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Providing Safe Drinking Water in Benin: the POUZN Aquatabs Program Results and Lessons Learned

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Providing Safe Drinking Water in Benin: the POUZN Aquatabs Program Results and Lessons Learned PROVIDING SAFE DRINKING WATER IN BENIN: THE POUZN AQUATABS PROGRAM RESULTS AND LESSONS LEARNED PROGRAM CONTEXT water sources (Institut National de la Statistique et de l’Analyse Économique et Located on the west coast of Africa between al. 2007).1 The 2006 DHS also showed that Nigeria and Togo on the Gulf of Benin (Figure 94 percent of the population did nothing 1), Benin is one of the poorest and least to treat drinking water to prevent diarrhea. developed countries of the world, ranking Of those who did treat, 50 percent used 161/182 in the UN’s Human Development eau de javel (household bleach, which is not Index for 2009. Sixty-six percent of the manufactured to foodgrade standards and is population resides in not of a consistent concentration that allows rural areas. Overall health for proper dosing for water treatment) and indicators are poor, with a low 33 percent used other often inadequate life expectancy of 56 years treatments (such as straining through a and high infant (78/1000 live cloth). According to the Ministry of Health births) and child mortality (MOH) 2005 Annual Report and data from (123/1000 live births) the national health management information (UNICEF 2008). system (Système National d’Information Lack of safe drinking et de Gestion Sanitaires, or SNIGS), the water is a major problem principal reasons for health facility visits confronting Benin’s residents, for children under five were: malaria (41 particularly in rural areas, percent), respiratory infections (20 percent), where, according to the 2006 1 A 2007 GTZ-funded survey of 300 deep wells in the Demographic and Health Ouéme and Plateau departments revealed that 97 Survey (DHS), 43 percent do percent were contaminated with fecal coliform and other diarrhea-causing microbes. (Interview with GTZ not have access to improved advisor, June 2007, Ministry of Water, Directorate of Mines, Energy and Hydraulics.) CountryBrief diarrhea and gastrointestinal problems PROGRAM GOALS (15 percent), and anemia (7 percent). The The goal of the Aquatabs program is to World Health Organization estimates that reduce incidence of diarrhea among children 13 percent of deaths in children under under five by: five in Benin are caused by diarrhea.2 High diarrhea-related death rates can be Creating a sustainable supply and attributed to poor hygiene and sanitation increasing access to a chlorine-based practices and poor quality drinking water – household water disinfection product (Aquatabs). both of which contribute to the spread of water-related diseases. Improving caregiver knowledge of the importance of treating and The Social Marketing Plus for Diarrheal appropriately storing household drinking Disease Control: Point-of-Use Water water. Disinfection and Zinc Treatment (POUZN) Increasing use of Aquatabs to treat Project, implemented by Abt Associates household water. and Population Services International (PSI), was invited by the U.S. Agency for International Development (USAID) in TIMELINE Benin 2007 to implement an integrated diarrhea Aquatabs prevention and treatment program The POUZN design team visited Benin in June 2007 to assess the need for and through private sector channels focusing 2 the feasibility of importing and social on water treatment at the household marketing a water disinfection product. Brief level. The POUZN Project determined Country The POUZN workplan was approved by that introducing the chlorine-based water USAID in October 2007 and in March treatment tablet, Aquatabs, through the 2008 the POUZN team developed a private sector was the most appropriate detailed marketing plan. intervention for addressing the need for The product was officially launched into household water treatment. Initial marketing the Benin market in September 2008. efforts centered around seven major urban and surrounding peri-urban areas located in In 2009, the POUZN team expanded the following departments: Alibori, Atacora, marketing through a number of new community channels and in 2010 Atlantique, Bourgou, Collines, Donga, and launched a television advertisement that Zou, where PSI was already implementing considerably increased sales. a social marketing program that included The program was evaluated using a child health products, and the capital city representative household survey in the of Cotonou. In total the program reaches target departments in November 2009. 70 percent of the population or about 6.1 million people. Aquatabs are the only widely available product for disinfecting water, other than the household bleach mentioned above. 2 www.countdown2015mnch.org/ documents/2010report/Profile-Benin.pdf (2010. UNICEF) PROGRAM COMPONENTS Price: After conducting formative research with potential consumers in a number of Product: Household Water Treatment areas of Benin, the decision was made to with Aquatabs. The POUZN team sell each strip of 10 tablets of Aquatabs for imported Sodium Dichloroisocyanurate a cost recovered retail price of FCFA 125 (NaDCC) tablets, manufactured by the Irish (US$0.25). Each tablet treats 20 liters of company Medentech under the brand name water; therefore, a strip of 10 is designed Aquatabs, for distribution in Benin. The to treat the drinking water for a family of June 2007 assessment examined the various five for approximately 10 days. Aquatabs product options and selected Aquatabs as are promoted as an effective and affordable the most appropriate product for Benin, household drinking water treatment product given that there was not an acceptable local to consumers in lower socioeconomic groups manufacturing option. Aquatabs, packaged where water treatment has not been the in strips of 10 tablets, have proven effective norm. in field trials in the developing world for treating water in the home (Clasen Due to the fact that the Aquatab strips were et al. 2007). The 67 mg tablet imported very plain and had no use instructions printed thereon, the team developed a colorful box, specifically for this project was registered in Benin Benin by PSI through an Autorisation de Mise with use instructions printed thereon, to en Marché. educate of the target population. However, Aquatabs this doubled the base cost of the product. 3 In order to maintain an affordable yet sustainable price, the initial margins for both CountryBrief wholesaler and retailers were kept relatively low, as shown in Table 1. Medentech has since redesigned its packaging, both making it more colourful and printing use instructions in three languages on the reverse side. This will allow the POUZN team to eliminate the overpackaging and readjust trade margins in the future. TABLE 1. RETAIL AND CONSUMER PRICE MARGINS FOR AQUATABS Prices Treatment Prices Margin % (US$) Base Price for Tablet 40 FCFA $0.08 — Packaging 40 FCFA $0.08 — Total Cost (PSI) 80 FCFA $0.16 6% Wholesaler/NGO 85 FCFA $0.17 17% Retailer 100 FCFA $0.20 25% Consumer 125 FCFA $0.25 — DISTRIBUTION: ENSURING the television advertising, which has already AccESS TO AND AVAILABILITY improved demand, and reductions in base OF AFFORDABLE PRODUCTS costs through revised packaging, which will impact wholesaler and retailer margins, Building on its existing distribution system, should address these issues. PSI expanded the network for Aquatabs POUZN promotional efforts were (Figure 2) by working actively with two concentrated in the seven target private pharmacy wholesalers and one departments and the capital city of government pharmacy wholesaler, Centrale Cotonou. However, Aquatabs are d’Achat des Medicaments Essentials (CAMÉ), distributed nationwide and are available to distribute and sell Aquatabs through for sale in approximately 1,050 commercial private pharmacies and public sector outlets and 450 public health clinics clinics and pharmacies. In addition, the throughout the country. POUZN team worked with 10 commercial wholesalers to market the product through The government’s pharmaceutical the commercial distribution channels wholesaler, CAMÉ, operates in a fashion for fast-moving consumer goods such as similar to commercial wholesalers. Benin shops and kiosks. Given that this is a low They purchase Aquatabs from PSI at the Aquatabs cost product with relatively low profit wholesale price and sell to clients through margins for distributors and retailers, public sector clinics at the full cost price. 4 and still untested demand by consumers, Both CAMÉ and clinics benefit from this one additional pharmaceutical wholesaler, price structure with the margins funding CountryBrief covering half of the pharmacies in southern distribution costs, which contributes to Benin refused to carry the product and only sustainability through this channel. While half of the commercial wholesalers agreed sales through the clinics were initially slow, to market the product. Both the advent of they have increased markedly with the advent of both the television advertising and a new supervisory linkage between the FIGURE 2: DISTRIBUTION SYSTEM clinics and the community sales personnel. A portion of institutional sales are also distributed through public health centers as part of emergency relief efforts. Since inception, 47 percent of the product has been purchased by commercial wholesalers and sold through shops and kiosks, 14 percent was purchased by pharmaceutical wholesalers and marketed through private pharmacies, 4 percent was purchased by CAMÉ for sale through MOH health clinic pharmacies, 31 percent of sales were made to institutional entities (primarily the Red Cross) for humanitarian one promoting household water
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