{"id":7044,"date":"2024-06-06T13:08:42","date_gmt":"2024-06-06T13:08:42","guid":{"rendered":"https:\/\/kmtraining.org\/leveraging-the-private-sector-to-expand-access-to-contraception-in-the-era-of-decreasing-donor-funding\/"},"modified":"2026-04-28T13:20:10","modified_gmt":"2026-04-28T13:20:10","slug":"leveraging-the-private-sector-to-expand-access-to-contraception-in-the-era-of-decreasing-donor-funding","status":"publish","type":"post","link":"https:\/\/kmtraining.org\/fr\/leveraging-the-private-sector-to-expand-access-to-contraception-in-the-era-of-decreasing-donor-funding\/","title":{"rendered":"Leveraging the Private Sector to Expand Access to Contraception in the Era of Decreasing Donor Funding"},"content":{"rendered":"
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Family planning (FP) commodities and services in lower- and middle-income countries (LMIC) have historically been heavily subsidized by the donor community. However, donor funding for FP has plateaued and is expected to decline while many countries have yet to meet their FP goals. Countries are looking toward new financing methods and delivery models to create more resilient reproductive health systems, in part through leveraging the private sector\u2019s contributions towards expanding the reach of FP services.<\/p>\n

The private sector has been a significant source from which people obtain contraception, with roughly a third of women in LMICs going to private sector outlets particularly for short-term methods, like condoms and pills. Fewer users rely on the private sector for long-term methods such as injectables, implants and IUDs, which are predominantly obtained in the public sector.[1]<\/sup><\/a> The private sector consists of both the not-for-profit private sector and the commercial sector, with only the former historically having access to \u2013 and the benefit of \u2013 subsidized commodities and services. All sectors \u2013 the public sector, not-for-profit private sector, and the commercial sector \u2013 are key to ensuring that women everywhere have access to the services and care they need. But more effort is needed to support market stewardship so that the private sector is more effectively harnessed to expand access to FP method choice. Ideally, market stewardship is delivered through government mechanisms, but in some instances an intermediary needs to play an interim role.<\/p>\n

Contraceptive implants provide an intriguing case study where opportunities exist to better steward and leverage the private sector amidst this broader funding shift. While they have gained significant popularity as an FP method in the public sector, the share of implants obtained in the private sector has remained minimal at 13% in LMICs compared to 86% in the public sector.[2]<\/sup><\/a> Over a decade ago, implants were made available at a reduced price to public purchasers through the Implants Access Program (IAP) which aided a nearly three-fold increase in global procurement of implants from 3.9 million in 2012 to 10.6 million in 2021.[3]<\/sup><\/a> The public health impact of implants is unquestioned. However, for implants to be sustainably available in the long term, actors throughout the private sector value chain need to be engaged \u2013 and appropriately incentivized \u2013 to offer implant services. Doing this at scale is particularly challenging given the high upfront unit cost of implants (roughly USD $8.50\/unit) and mixed practices and expectations around financing FP supplies and services across LMICs.<\/p>\n

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The Rationale<\/h3>\n\n\t\t<\/div>\n\t<\/div>\n
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As a part of the Expanding Family Planning Choices (EFPC) project, Jhpiego and Impact for Health collaborated in 2022 to understand the barriers to quality provision of contraceptive implant services by the private sector (check out our project landing page<\/a> and associated blog<\/a> for more information). In 2023, we collaborated again to build on these findings to develop roadmaps to cultivate the private sector market for implants in two countries: Kenya<\/strong> and Punjab, Pakistan.<\/strong><\/p>\n

Kenya <\/strong>is well-poised to expand its private implant market with an active private sector for FP (33% of all FP users access care through the private medical sector: <\/strong>private pharmacies, hospitals and clinics),[1]<\/sup><\/a> a comprehensive FP Total Market Approach (TMA) strategy ready to implement, and widespread population awareness and use of implants (37% of women who use a modern form of FP use implants).[2]<\/sup><\/a> However, the private sector has a disproportionately lower share of the implants market (14%) compared to other similar methods (injectables \u2013 37%; and IUCDs \u2013 34%) that also require services from a trained provider. If barriers to private sector expansion are addressed, the implant market could double in size to over 500,000 users within the next few years. Currently, the vast majority of implants are provided by the government to public facilities and select private facilities at no cost and explicitly labeled \u201cnot for sale\u201d. But access to free commodities is expected to end as donor funding declines and the Ministry of Health plans to fully fund their FP commodity purchasing by 2025, thus creating pressure to optimize and restrict use of publicly funded goods and, in turn, an opportunity for a true private market for implants.<\/p>\n

In Pakistan, <\/strong>despite significant donor investment, the CPR has stagnated around 30% for nearly two decades[3]<\/sup><\/a> while unmet need for family planning ranged from 25% to 17% during this time.[4]<\/sup><\/a> Traditional methods, condoms and female sterilization account for over 75% of the method mix. More work is needed to diversify method choice and leverage all possible channels to reach women. Only 1% of FP users in Pakistan use implants, 86% of whom obtain it from the public sector (funded by the government) with the remaining 14% obtaining them from the private not-for-profit sector (funded by donors). The commercial private sector, while an active source of healthcare, has not played a significant role in FP provision including implants. Jadelle is the only implant currently in the market, but it is currently registered at a Maximum Retail Price (MRP) that, due to the devaluating PKR, is lower than the purchase price set in USD. However, DKT with support from DKT WomenCare Global is planning to import significant volumes of Levoplant in 2024 and sell to the public sector, private sector (NGO and large hospitals), and small private sector providers, which could be a starting point to build the market.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n

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The Process<\/h3>\n\n\t\t<\/div>\n\t<\/div>\n
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Literature review and key informant interviews were conducted to compile country Market Analysis Reports for Kenya<\/a> and Pakistan<\/a>. Then, building on these reports, key stakeholders across the value chain in each country were convened to develop Roadmaps charting a pathway for private sector provision of implants in Kenya and Punjab, Pakistan.<\/p>\n

The Kenya Roadmap <\/strong>explores several key opportunities:<\/p>\n