and norms low risk perception. 21Identified Market Failures in the Cameroon Market
Areas highlighted in red indicate structural weaknesses in the condom market.
Partnerships
Coordination
Subsidies
Commodity forecasting The market Landscaping
R&D exercise identified the
Information
Credit facilities highlighted weaknesses, or
Quality inefficiencies, in the condom
Assurance Core Supply & Demand market.
By addressing the root cause
Distrib-
Importers uters /
of each of these weaknesses,
retail consumers
wholesalers it’s possible to move beyond
traditional procurement and
delivery of condoms to
systemic, sustainable
Regulations Informal rules improvements in the condom
– import & & norms market.
quality
Taxes Licensing
Rules
22Scope of Work & Purpose 3
Donor Landscape 5
Condom Use & Need: Who is the 7
Condom Market Failing?
Condom Market Structure & Trends 10
How is the Market Failing – 20
Inefficiencies & Weaknesses
The Role of Subsidy in the Condom 24
Market
Readiness to Steward a TMA 28
Recommendations Moving Forward 33
Condom Market Landscape - Cameroon
Information & Data Gaps 36
23The role of subsidy in the condom market
How much subsidy is currently required to support cost of condom commodity and packaging?
2015 2016
Male Condoms (commodity & shipping) $839,554 $678,337
Female Condoms $1,539,842 $2,223,455
Total $2,379,396 $2,901,782
• ACMS CSM is currently at ~ 78% commodity and packaging cost recovery. Subsidy estimates assume revenue generated
from sale of condoms are re-invested in commodity. A 25% price adjustment would place the product at or near commodity
cost recovery.
• Important to note donor support / subsidy is required to support distribution, promotion and other programmatic
support.
• DKT’s Kiss condoms (commodity + packaging)) are fully cost recoverable at 200/250 CFA. Light presence in country, coupled
with regionalized program management (from marketing through supply chain mgt.) indicate promising model to cost
effectively support condom provision. Revenues from Kiss do not support operational costs.
• Further analysis required to determine level of subsidy required to support distribution (including to KP), marketing
/promotion efforts. While difficult to understand how subsidy is supporting every element of use (product, distribution/access,
promotion/demand, overheads) it would be possible to make strategic investment decisions understanding.
• Female condoms, at an estimated $0.57/unit, are nowhere near cost recovery; willingness and ability to pay indicate significant
subsidy will be required to support affordable access in future.
Data for Female Condom and male condom extracted from UNFPA RH interchange
site, and SM data from ACMS and DKT interviews. 24Who Does, Who Pays?
How Subsidy is deployed in the Cameroon Condom Market: Current state of the market
Core Supply & Demand
Players
Functions and rules Who does? Who pays? Why?
Donors (KfW, UNFPA,
Manufacture Belief that condoms needed to
Manufacturers USAID, GF) &
(Procurement) subsidized
commercial sector
UNFPA / USAID
GF/CAMNAFAW Donors (mostly)
Importers / Supply chain Has long been this way
ACMS Private sector
Private sector
NGOs
Donors
Wholesalers / Supply chain GoC (CENAME, FSPS) Has long been this way
Wholesalers
Wholesalers
Margins presumed to support
Pharmacies, Retailers, Pharmacies, Retailers,
Retail / Pharmacies / Providers sale and donors to support
CBOs, govt. Clinics Donors
CBOS
Needed to address emergent
Consumer (Demand Creation) Social marketing, CBOs, GoC Donors
threat of HIV
‘Who does, Who pays’ is construct of Springfielde Centre
25Who Does, Who Pays?
How Subsidy is deployed in the Cameroon Condom Market: Future state of the market
Core Supply & Demand Functions
Players
Functions and rules Who does? Who pays? Why?
Donor resources no longer
Manufacture GoC, donors (targeted) &
Manufacturers available, GoC commits
(Procurement) commercial & SM sector
budget line to procure
Private Sector Donors (targeted) Private sector and SM cost
SM entities (cost recovery
Donors (targeted) recoverable, targeted
Importers / Supply chain Program Income)
Sustainable SM entities GoC
procurement of GoC / donors
GoC Commercial sector to support free dist.
Margins support distribution,
GoC (CENAME, FSPS), Donors (targeted), except for targeted donor
Wholesalers / Supply chain
wholesalers Wholesalers, GoC support for high risk pops.
GoC pays for supply chain
Margins presumed to support
Pharmacies, retailers, CBOs, Pharmacies, retailers, GoC,
Retail / Pharmacies / Providers sale. Targeted donor support
Govt clinics donors (targeted
for dist to high risk pops.
Donors (targeted)
Sustained support of demand
Consumer (Demand Creation) NGOs Manufacturers / commercial
creation required by donors.
sector, SM entities
26Scope of Work & Purpose 3
Donor Landscape 5
Condom Use & Need: Who is the 7
Condom Market Failing?
Condom Market Structure & Trends 20
How is the Market Failing – 10
Inefficiencies & Weaknesses
The Role of Subsidy in the Condom 24
Market
Readiness to Steward a TMA 28
Recommendations Moving Forward 33
Condom Market Landscape - Cameroon
Information & Data Gaps 36
27Capability Assessment of Stewarding a TMA
The drafting of the NSP/CPP and formation of the GTTP are important first steps toward a coordinated approach supporting a
sustainable condom market. Both can and should be leveraged to move a TMA agenda forward. Membership composition of the
GTTP has ensured right people at the table.
The stewardship role involves collecting and analyzing data to better understand the market; engaging sectors and actors to coordinate efforts;
monitoring and regulating the quality of commodities; and monitoring progress along TMA indicators. The framework below was leveraged in the
rapid assessment of the readiness of the GoC and partners to steward markets*.
1 2
Understand the Market Policy & Dialogue 3 Regulation
• Data Collection • Mandate & Governance • Sufficient Funding Sources
• Data Analysis • Sufficient Funding sources • Legal Framework
• Data Management • Recognized Need • Regulation
• Data Quality • Monitoring & Evaluation
• Data Dissemination & Application • Human Resources
* Adapted from the Abt Associates: Total Market Approach Stewardship Capacity Assessment Report.
http://www.rhsupplies.org/uploads/tx_rhscpublications/Total_Market_Approach_Stewardship_Capacity_Assessment_Report_-_07_31_15.....pdf 28Critical Components of Stewarding a TMA (I)
Understanding all components of the market – the public, social marketing, and commercial markets is a
critical step in coordinating the market response to support sustainable, equitable use of condoms.
Data Collection / Data Analysis / Data Management / Data Quality / Data
Dissemination & Application
Key Findings & Insights
• ACMS has been tracking key market indicators related to Health Impact, Equity, and efficient use of subsidy
Understand the Market
in Cameroon.
• Data gaps remain - public sector distribution not fully integrated into analysis, while unregistered (‘dark
market’) private sector data – a potentially large element of the market - is not being estimated or analyzed.
• Significant opportunities exist to improve on data quality, dissemination, analysis to inform specific
decisions.
Opportunities & Recommendations:
• Include Understanding of the Market as an integral priority of the GTTP. In addition to core supply and
demand market elements, build into analysis total current use against need, and holistic market elements
such as support and financing functions, the role of rules and regulations in supporting markets.
• Form a sub-working group to lead this important function – designating leadership, milestones, and
supported by clear work plan. The role of the sub-working group will be to present findings to inform
decisions to the broader TWG.
• Adopt a uniform set of indicators to measure progress toward a TMA. New guidance outlining
approaches can be found here Measure Evaluation - indicators measuring FP markets
29Critical Components of Stewarding a TMA (II)
General Consensus the GTTP is ideal coordinating mechanism to support stewardship of TMA, but requires
further investment in capacity development to deliver on the promise.
Mandate & legal framework / Sufficient funding sources / Recognized need /
Monitoring & Evaluation
Key Findings & Insights
• Little common understanding of TMA as concept, and specific activities to support the objectives of a
coordinated, sustainable, healthy condom market.
• Insufficient resources – financial and HR – raised repeatedly as a barrier, particularly by GoC representatives.
Policy & Dialogue
• Consensus that partners would like to see more from the GTTP, focusing on actionable elements of the newly
implemented NSP/CCP to drive interventions forward.
Opportunities & Recommendations:
• Upstream advocacy important to ensure buy in and support for TMA, and implications in implementation
(particularly in relation to improved targeting of subsidy and pending price adjustments). Leverage urgency of
imminent donor pullout.
• Invest (capacity building, ongoing support) in aligning understanding of TMA, & guide activities.
• Prioritize actions around specific agreed activities identified in the NSP/CCP, leveraging resources members
already have in country for early wins.
• CNLS leadership critical, but requires the support of a community of champions. Cascade ownership &
implementation of tasks to members of the TWG. Appoint working groups tackling specific tasks (e.g., sub group
supporting ”Understanding of the market” & “policy & regulatory challenges”)
• “More frequent, less long” meetings. A regular cadence of meetings – monthly was suggested – would ‘make the
meetings more substantive.’
• Leverage M&E, using TMA indicators developed for Cameroon context, to move efforts forward.
30Critical Components of Stewarding a TMA (III)
Regulations establishing quality condoms in market lacking
Sufficient Funding Sources / Legal Framework / Regulation
Key Findings & Insights
• While there are very few barriers to register condoms in Cameroon– a positive for commercial
brands – the quality of lower priced questions is questionable. What testing that is done is by
SM organizations, donors, and high end brands imported through pharmaceutical sector pre
shipment.
Regulation
• Condoms are classified as an essential medicine. However, no formal policy or guidelines exist that
outline requirements for testing or even registration of condoms. It’s therefore possible and
technically legal to import condoms w/out registering them with DPML, or testing them at
LANACOM.
• Unknown and questionable quality of leading condom brands at low end of market.
Opportunities & Recommendations:
• Outreach to importers of Alex to encourage testing. If necessary, seed investment to support testing &
registration of Alex to ascertain quality (Scope of Work & Purpose 3
Donor Landscape 5
Condom Use & Need: Who is the 7
Condom Market Failing?
Condom Market Structure & Trends 10
How is the Market Failing – 20
Inefficiencies & Weaknesses
The Role of Subsidy in the Condom 24
Market
Readiness to Steward a TMA 28
Recommendations Moving Forward 33
Condom Market Landscape - Cameroon
Information & Data Gaps 36
32Market Analysis and Recommendations (I)
Potential interventions to address identified Market weaknesses
MARKET WEAKNESS / FAILURE IMPLICATIONS MITIGATION STRATEGY / RECOMENDATIONS
Invest in evidence based generic category promotion of condoms to continue to
While targeted interventions reaching KP proving support and grow consistent condom usage, complimenting targeted interventions
1. Promotion: No harmonized national Social BCC / effective, emergent trends (to be confirmed with reaching KP.
Core Supply & Demand
Category Promotion strategy to address persistent research) suggests male clients are significant barrier • Emergent affordable brands on market will benefit from category promotion- such
barriers to consistent condom use. to condom use with both SW and non-paying as Kiss, updated Prudence Plus, PPSAC regional condom, and commercial brands.
partners. • Confirm need, approach & messaging through evidence driven design (including
assumption confirmation category promotion needed)
• Support / encourage intro of new brands to expand and sustain promising condom
market. Pending launch of DKT’s Kiss/Fiesta, ACMS regional brand is promising.
ACMS opportunity to rationalize Lover’s Plus brand, currently at the same price point
2 . Product: Consumers still have limited options for • One size fits all solutions limited in growing &
as Prudence Plus, as regional Prudence Plus introduced.
affordable condoms (Free, Prudence, and Alex). sustaining use
• Given launch of Kiss, confirm need of PPSAC youth condom.
• Bring importer / distributor of Alex to the table to benefit from TMA efforts.
• Ensure new entrants have access to market info generated under initiative (7) below.
Conduct national willingness to pay studies amongst market segments, including KPs,
• SM sector (and the ~30m condoms provided in to determine impact of pricing adjustments, and determine how quickly to phase out
3. Subsidy: Current level of subsidy is too high (part I) Cameroon) not sustainable. / reduce reliance on subsidy of condoms.
ACMS has not had price adjustment to consumer since • Harder for commercial brands to compete, & ACMS to develop and share sustainability strategy that addresses cost structure &
launch. KfW entering into final phase of support for SM. retailers to sell the product, reducing access. transitions / repositions SM brands given pullout of KfW. The strategy should lay out
Financing Functions
Commodity/packaging COGS not yet recovered. • Lack of product differentiation and one-size-fits-all incremental pricing changes leading to cost recovery, how coordination with free
approach to different consumer segments inhibits distribution to manage those unable to pay new pricing, and opportunities for cross
use subsidization of brands. Explore whether /how Lover’s Plus can be used to segment
market.
• Coordinate future procurement & distribution of free with SM, commercial sector;
Engage quantification support from GHSC Project/Deliver for compressive
• Free condoms competing with SM and commercial
4. Subsidy: Current level of subsidy is too high (part II) procurement integrating all sectors, shift in market
brands, impeding opportunities for sustainable
• Target free distribution to consumer segment based on need (geography, ability and
Recent surge of free condoms to 18m, or 25% of market development
WtP, preferences).support from GHSC project/Deliver.
market, and can’t be sustained w/UNFPA support • Subsidy wasted on those that can afford to pay
• Implement recommendations in support of improved targeting of free condoms,
declining. • Markets / beneficiaries poorly prepared when
female condoms, and lubricants (slide 19)
UNFPA for condoms ends 2018.
• Explore feasibility (based on addressing defined need) of integrating CHAMP 33
supported CBOs into more sustainable ACMS SM interventionsMarket Analysis and Recommendations (II)
Potential interventions to address identified Market weaknesses
MARKET WEAKNESS / FAILURE IMPLICATIONS MITIGATION STRATEGY / RECOMENDATIONS
5. Quality of condoms in commercial market • ST: Outreach to importers of Alex to encourage testing. If necessary, seed invest in
largely unknown – particularly lower end testing of Alex to ascertain quality (Scope of Work & Purpose 3
Donor Landscape 5
Condom Use & Need: Who is the 7
Condom Market Failing?
Condom Market Structure & Trends 10
How is the Market Failing – 20
Inefficiencies & Weaknesses
The Role of Subsidy in the Condom 24
Market
Readiness to Steward a TMA 28
Recommendations Moving Forward 33
Condom Market Landscape - Cameroon
Information & Data Gaps 36
35Key Questions, Information and data gaps
• What will the impact of pricing adjustments, and rationalizing free distribution, have on use?
o Willingness & Ability to pay studies, by population segment (such as SW, MSM, socio-economic segments of general population) are
required to better understand implications for price adjustments of social marketing segment, adjustments of quantities of condoms
allocated for free distribution.
• What are underlying factors of conditional condom use by male clients, and men & women in high risk
relationships (multiple partners)
o Qualitative research to improve understanding of risk perception and conditional condom use, particularly for male clients and men and
women with multiple partners. Particularly important as SW anecdotally cite men as the factor of condom use.
• What is the true size and value of the commercial condom market?
o Continue to understand market value (indicating potential for private sector actors – ACMS began estimating but data lacks non registered private
sector). Market value can be determined by applying sales volume estimates with estimated sales price. E.g., the estimated value of the social
marketing sector is $1.48m per annum.
o Update number of condom imported from 2015 from customs.
o Data gaps in total market size – particularly unregistered private sector. Find importer of Alex condoms to determine quantities imported, strategy and
plan for the condom, encourage registration and testing.
o Need to clarify purchase behaviors of larger fmcg wholesalers, and more fragmented FMCG importers- who do they purchase from, how decisions
made, etc.
• Further analysis required to determine level of subsidy required to support distribution (including to KP),
marketing /promotion efforts. While difficult to understand how subsidy is supporting every element of use
(product, distribution/access, promotion/demand, overheads) it would be possible to make strategic investment
decisions understanding.
36Free Male Condom & Female Condom Distribution by partner & channel
2016 IPPF / UNFPA Care /
Distribution MOH Units CBCHS CNLS ACMS CAMNAFAW Units CHAMP DHAPP (DoD) Peace Corps Other TOTAL UNITS
Male Condoms
UNFPA 2,603,600 216,000 4,869,912 2,786,400 4,146,088 216,000 14,838,000
USG
1,012,528 200,000 1,359,900 841,000 862,000 400,000 150,000 150,000 4,975,428
Total 3,616,128 416,000 4,869,912 4,146,300 4,987,088 216,000 862,000 400,000 150,000 150,000 19,813,428
Female
Condoms
UNFPA 40,000 388,000 154,000 328,000 90,000 1,000,000
USG 5,000 119,000 130,000 60,000 25,000 339,000
Total 40,000 5,000 388,000 273,000 458,000 90,000 0 60,000 25,000 0 1,339,000
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