Strengthening Markets for Reproductive Health: PATH says partnerships show there’s room for the private sector
Editor’s note: This article is part of the Market Dynamics initiative on NextBillion Health Care. The ongoing series is designed to encourage discussion and understanding around how markets impact health outcomes. Click here to read our recently published e-book on the topic.
Ultimately, great new technologies and ideas have no impact unless they reach and are used by the right people. Our work at PATH focuses on finding the ideas that make current health interventions more effective, affordable and accessible. We work with partners around the world to understand markets so that high-impact innovations are produced and distributed at an affordable price, in the right volume and through the appropriate distribution channels to meet demand.
Understanding market issues that affect access is particularly critical for reproductive health commodities. Over 222 million women worldwide are estimated to have unmet reproductive health needs (women who do not want to become pregnant but are not using contraception). This is a very clear need for improving access and choice of reproductive health options. So what does a viable market for reproductive health in low-resource settings look like, and how can it be sustained?
I believe – as do my colleagues at PATH – that every woman around the world, no matter where she lives, should have access to options to meet her reproductive health needs. Access to these options – characterized by the widespread availability of well-designed, high-quality, acceptable and affordably priced products – relies upon strong, healthy markets.
Establishing a viable market for a health technology in Malawi, for example, follows the same principles as in Michigan. We need to design and develop an effective product that can be manufactured at the right cost, quality and volume to meet the demand in a given country. We also need to establish a distribution system that links supply and demand.
So what do we do differently in low- and middle-income countries? In these settings, there are frequently many intermediary funders, which creates additional uncertainty about the size and growth of a market. Coupled with this uncertainty, these markets are typically characterized by low profit margins and high-volume needs, so the economics have to line up just right in order to support development and production and ensure sustainability. Just like with any product, we have to carefully consider where people can most readily access a new health technology, and make sure that our partners and PATH are there to provide the technology at the right price, in the right quantity and in the right format and packaging.
(PATH and its partners talk with women all over the world about reproductive health options. Photo courtesy of PATH)
Which is not to say that market shaping for reproductive health is a new concept. In fact, PATH started in the 1970s on the premise that couples around the world should have access to condoms, birth control pills, intrauterine devices and other modern forms of contraceptives. And many other partners – including many of the members of the PATH-housed Reproductive Health Supplies Coalition – have been operating around this ideal for decades.
At PATH we talk with women all over the world to understand more about the suite of reproductive health options they want. And based on what they tell us, we’ve adapted our approach and the way we work with our partners to address a range of market issues that can inhibit or catalyze access to reproductive health commodities – such as regulatory approvals, demand forecasting, distribution and delivery issues, user awareness and demand, price and health system readiness. We use both short-term actions intended to catalyze specific market changes, as well as interventions that address the long-term sustainability of market health. Both are critical components to securing access.
A great example of PATH’s work with partners to develop a new product is Sayana Press. In assessing gaps in the contraceptive market, we discovered that injectable methods are among the most popular contraceptives (in part for the privacy they can afford). Unfortunately, they need to be delivered in a clinical setting, putting this option out of the hands of those women who don’t have easy access to a clinic. Recognizing the constraints of a standard health system, we worked with private-sector partners and manufacturers to develop and now deliver a low-cost option that can be delivered by lower-cadre health workers at an easier-to-access facility.
We have also partnered to develop the SILCS diaphragm, a one-size-fits-most option that addresses women’s desire to have a nonhormonal and discreet barrier method. By eliminating the need for a pelvic exam to size a diaphragm to a woman, we reduced the dependency on family planning programs that typically comes with diaphragm use. And in using a tiered-pricing structure, which ensures low-cost access to women in the developing world while allowing a modest return in higher-income markets, SILCS provides a long-term sustainable model for private-sector manufacturers who can market the product in Europe and in the developing world.
PATH’s work to strengthen markets for reproductive health continues. For example, we’re currently assessing the market issues related to cryotherapy, an important method for treating cervical cancer. A PATH-led analysis is looking at the supply and demand factors that can be influenced to improve access to cryotherapy equipment. We’re also exploring options for introducing pericoital, or on-demand, contraception, including assessing the range of market dynamics that can enable access to this method.
PATH’s public-private partnerships demonstrate that there is room for the private sector to participate in developing and sustaining a viable market for reproductive health commodities, bringing a high return at low cost.
Amie Batson is responsible for guiding PATH’s strategy, strengthening partnerships and business relationships in the global health community and contributing to the organization’s advocacy and policy priorities. Contact PATH at firstname.lastname@example.org and follow them on Twitter @PATHtweets and Facebook @PATHglobalhealth.
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