Submitted to: A.I.D.I Office of Population Family Planning Services Division Rosslyn, Virginia SOMARC YEAR IV-V WORKPLAN July 1996 SO MARC LIBRARY The Futures Group, Inc. Prepared by: SOMARCfThe Futures Group 10S0 17th Street, NW, #1000 Washington, DC 20036 Under Contract No. A.I.D.lCCP-30S1-C-00-2016-00 CONTENTS INTRODUCTION 1 KEY OBJECTIVES 3 Increase Modern Method Prevalence Rates 3 Improve Cost-Recovery and Access 4 Maximize Use of Alternative Commodities 4 Increase Correct, Effective Use of Contraceptives 6 Develop Innovative Advertising and Promotion Techniques 6 Enhance Institutionalization of Local Skills 7 Information Dissemination 7 Research and Evaluation 8 Management Information Systems 8 Resource Issues 9 REGIONAL OVERVIEW 11 Asia/Near East 11 Newly Independent States 25 North Africa and Middle East 49 Sub-Saharan Africa 67 Latin America and Caribbean 77 INTRODUCTION The Social Marketing for Change (SOMARC III) project is currently in its fourth year of implementation. This WORKPLAN provides a comprehensive overview of SO MARC's proposed activities for the remaining six months of 1996 through September 1997. Included in the workplan is an overview of the key objectives of the SOMARC III project and how they relate to the United States Agency for International Development (USAID) and particularly the Global Bureau's Population, Health, and Nutrition (G/PHN) Center's new strategic plan. The submission of the workplan is delayed due to the recent congressional mandates regarding fiscal year funding for 1996 (FY96) which also prohibited expenditure of these funds before July 1, 1996. Included within this workplan are individual country plans, offering a comprehensive overview for each country, providing important background information, and including accomplishments for Years I through III. The individual country plans also describe the current challenges facing each social marketing initiative and describe the planned activities for 1996 and 1997 and their quantitative outputs. In addition, each country plan also presents a second scenario which describes SO MARC's expected activities and outputs if the project is extended to 1998. Within the resources section, there is also an overview of the financial information and additional resources required. The activities described herein are funded through a combination of core, field support, and buy-in monies. SOMARC's core monies will be used to fund new initiatives, research and evaluation, and technical leadership activities. Field support and buy-in funds are designed to cover country-specific activities. KEY OBJECTIVES Increase Modern Method Prevalence Rates SOMARC III has contributed significantly to increased contraceptive usage through commercial channels, and particularly with the promotion of long-term methods. This key objective for SOMARC is directly related to the Global Bureau's Population, Health, and Nutrition (G/PHN) Center's Strategic Objective #1 of increased use by women and men of voluntary practices that contribute to reduced fertility. Because it is difficult, if not impossible, to measure the impact on contraceptive prevalence of any discrete family planning initiative, SOMARC monitors its contribution to this indicator through the tracking of sales and couple years of protection (CYP) that can be attributed directly to its social marketing efforts. Since the beginning of SOMARC III in September 1992, sales and CYPs have increased approximately 9 percent from 1992 to 1995 with a total cumulative contribution of 15,402,165 CYPs as of December 1995. This increase reflects an approximate 3 percent increase annually. Based upon these historical increases, by September 1997 SOMARC III will have contributed to over 26 million cumulative CYPs. .. Should this trend continue, SOMARC estimates a total cumulative contribution to 43 million CYPs by September 1998. Table 1 summarizes the expected CYP outputs for 1996-1997 as well as for 1998 should the SOMARC project be extended. Table 1. SO MARC CYP Summary 1992 1993 1994 1995 1996 to 1996 to 1997 1998 PRODUCT CYPs CYPs CYPs CYPs CYPs CYPs CONDOMS 515.092 437.123 632.305 919.704 2.013.390 3.391.299 VFTS 48,143 65,737 58,204 51,871 95,178 148,055 ORALS 1,276,419 1,373,673 1,354,410 1,363,052 3,956,813 6,561,233 INJECTABL ES 610,430 496,238 391,367 394,507 821,557 1,447,196 IUDS 1,210,198 542,908 2,306,113 1,084,648 3,386,604 5,523,884 IMPLANTS - 670 75,920 193,435 348,111 541,506 SHORT- TERM 1,839,655 1,876,533 2,044,919 2,334,627 6,065,381 10,100,587 LONG- TERM 1,820,628 1,039,815 2,773,400 1,672,589 4,556,272 7,512,586 TOTAL 3,660,283 2,916,348 4,818,319 4,007,216 10,621,65 17,613,173 4 PREVIOUS PAGE BLANK 3 - ... Improve Cost-Recovery and Access All of SOMARC programs are designed to pursue the dual objectives of cost recovery and maximized access. This key SOMARC objective is directly related to G/PHN's Result 1.3 of enhanced capacity for private, non-governmental organizations (NGOs), and community-based organizations to design, implement, and evaluate sustainable family planning programs. SOMARC is working with all of these types of organizations ..... in its social marketing programs to expand access, but also to address increased cost­ recovery and sustainability. In Latin America, for example, much of SOMARC's work is currently with NGOs, assisting them to improve the cost-recovery potential of their programs. This technical leadership is provided in a regional environment where USAID's strategy is to phase out donor assistance to these agencies. SOMARC's work helps to improve the NGO's cost-recovery at the same time as ensure continued .... access to quality, affordable family planning products and services. Table 2 summarizes SOMARC's current projections by product of cost-recovery and self­ sufficiency for each of its social marketing projects, and the expected status in 1998 - should SOMARC be extended. Maximize Use of Alternative Commodities SOMARC continues to emphasize the use of locally available or commercially purchased commodities to eliminate reliance on USAID-sourced commodities as a key objective. Throughout the Asian, Middle East, Newly Independent States, and Latin American regions, the large majority of social marketing projects are using commercially purchased or locally available products. For those countries that started with donated products, there has been an increased effort to move these programs to commercial products. This key objective of the SOMARC III project is also directly related to G/PHN's Result 1.3 of ... enhanced capacity for private, NGO, and community-based organizations to design, implement, and evaluate sustainable family planning programs. The emphasis on alternative sourcing of commodities helps to ensure that programs are cost-effective and sustainable and that they leverage private sector resources where feasible. Table 3 illustrates the current commodity sourcing under SOMARC III for all country programs, representing a cumulative cost savings to USAID of over US$21 million for all of its ... commercially sourced products. Table 3 also depicts what additional products would transition to commercial purchase by 1998. .... iool - .... " ,-' -. '" .~, .,. 4 , ::- .': I I ( I I I, I. I 1 II II. I( I I I I Table 2. Self-Sufficiency Status Distributionl Product! em ,n' .99. Current 1998 I 199. eurre~,mPI. ;";,~~nCY/R.A;! ~, nh .j" eo~~,~dity Sal~~q:~rce e,,,,.ntdve,~~;omo Ecuador Condoms 100 100 100 46 100 100 25 57 65 19 30 40 Current plans for phase out and 100% self- Pills 100 100 100 46 46 55 0 0 0 19 19 25 sufficiency by 2000. Preg. Test 100 100 100 46 46 55 0 50 60 19 19 25 Guatemala Commercial 100 100 100 40 100 100 35 100 100 30 100 100 100''/0 self·suffrciency for donated products by 2000. Donated 0 50 60 40 90 90 35 90 95 30 90 95 Haiti Pills 100 100 100 100 100 100 80 100 100 40 100 100 100% self-sufficiency in both products by 2004. DMPA 0 0 0 0 0 0 0 0 0 40 60 70 Jamaica Pills 100 100 100 100 100 100 0 85 90 0 100 100 Project can be 100% self-sufficient if no funding IUDs N/A 100 100 100 100 100 0 85 90 0 100 100 received DMPA 100 100 100 100 100 100 0 85 90 0 100 100 NSV 100 100 100 100 100 100 100 100 100 100 100 100 Pe, Condoms 0 100 100 100 100 100 0 100 100 0 100 100 Egypt Condoms 0 NA NA 100 NA NA 100 NA NA 0 NA NA Products projected to be self-sufficient. Continued Pills 0 100 100 100 100 100 75 100 100 0 NA NA funding uncertain. IUDs 0 100 100 100 100 100 100 100 100 0 NA NA DMPA 0 100 100 100 100 100 0 100 100 0 NA NA Jordan Pills 100 100 100 100 100 100 0 50-100 50-100 0 NA NA Products projected to be self-sufficient. Continued IUDs 100 100 100 100 100 100 0 50-100 50-100 0 NA NA funding uncertain. DMPA 100 100 100 100 100 100 0 50-100 50-100 0 NA NA CA.R. Condoms 100 100 100 100 100 100 25 25 35 0 NA NA limited condom promotion funds provided by Pills 100 100 100 100 100 100 0 0 0 0 NA NA sector. Continued funding uncertain. IUDs 100 100 100 100 100 100 0 0 0 0 NA NA DMPA 100 100 100 100 100 100 0 0 0 0 NA NA Morocco Condom 100 100 100 100 100 100 100 100 100 100 100 100 Condom at 100% self-sufficiency.