Getting to FP2020: Harnessing the private sector to increase modern contraceptive access and choice in Ethiopia, Nigeria, and DRC

Abstract

BackgroundAn estimated 214 million women have unmet need for family planning in developing regions. Improved utilization of the private sector is key to achieving universal access to a range of safe and effective modern contraceptive methods stipulated by FP2020 and SDG commitments. Until now, a lack of market data has limited understanding of the private sector’s role in increasing contraceptive coverage and choice.MethodsIn 2015, the FPwatch Project conducted representative outlet surveys in Ethiopia, Nigeria, and DRC using a full census approach in selected administrative areas. Every public and private sector outlet with the potential to sell or distribute modern contraceptives was approached. In outlets with modern contraceptives, product audits and provider interviews assessed contraceptive market composition, availability, and price.FindingsExcluding general retailers, 96% of potential outlets in Ethiopia, 55% in Nigeria, and 41% in DRC had modern contraceptive methods available. In Ethiopia, 41% of modern contraceptive stocking outlets were in the private sector compared with approximately 80% in Nigeria and DRC where drug shops were dominant. Ninety-five percent of private sector outlets in Ethiopia had modern contraceptive methods available; 37% had three or more methods. In Nigeria and DRC, only 54% and 42% of private sector outlets stocked modern contraceptives with 5% and 4% stocking three or more methods, respectively. High prices in Nigeria and DRC create barriers to consumer access and choice.DiscussionThere is a missed opportunity to provide modern contraception through the private sector, particularly drug shops. Subsidies and interventions, like social marketing and social franchising, could leverage the private sector’s role in increasing access to a range of contraceptives. Achieving global FP2020 commitments depends on the expansion of national contraceptive policies that promote greater partnership and cooperation with the private sector and improvement of decisions around funding streams of countries with large populations and high unmet need like Ethiopia, Nigeria, and DRC.

Quality of Family Planning Counseling in Ethiopia: Trends and determinants of information received by female modern contraceptive users, evidence from national survey data, (2014- 2018)

“…This finding follows the pattern observed in other African countries such as Ghana and Rwanda, where the public sector also plays a dominant role in family planning services [23]. In the context of Ethiopia, the quality of the private sector should be of concern to healthcare regulators, policymakers, and family planning programmers since the private sector, including pharmacies and drug stores, have succeeded in providing access to short-acting methods and a preferred access points for underserved populations such as unmarried youth [36].…”

FPwatch: Facility‐based Survey Data for Family Planning Market Analysis in Five FP2020‐focus Countries

“…The extent of all outlet types visited during the FPwatch surveys are detailed elsewhere (FPwatch group , , , , ; Riley et al. ). The comprehensive census approach within sampled geographic areas allowed for unique estimates of market composition (e.g., what is the proportional availability of contraceptive methods across a range of facility types?)…”

“…In filling the gap in private sector knowledge, FPwatch data highlight missed opportunities in a country's overall modern contraceptive market such as the potential access to modern contraception offered via the ubiquity of drug shops in Nigeria and DRC (Riley et al. ). FPwatch's standardized approach allows for comparability of total markets. The success of countries with strong markets can provide lessons learned and act as a roadmap for identifying opportunities such as high‐impact outlet types in countries with less developed markets (Thanel et al.…”

“…In developing countries, where information on the private sector is largely missing, or not required or regulated (Ahmadi et al 2013;Phalkey et al 2017), FPwatch data allow for comparability within and across countries, and paint a clear picture of the contraceptive market for program and policy implementers. In filling the gap in private sector knowledge, FPwatch data highlight missed opportunities in a country's overall modern contraceptive market such as the potential access to modern contraception offered via the ubiquity of drug shops in Nigeria and DRC (Riley et al 2018). r FPwatch's standardized approach allows for comparability of total markets.…”

“…A major distinction of FPwatch, compared to other facility-based surveys, is that FPwatch conducted a full census of all facilities potentially offering FP products or services within selected geographic areas, including those outside the formal health system such as itinerant and/or mobile drug vendors, unregistered drug outlets, and traditional medicine providers. The extent of all outlet types visited during the FPwatch surveys are detailed elsewhere (FPwatch group 2016a(FPwatch group , 2016b(FPwatch group , 2016c(FPwatch group , 2017a(FPwatch group , 2017bRiley et al 2018). The comprehensive census approach within sampled geographic areas allowed for unique estimates of market composition (e.g., what is the proportional availability of contraceptive methods across a range of facility types?)…”