Contraceptive Market Analysis in
Nicaragua
A Tool to develop Alliances and Improve
Commodity Security
3 August 2010
¿What is a Market Analysis?
• A tool to analyze access to services and define strategies
to segment, focus, and ensure equitable resource
allocation:
– Utilizes each country’s demographic surveys
– Analyzes contraceptive use, demand, and provision in
the whole market (public and private).
– Groups clients according to characteristics, needs
and/or common preferences.
Why is a Market Analysis Conducted?
• To better understand clients’ needs
• To better understand coverage and institutional
potential to satisfy demand
• To ensure more effective and efficient use of
resources assigned to each institution to provide
family planning services
What are the Benefits of a Market Analysis?
• A more complete outlook – Sharing information and data
helps stakeholders better understand the market they are
working in.
• The supply adapts to demand – When coordinating service
provision among all actors to better fulfill clients’ needs,
the supply is tailored to demand and gaps to access are
reduced.
• Client Satisfaction - Clients can have better access to their
method of choice, from a convenient source and at a fair
price.
Market analysis helps us
monitor progress in:
• CS in our country
• FP/SRH indicators
• Coverage of the different actors
Let’s see a few examples of …..
Methodology
Geographical Analysis
• Identified departments with
wider gapt to FP access, based on
ethnic, economic, educational
aspects, CPR in women of
reproductive age, unmet need for
contraceptives and others
• Data are reflected on maps to
visualize the distribution of each
variable and analyze the areas
with wider gaps in access
Market Analysis
• ENDESA 2001 and ENDESA
2006-07 secondary data
analysis
• Each home is classified
according to the availability
of goods and services
– Provides an approximate
indicator of socio-economic
level: classification by
quintiles
Quintile Analysis
Proxy for socio-economic rate based on having
goods and services
Q5
20% of homes with highest socioeconomic rates
Q4
Q3
Q2
Q1
20% of homes with lowest socio-economic
rates
Total Fertility Rate (TFR)
Total Fertility Rate Trends: 1992-2007
5
4.5
4.6
4
3.9
3.5
Total Fertility Rates by Quintile: 2006-07
3.3
3
2.7
2.5
5
2
1.5
4.5
4
1
3.0
0.5
3
2.6
0
1992-93
1998
2001
2006-07
2
1.9
1.8
Q4
Q5
1
0
Q1
Q2
Q3
Contraceptive
Prevalence Rate Trends
80
70
66
60
50
60
57
71
69
66
75
72
70
60
Total
52
Modern Methods
Traditional Methods
40
Urban
Rural
30
20
10
0
2.6
1998
2.5
2001
2.6
2006-07
Contraceptive Use by Quintile
2006-07
100%
90%
80%
34.8
30.2
25.3
24.5
21.4
70%
60%
10%
15.3
13.7
28.6
28.7
32.9
30%
20%
19.3
13.5
27
50%
40%
22.1
12.3
13.6
12.6
21.9
32.4
12.6
0%
Q1
Q2
Q3
Q4
Q5
TPA 65% TPA 70% TPA 75% TPA 76% TPA 79%
Does not use
Traditional Methods
Other modern
Male Condom
Injectable
IUD
Pill
Female Sterilization
Method Mix
100%
4.3
5.2
8.7
80%
15.2
32.3
Traditional Methods
Other modern
60%
23.2
4.7
18.6
40%
Male Condom
Injectable
IUD
Pill
Female Sterilization
20%
43.5
33.6
0%
1998
2006-07
Method Mix by Quintile
2006-07
100%
90%
80%
70%
38.7%
29.6%
25.6%
17.2%
50.5%
60%
50%
15.6%
38.3%
38.0%
41.2%
Q3
Q4
Q5
19.3%
20%
10%
18.1%
19.5%
40%
30%
20.5%
31.4%
19.3%
0%
Q1
Q2
Traditional Methods
Other modern
Male Condom
Injectable
IUD
Pill
Female Sterilization
Method Mix by Residence Area
2006-07
100%
90%
80%
24.4
42.3
70%
60%
4.9
50%
13.1
40%
Male Condom
Injectable
1.6
IUD
14
Pill
Female Sterilization
30%
20%
Traditional Methods
38.6
27.3
10%
0%
Urban
Rural
Unmet Need: Traditional Definition
“women who are not pregnant, do
not want to be pregnant, are at
reproductive risk and do not use
contraception”
Prevalence and Unmet Need
2001
2006-2007
Do not use
16.9%
Do not use
16.8%
Need FP
10.7%
Need FP
14.6%
Traditional Methods
2.6%
Traditional
Methods
4.3%
Modern Methods
69.8%
Modern Methods
64.3%
FP Services Need by Quintile
2006-07
100
90
11.1
8.9
7.3
74.7
75.5
78.6
65.2
69.8
Q1
Q2
Q3
Q4
Q5
% women in union
80
70
13.3
12
60
50
40
30
20
10
0
Met Need for FP
Unmet Need for FP
Total Unmet Need: 10.7%
Unmet Need by Geographic Area:
2001 and 2006-07
100
15.1
14.6
80
11.5
10.5
70
4.0
3.6
90
19.0
19.6
18.7
10.9
1.5
Do not use
Need for FP
4.8
60
50
Traditional Methods
Modern Methods
40
69.4
71.3
30
68.0
57.5
20
10
0
Urban 2001
Urban 2006-07
Rural 2001
Rural 2006-07
Contraceptive Source
100%
6.2
4.5
2.8
11.4
12.4
14.6
11.9
9.8
5.0
3.9
7.1
6.5
80%
3.6%
Other source/Does not know
Other NGOs
60%
Pharmacy/Market
PROFAMILIA
Private Clinic/Hospital/Provider
40%
Community Sector
62.0
63.6
1998
2001
67.8
Previsional Medical Company
Public Sector (MOH)
20%
0%
ENDESA
2006-07
Contraceptive Source by Quintile
100.0
1.5
90.0
80.0
5.0
2.7
0.2
2.1
8.3
2.6
20.6
5.2
2.3
3.5
70.0
4.6
14.4
4.5
1.2
3.7
26.0
4.8
4.3
5.8
60.0
7.0
12.2
50.0
40.0
83.2
8.3
80.2
41.0
20.0
10.0
0.0
Q2
Q3
Other NGOs
Pharmacy/Market
PROFAMILIA
Private Clinic/Hospital/Provider
Community Sector
Public Sector (MOH)
59.3
Q1
Other source/Does not know
Previsional Medical Company
71.1
30.0
2006-07
Q4
Q5
Contraceptive Source by Geographic Area
100%
90%
20.2
80%
70%
60%
7.5
4.3
1.6
0.9
Other source/Does not know
5.4
5.8
5.7
Other NGOs
Pharmacy/Market
PROFAMILIA
50%
Private Clinic/Hospital/Provider
79.0
40%
30%
2006-07
Previsional Medical Company
58.3
Public Sector (MOH)
20%
10%
0%
Urban
Community Sector
Rural
Source of Oral Contraceptives by Quintile
100
90
80
11.5
0.0
2006-07
18.9
1.3
35.5
48.9
70
58.9
Other NGOs
2.7
60
Other source/Does not know
Pharmacy/Market
PROFAMILIA
50
40
3.3
79.3
Community Sector
74.9
30
Private Clinic/Hospital/Provider
6.9
59.1
Public Sector (MOH)
41.9
20
24.5
10
0
Q1
Q2
Q3
Previsional Medical Company
Q4
Q5
Source of IUDs by Quintile
100
6.8
5.9
12.5
11.8
3.4
90
11.0
6.3
80
4.1
13.0
5.0
70
Other source/Does not know
60
25.3
50
2006-07
93.3
Other NGOs
Previsional Medical Company
88.6
40
86.5
PROFAMILIA
76.3
Private Clinic/Hospital/Provider
30
Public Sector
42.5
20
10
0
Q1
Q2
Q3
Q4
Q5
Source of Injectables by Quintile
100
5.1
90
6.2
9.4
2006-07
3.8
26.9
80
38.0
70
5.9
Other source/Does not know
60
4.3
4.1
50
87.4
89.5
40
Other NGOs
Pharmacy/Market
PROFAMILIA
84.7
Private Clinic/Hospital/Provider
Community Sector
Previsional Medical Company
62.3
30
50.2
20
10
0
Q1
Q2
Q3
Q4
Q5
Public Sector (MOH)
Source of Sterilizations by Quintile
100
90
3.3
12.6
1.4
4.6
8.1
12.6
3.3
80
5.4
13.5
2.9
12.5
2006-07
10.7
6.2
70
7.4
60
12.1
16.2
Other source/Does not know
Other NGOs
50
Previsional Medical Company
40
84.1
79.0
PROFAMILIA
74.9
Private Clinic/Hospital/Provider
68.0
30
Public Sector (MOH)
51.4
20
10
0
Q1
Q2
Q3
Q4
Q5
Source of Condoms by Quintile
100
7.5
2006-07
90
80
51.1
70
66.8
60
Other source/Does not know
77.3
91.2
50
Pharmacy/Market
Previsional Medical Company
90.9
PROFAMILIA
40
Private Clinic/Hospital/Provider
Community Sector
5.4
30
Public Sector (MOH)
46.7
20
24.7
10
18.8
7.7
0
Q1
Q2
Q3
Q4
Q5
Method Mix: Health Insurance Beneficiaries
Condom
5.5%
Other
0.3%
Injectable
22.6%
Female
Sterilization
57.0%
IUD
8.7%
Pill
18.2%
Vasectomy
1.7%
Distribution of Health Insurance Beneficiaries
by Supply Source
100%
1.6
5.6
0.7
3.3
18.9
20.7
9.3
4.2
8.3
90%
80%
70%
60%
50%
16.0
2.8
19.9
2001 and 2006-07
Other source/Does not know
Other NGOs
Pharmacy/Market
PROFAMILIA
Private Clinic/Hospital/Provider
40%
Community Sector
30%
20%
Previsional Medical Companies
45.8
42.8
2001
2006-07
10%
0%
Public Sector (MOH)
Intention to use FP in Non-Users
2001
2006-07
Does not Other/traditional
know/NA
1%
5%
NS 5% Traditional 2%
Female
Sterilization 20%
Pill 24%
Pill
22%
Female
Sterilization
22%
Condom
2%
Condom 3%
IUD 8%
IUD
6%
Inyectable 38%
Injectable
42%
Need to reach adolescents to be able to …
• Meet their demand for services
• Reduce unmet need
• Offer them the most appropriate
services
Let’s see some examples
Concentration of the adolescent population
(15 to 19 years) in union, 2006-07
Contraceptive Use by Age
and Total
100
90
80
CPR all methods
CPR modern methods
Female Sterilization
Pill
IUD
Injectable
Male Condom
Does not Use
70
60
50
40
30
20
10
0
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Contraceptive Source by Age: 2006-07
100%
80%
22.2
17.1
19.7
13.7
11.2
8.4
5.4
10.0
0.5
1.3
0.1
3.8
10.2
12.4
Other source/Does not know
Other NGOs
Pharmacy/Market
60%
Previsional Medical Company
PROFAMILIA
40%
69.8
72.7
Private Clinic/Hospital/Provider
68.1
68.2
63.0
61.9
68.8
Community Sector
Public Sector
20%
0%
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Contraceptive Prevalence Rate
By Age: 2006-07
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
82%
81%
71%
74%
59% 61%
Sexually Active - Not in
Union
Currently in Union
15-19
20-24
25-29
Client Method Preference:
2006-07 (15-19)
Other, 4.5%
Female
Sterilization,
3.6%
Pills, 21.4%
Injectable,
61.6%
Copper T or
IUD, 8.9%
Non-User Method Preference:
2006-07 (15-19)
Progress
• The use of modern methods has increased, mainly in quintile 1
• Gap in CPR between rural and urban area has been closed
• Unmet need for FP and TFR has decreased, but % of non-use
is the same
• The use of traditional methods methods has remained the
same between 1998 and 2006-07, with a slight increase in the
urban area
• Previsional medical companies (part of the national insurance
scheme) began to offer more FP services
To Analyze…(1)
• Method mix shows a great disparity between rural and urban area
• Difference in CPR and TFR betweenntre Q1 and Q5 is still
significant
• The public sector is the main provider of contraceptives, but
provides services to an important % of quintiles 4 and 5
• The NGO sector has shrunk, reflecting a slight increase in
pharmacies
• An important % of quintiles 1 and 2 obtain their methods from
pharmacies and NGOs
• Clients with private insurance go mainly to MOH sites
To Analyze…(2)
• Intention of future use among women of reproductive age is
concentrated in injectables, followed by sterilization
• Use and future preference for the IUD, being a cost-effective and
innocuous method, has decreased
• The higher maternal mortality rates are concentrated in the
departments with higher TFRs and lower long term and
permanent methods
• 54% of women between 15-24 years prefer the injectable and
26% the pill
• 79% of adolescents want to use contraceptives in the future
Challenges (1)
Can the MOH continue fulfilling the needs of every sector of
the population?
¿Does it have the financial resources to do this?
¿Where should it focus its efforts, considering budget limits
and the global financial crisis?
Are the institutions and services prepared to fulfill the current
market, and especially, the future market?
How can FP services be increased in previsional medical clinics
and social security institute sites and have cost-effective
methods?
Challenges (2)
How can access to long term methods be improved in rural areas?
How can we ensure access to modern methods for adolescents?
What strategies must the public sector develop for people who have the
capacity to pay to go to private services?
What changes must be considered in form and content to provide
appropriate reproductive health counseling?
What does the private sector need to improve access to FP in quintiles with
the capacity to pay?
What role should NGOs play in the supply of FP methods and services?
How can we ensure sustainability in this endeavor?
¿How can Countries and Institutions Improve?….
¿How can we create inter-institutional synergies
to reduce disparities and unmet need for Family
Planning services?
¡Without Products…
…There is No Program!