A Total Market Approach for Condoms in Nigeria Omini Efiong, AIDSFree October 24, 2017

The Nigeria condom market is large and diverse and offers opportunity for more strategic and effective partnerships between the public and private sector. This presentation highlights the results of the condom market landscape assessment completed in Nigeria in March, 2017

But, the condom market is failing those at risk of HIV.

Condom use is disproportionately lower among Young women (ages 15 – 24) Rural population Poorest wealth segments

> 600 million condoms needed per year to close the condom gap in Nigeria Estimated condom needs of 1.15 billion ~400 million condoms used Nigeria Condom need estimates are based on 90% consistent condom use The gap between current condom Use* and total Need to achieve full coverage (90% consistent use) is ~ 6-700 million condoms. Additional commodity costs alone run $18 million/year + to support the use/need gap** Implications: Bridging the annual 600 m condom gap will require leveraging the relative strengths of of all sectors – public, social marketing, and commercial partners – to achieve 90% condom use with non-regular partners as outlined in 20 by 20 objectives. Use estimates based on existing market size of commercial (estimated), public, and social marketing sectors. **based on procurement estimate of $0.03 USD condom Source: USAID 2017

A total market approach for condoms ENGAGING WITH PRIVATE SECTOR UNDERSTANDING MARKET CONDITIONS ENSURING A SUSTAINABLE HEALTH MARKET Donors and governments are interested in more strategic engagement, coordination and leveraging of the private sector to reach all segments of the population A sustainable condom market requires a market-based approach to program strategy and investment. This requires understanding market conditions and opportunities to grow and sustain the condom market in Nigeria.

A total market approach to condoms can help… Better target free or subsidized condoms to the underserved Create demand for consistent condom use among key populations at risk for HIV Reduce supply chain inefficiencies and overlaps across sectors and programs Ensure policies and regulations better enable private sector participation and market growth of high-quality condoms Coordinate market players (public, private-for-profit, NGO, donors, implementers, etc.) A total market approach to condoms can help… TMA AIMS TO INCREASE EQUITY & ACCESS TO COST-EFFECTIVE HEALTH PRODUCTS AND SERVICES BY MAXIMIZING THE COMPARATIVE ADVANTAGE OF ALL THE SECTORS.

AIDSFree in Nigeria Project objective: To enhance sustainable condom programming using a TMA. Support Government stewardship for TMA Strengthen informed demand creation for condoms Generate market intelligence

Nigeria’s condom market Size & Trends 1 Nigeria’s condom market Size & Trends

Total Condom Market Socially marketed brands comprise close to 60% of the condom market Source: USAID 2017 Discuss the large investments made over time in social marketing.

Public Sector Free Condom Market Source: USAID 2017

Trends in Market Share Socially-marketed condom sales have plateaued from peak in 2012; commercial sector sales are increasing Source: USAID 2017

Considerable Condom Choice on the Market >100 brands available Most of these brands are not registered with NAFDAC 32 importers have registered brands Considerable choice on market: FP Watch found just under 100 brands on the market – most unregistered. Supported by fairly large # players: 32 importers have registered brands w/ NAFDAC. That number includes a) 2 social marketers; b) 1 larger commercial entity, the Reckitt Benckiser Group supporting the Durex brand; c) 3-4 other pharmaceutical importers that have ‘franchised’ a brand (such as Zubdy Max Ltd. Importing Karex condoms); d) and 8-12 importers that have created and invested in their own condom brand, such as Jones condom. Many more suitcase importers bring condoms in, often as one off to fill container space. Source: Hoel_080523_DSC1751

Most Commonly-Used Condom Brands Source: NPC [Nigeria] and ICF International. 2014.

A snapshot of the range of condom brands at various price points Social Marketers contributing to robust market: competing SM entities introducing variants, premium brands aiming for cross subsidization Market taking care of quality issues itself – very low end, low quality condoms have yet to gain foothold in the market – with most commercial brands clustering tiers above SM pricing.

Condom Use A closer look at consumers 16 2 Condom Use A closer look at consumers

Use of Condom Brands by Wealth Category Limitation of this analysis is that it doesn’t reflect Fiesta because it dates back to 2013. Pending willingness to pay study results will further enlighten us on unnecessary subsidies for wealthier quintiles. Source: NPC [Nigeria] and ICF International. 2014.

High Geographic and Wealth Disparities in Condom Use Source: JSI 2014.

19 3 Condom Sourcing

Condom Availability Rural vs. Urban Higher availability in urban areas overall. Efforts need to be made to orient free condoms to rural areas. Source: USAID 2017; FPWatch 2016

Across almost all zones, condoms are more available in the private sector Source: FPwatch Group 2016. Condom outlet penetration quite high. Availability drops in public sector, likely related to challenges (hence addressed) of MoH policy to eliminate user fees that formally supported last mile distribution. Pockets of low availability persist, such as NW and SW public sector.

Snapshot of brands available in the drug shops and pharmacies Source: FPwatch Group. (2016). FPwatch Study Reference Document: The Federal Republic of Nigeria, 2015. Washington DC: PSI

Program & Market considerations 4 Program & Market considerations

Condom Programming Gaps < 50% of women know where to obtain a condom Among the poorest wealth segment, only 57% feel condoms are accessible Condom use among men with 2 or more partners: Only 11% among rural men ~1% of poor men (lowest wealth segment)

To help grow and sustain a condom market that achieves public impact will require… Targeted distribution & demand generation Coordination of public, commercial and social marketing sectors Commercial partnerships & improved regulatory environment

Total Market Approach This will take moving from conventional social marketing programming to a total market approach that reaches all population segments

Thank You!