Full Market Impact: Measuring
Impact of Private-sector Health
Projects
AED’s N-MARC Project
Nepal
Nadra Franklin
March 31, 2009
Nepal Social Marketing & Franchising Project:
AIDS, Reproductive Health, and Child Survival
2006-2009
Goal
Expand the depth, reach, and impact of Family
Planning/Reproductive Health, MCH, and HIV/AIDS
prevention products and services among low socioeconomic populations through sustainable social
marketing and social franchising programs
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
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
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
Key Products and Services
N-MARC invests in subsidized and fully-priced locally owned
brands
HIV/AIDS
Prevention
• Male condoms
• Latex female condom
• Oral contraceptives
Family
Planning/
Reproductive
Health
• Injectable contraceptives
• Long-term methods (IUD and Norplant)
• Emergency contraceptive pills
• Clean delivery kits
Maternal &
Child Health
• Oral rehydration salts
• POU chlorine solution
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
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
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)
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
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
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
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
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
Full Market Impact™
PRIVATE
Coordination
Product
Capacity building
Quality Assurance
PUBLIC
Supply
Market Research
Price
Affordability
Distribution Support/
Marketing Funds
Place
Promotion
Financing
Policy/ Advocacy
Distribution
Demand/Use
Demand Creation/
Matching Funds
Targeted Subsidies
Vouchers
Sustainable
Markets
Equity
Increase Usage of Public Health
Products/Services
Sustainable Public
Health Impact
Family Planning/Reproductive Health
Results (2007-2008)
Indicator
Target
Achievement
Private Sector CYP
312,481
369,977
Private sector oral contraceptive market
size
781,508
912,699
Number of people trained in FP/RH with
USG funds
1,500
1,817
• Male
900
1,252
• Female
600
565
55,000
97,380
• Male
11,000
29,614
• Female
44,000
67,766
Number of people that have seen or
heard a specific USG-supported FP/RH
messages
HIV/AIDS Results (2007-2008)
Indicator
Coverage of condom distribution in geographically
defined areas
Target
Achievement
85%
88%
21,524,709
21,804,780
700
5,466
3,500
43,785
• Male
1,750
29,611
• Female
1,750
14,174
Number of individuals trained to promote HIV/AIDS
prevention through other behavior change beyond
abstinence and/or being faithful
1,600
4,509
Number of franchised health providers trained to provide
STI treatment
1,800
1,674
Sales of USG-supported condom brands
Number of targeted condom outlets opened in “hot
zones”
Number of individuals reached through community
outreach that promotes HIV/AIDS prevention through
other behavior change beyond abstinence and/or being
faithful
Results: Increased Demand and Access
Individual Sales Performance of commercial partners
Aug 06-Jul 07
Aug 07-Jul 08
% Growth
Praxis
1,250,000
2,474,861
97%
Gayatra
3,500,000
4,728,573
35%
Pioneer
Launched Dec
07
720,000
N/A
Total
4,750,000
7,923,434
66 %
Increased Geographic Coverage
Prior to
After Intervention
intervention
Commercial Partners
20/75
72/75
Results: Sustainability
Private sector market size has increased by 20% since the
intervention was initiated, resulting in greater commercial sector role
22,000,000
21,419,289
20,000,000
18,000,000
17,416,357
17,365,620
2003-2004
2004-2006
17,843,361
17,823,990
2005-2006
2006-2007
16,000,000
14,000,000
12,000,000
Source: ACNielsen, Retail Market Audit
2007-2008
Results: Efficiency
Increased investment from commercial sector
Period: August 2007-July 2008
AED
support ($)
51,269
Partner
Investment ($)
250,035
Gayatra
Store
Pioneer
50,577
147,222
1:3
21,481
45,237
1:2
TOTAL
123,326
442,494
1:4
Praxis
Ratio
1:5
Full Market Impact
• Creating a sustainable market for maximum
public health impact through improved
access, sustainability and consumerfocused efficient use of funds
• Three main outcomes – equity, commercial
viability, and public health impact
– Calculate FMI Index
– Model births averted
– Model HIV infections averted
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
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
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