Rob Wood, ESHE Project Team Leader, Kenya wednesday, february 1, 2017 From Introduction to Integration A Total Market Approach is essential to the smart introduction of DMPA-SC in your country Many thanks Megan. Good morning everybody I’m going to spend a few minutes outlining why a Total Market Approach is critical for DMPA-SC in all our countries Over the next few minutes my presentation will touch on Palladium’s Total Market Approach in Mali, Zambia and Malawi and particularly the work that I oversee in Kenya Much of what I will tall about is also available in Palladium’s new brief on Total Market Approach and implications for DMPA – SC which you can find at XXXX. Rob Wood, ESHE Project Team Leader, Kenya wednesday, february 1, 2017 Increasing Access to Next Generation Injectables - January 30 - February 2, 2017 - Dakar, Senegal

Total Market Approach concept and framework Is an evidence-based process that brings together and leverages the advantages of all players – the public sector, donors, social marketing, private and for-profit – to inform strategies and interventions that will address inefficiencies, distortions and strengthen the total FP market. Can mean different things to different people on different days DEFINITION Stewardship is key – usually by MoH Total Market Approach is not a new concept but it has been making a resurgence over recent years - in some countries we are seeing a shift away from just discussing the benefits of a concept to the implementation of a practical framework. The Palladium framework for Total Market Approach provides a simple, smart and practical pathway to building up advocacy engagements and the implementation of a Total Market Approach. We have used this widely in Kenya and it has turned an often ill-defined process into something tangible and do-able Increasing Access to Next Generation Injectables - January 30 - February 2, 2017 - Dakar, Senegal

Total Market Approach can offer multiple benefits for DMPA-SC Expands access and choice –inclusion of non-public players; more products and new brands Better FP results – through more market players, more products, more choice and targeted delivery channels A Total Market Approach can offer your countries significant benefits for DMPA – SC What’s presented here are not all of the benefits, just some of many Total Market Approach can expands out FP access and choice. From around 15 brands in Kenya before TMA to 35 brands after applying a total market lens. More than 40 by the end of the years Total Market Approach can give us more FP results, which contributes to our increasing contraceptive prevalence rates 1.5m FP products each year – 6% of the total market as opposed to 1% Increasing Access to Next Generation Injectables - January 30 - February 2, 2017 - Dakar, Senegal

Total Market Approach can offer multiple benefits for DMPA-SC Improves efficiencies and savings to the sector – more market players, more products and brands; reducing market distortions improves cost efficiency Equity and “leave no one behind” – more efficient resource use frees-up other resources to target the poor, rather than subsidising those that can afford to pay $1m p.a. $6m p.a. A Total Market Approach increase cost efficiencies and can save your country money. The inclusion of the commercial sector into the Kenyan FP programme now means that their $1m spent each year is now captured in national plans, reducing the “funding gap” that for FP commodities that we have every year. We are now working on other market analysis that I believe can demonstrate additional efficiencies worth $6m per year – savings to the MoH and donors TMA increases the longer-term financial sustainability of programmes, essentially by including the for-profit sector and improving coist-efficiencies TMA should increase our ability to programme more equitable and to leave no one behind. In Kenya this means segmenting and aligning market players to reach the needs of counties with very high CPR while focussing on those at the very bottom. Increasing Access to Next Generation Injectables - January 30 - February 2, 2017 - Dakar, Senegal

Preventing cannibalisation: can DMPA-SC co-exist in public and private markets? We need to strive for this – and applying total market principles and perspectives are key Learn from other countries – Uganda, Nigeria and others Total market planning and forecasting is needed between all players – stewarded by MoH and with donors Differentiated DMPA-SC approaches Brand differentiation and specific marketing vs generic packaging Free/subsidised/non-subsidised reaching appropriate clients Market monitoring and regulation to prevent distortions Massive free, or subsidised, distribution of DMPA-SC crowding our the private sector “Leakage” - or re-selling of free products in the private sector; leakage between states/countries DMPA-SC sales not undermining invested supplies of IM Yesterday we heard from Bangladesh about how DMPA-SC was not cannibalising the IM market, but I’ve also heard about potential threats in other countries where new DMPA-SC stocks could potentially mess up the market Need to ALL strive to have balanced markets We need to learn more from Nigeria, Uganda and other countries that are further ahead We need to start some Total Market planning together – NOW - if we have not done already better understand our own FP and injectable market we should be differentiating our approaches – Senegal overbranded SP clear distribution strategies in place And critically we need good monitoring and proper regulation of the market Increasing Access to Next Generation Injectables - January 30 - February 2, 2017 - Dakar, Senegal

High-level recommendations for advocacy Markets matter – and healthy markets are critical to realising the potential of DMPA-SC It’s not just about increasing access to DMPA-SC at whatever cost Get it right first! - applying a Total Market Approach to a new product or market, such as DMPA-SC, is easier than undoing a distorted FP market Differentiated DMPA-SC strategies and delivery will be critical to reach different clients The largest impact of DMPA-SC in your country might be realised through the private sector… and the private sector needs a healthy market to survive and thrive 1. Markets matter – and they matter to realising the potential of DMPA-SC 2. It’s not just about increasing access at whatever cost. We need to do so in a way that allows all sector players to co-exist and we need to do this so we have a balanced and sustainable marker. We don’t just want free supply everywhere 3. Get it right first – apply a Total Market perspective now. Undoing a distorted market is really hard to do and takes a very long time. 4. DMPA-SC plans in all countries needs to be differentiated to reach different clients 5. And finally, as we’ve heard this morning, the private sector matters in the delivery of DMPA-SC and could actually deliver more impact that we’d previously thought Increasing Access to Next Generation Injectables - January 30 - February 2, 2017 - Dakar, Senegal