Full Market Impact: Measuring Impact of Private-sector Health Projects

1. Full Market Impact: Measuring Impact of Private-sector Health Projects AED’s N-MARC Project Nepal Nadra Franklin March 31, 2009

2. GoalExpand the depth, reach, and impact of Family Planning/Reproductive Health, MCH, and HIV/AIDS prevention products and services among low socio-economic populations through sustainable social marketing and social franchising programs Nepal Social Marketing & Franchising Project: AIDS, Reproductive Health, and Child Survival2006-2009

3. A New Model of Private Sector Health Initiative - Full Market Impact™ • Social marketing approach to achieve “total market” development for essential healthcare products and services, coupled with sustainable health impact • Multiple partners from the private commercial sector, NGOs, public sector and civil society to increase the practice of healthy behaviors and generate/fulfill demand for an affordable and accessible range of “public health” products and services • Four P’s of marketing, (product/supply, price/affordability, place/distribution, and promotion/demand and appropriate use) • Three primary outcomes – equity, commercial viability, and sustainable public health impact • Facilitator and broker, steward of donor investment

4. N-MARC’s Program Strategy • Build on 30 years of USAID/Nepal’s investment in social marketing in Nepal • Conduct generic communication campaigns to build ‘total market’ demand for products • Enhance independence of social marketing organizations and local ownership

5. Commercial-Sector Partnerships • Matching funds • Joint-risk, joint-reward approach • 1 to 1 matching ratio (or higher ratio favoring USAID) • Partners responsible for own product procurement • Stimulates commercial-sector investment • Technical assistance • Sensitization to public health issues in Nepal • Refining and developing marketing strategies • Brand rationalization/new products • Market research (e.g. Household behavioral surveys, GIS mapping) • Support local partners’ implementation

6. Key Products and Services N-MARC invests in subsidized and fully-priced locally owned brands HIV/AIDSPrevention • Male condoms • Latex female condom • Oral contraceptives • Injectable contraceptives • Long-term methods (IUD and Norplant) • Emergency contraceptive pills Family Planning/ Reproductive Health • Clean delivery kits • Oral rehydration salts • POU chlorine solution Maternal & Child Health

7. Evaluation Theory Based on Program Theory: Full Market Impact (FMI) • Measure the program model • 7 results areas relate to intervention design • 7 results areas associated with specific indicators • FMI outcome is Impact • Prospective evaluation design • Refers to program model and intervention design • Developed at outset of program • Refined in real-time as program design is refined and revised

8. Result Area1: Improved Supply • Increased production capacity and output • Creating strong links between manufacturers and distributors • Number and percentage of partners utilizing fully developed marketing plans, including market segmentation strategy to facilitate development of sustainable business relationships between manufacturers and distributors (brand building, planning etc) • Providing technical support to expand manufacturing capacity and quality • Number of partners trained in development and implementation of social marketing communication strategies to increase capacity of local partners to design, implement and manage state-of-the-art social marketing and social franchise programs • Expansion of the number of outlets Improved stock management and distribution system

9. Result Area 2: Increased Demand • Generic demand creation campaigns based on extensive research • Increased equity to ensure equal demand and access (Household coverage rates as high or higher among low-income and high risk groups) • Private Market Size per product (Present Sales) • Commercial Market Size per product (Present Sales) • Percent increase in commercial sector market share per product or service (difference between baseline and present sales)

10. Result Area 3: Improved Technologies • Making cutting-edge technology and new products accessible to all manufacturers • Bringing new products to the attention of manufacturers and then to consumers • Latex female condom • Zinc treatment for diarrhea

11. Result Area 4: Increased Distribution • Franchise opportunities and targeted subsidy via commercial sector, vested party or additional donor • Franchising products through training • Voucher schemes • Coverage and reach • More outlets and enhanced stock management

12. Result Area 5: Efficiency • Maximizing public health impact through efficient investment • Resources leveraged by N-MARC project • Number and % of initiatives (e.g. research and communication) that include a minimal level of multi-sectoral representation • Efficiency ratio of using donor resources

13. Result Area 6: Access • Creating a sustainable marketplace for consumers at a variety of price-points • Coverage per product distributed for target population in geographically-defined populated areas • Access saturation index - monitor variations on the levels of coverage and access for enhanced program management, with the ultimate goal of increasing both coverage access at smaller geographically-defined areas and distances to maintain the focus on realizing public health impact

14. Result Area 7: Sustainability • Creating a sustainable business model among manufacturers, suppliers and their distributors to serve long-term consumer needs • Increased number of brands, partners, with steadily increasing investment in market development by commercial sector • Establishment of distribution networks and promotional capacity at the regional and country levels that are not dependant on any donor support beyond project • Sustainability indicator

16. Family Planning/Reproductive Health Results (2007-2008)

17. HIV/AIDS Results (2007-2008)

18. Results: Increased Demand and Access Individual Sales Performance of commercial partners Increased Geographic Coverage

19. Results: Sustainability Private sector market size has increased by 20% since the intervention was initiated, resulting in greater commercial sector role Source: ACNielsen, Retail Market Audit

20. Results: Efficiency Increased investment from commercial sector Period: August 2007-July 2008

21. Full Market Impact • Creating a sustainable market for maximum public health impact through improved access, sustainability and consumer-focused efficient use of funds • Three main outcomes – equity, commercial viability, and public health impact • Calculate FMI Index • Model births averted • Model HIV infections averted

22. Implications: Replicability • Key results areas can be applied to multiple interventions beyond private sector partnership development models • Results derived from multiple methods and approaches applied throughout project performance period • Translate FMI to non private-sector approaches

23. Implications: Data Quality • Triangulation of data from household surveys, retail audits, sales reports, GIS mapping, qualitative inquiry • Private-sector model results in nation-wide intervention and agnostic “selection” of program areas • Inability to identify “control” areas because of model’s reach and ethical concerns of not providing the intervention

24. Is this Impact? • Apply models to measure public health impact using program data – cases averted • Define program context that potentially contributed to and stalled program implementation over the three-year project period – attribution and speeding up secular change • Estimate costs of tracking results to measure impact – making budgetary allocations