|
Programs |
|||||||||||||||||||||||||||||||||||||||
|
|
|||||||||||||||||||||||||||||||||||||||
|
This report covers the FHI AIDS Control and Prevention (AIDSCAP) Project (1991-1997). Volume 1 covers regional program overviews, technical strategies, and program support strategies.
Volume 1 |
||||||||||||||||||||||||||||||||||||||||
| Country | Condoms Sold |
| Brazil | 82.0 million |
| Ethiopia | 44.0 million |
| Tanzania | 39.0 million |
| Cameroon | 24.0 million |
| Haiti | 16.3 million |
| Nepal | 12.0 million |
| Rwanda | 2.6 million |
| South Africa | 2.0 million |
Measures of Success
The effectiveness of AIDSCAP/FHI support to the CSM programs can be determined by comparing the programs' sales performance prior to AIDSCAP/FHI involvement with their sales performance in the final months of the AIDSCAP Project.
Condom sales for the PSI Ethiopia CSM project were 829,000 per month when AIDSCAP/FHI funding began. When funding ended in September 1996, sales totaled 2 million per month, an increase of 141 percent.
The PSI Haiti CSM project was averaging 250,000 condom sales per month in September 1992 prior to AIDSCAP/FHI support. By the closing date of April 1996, the project was averaging 540,000 per month -- a 116 percent increase. The Futures Group CSM project in Nepal was averaging 465,000 condoms sold per month prior to AIDSCAP/FHI support in February 1994. The current average is 1 million per month, a 115-percent increase.
As these figures indicate, each CSM project enjoyed a surprising increase in sales performance following AIDSCAP/FHI support. These impressive sales figures were achieved despite formidable obstacles and problems that arose in almost every country. In Ethiopia, for example, the PSI project was forced to ration condoms due to a 2-month stock out. The internecine war in Rwanda claimed the lives of four PSI staff, disrupted sales, and prompted PSI to distribute condoms free-of-charge in refugee camps. Political violence and an economic embargo in Haiti also posed safety concerns and logistical challenges to the PSI project there. Brazil has been plagued by both tariff and nontariff barriers, which have constricted sales and complicated the administration of the project.
The ability of the CSM projects to overcome these challenges and record such remarkable successes is a testament to the resilience and pragmatism of the social marketing approach. It also indicates the continued need for condoms in many countries throughout the world. AIDSCAP/FHI's experience suggests that providing convenient access to affordable condoms is the most effective way to meet that demand.
Another useful indictor of sales performance is the number of condoms sold per sexually active male for a 1-year period (see Table 18). This indicator illustrates the condom coverage of a target population.
Lessons Learned and Recommendations
- NGOs can become important partners for social marketing.
The association between NGOs and social marketing is not a natural one. The latter deals in the commercial sector (a social marketing operation often appears to differ little, if at all, from a commercial sales organization), and ordinarily speaks little of the language of volunteerism and altruistic objectives. NGOs generally define their purposes in providing assistance to the poor and may object philosophically to selling at a profit to their clients or members.
|
In the center of Kigali's most congested traffic circle stands a kiosk. Once a newspaper stand, the modest structure was a mute witness to one of this century's bloodiest tragedies: the 1994 slaughter of more than half a million Rwandans by their fellow citizens. Less than 1 year later, the kiosk -- freshly painted with a rainbow design -- became one of the first small businesses to reopen. In the midday heat, many stop here to buy cold drinks, but also take the opportunity to ask the nurse behind the counter about AIDS or buy packets of Prudence condoms. In its new role, the kiosk has become a bright symbol of hope in a nation desperate to renew itself. This tiny sales outlet is just one of hundreds throughout Rwanda created for CSM. By using commercial marketing techniques, affordable pricing, and existing retail networks to promote, distribute, and sell condoms, the AIDSCAP Project's nonprofit CSM programs -- designed and managed by PSI -- created an enormous demand for these preventive devices, even in areas where resistance to them was once so strong they couldn't be given away. |
Recognizing the importance of ensuring a reliable condom supply for the clients or members of NGOs working in STI/HIV/AIDS prevention, AIDSCAP/FHI has worked to define productive relationships between social marketing projects and NGOs. Two successful models have emerged. In Haiti, NGOs became significant retailers of condoms. Faced on the one hand with an ineffective supply of government condoms (a supply that ceased during periodic political crises), and on the other with the importance of their messages encouraging condom use, NGOs began buying condoms from the PSI social marketing project at wholesale prices and selling them to their high-risk clients at retail. As a result, NGO members saw that the (highly subsidized) retail price was acceptable to their clients, they experienced the superior performance of the private sector delivery system, and they began generating funds through the trade margin they received. Skeptical at first of the ability of NGOs to handle retail products, though aware of the need to deliver condoms to the populations served by them, the social marketing managers saw the NGOs account for an increasing share of their sales, reaching 25 percent of the 35 million condoms sold in the year of the AIDSCAP/FHI closeout in Haiti.
| Country | Total Condoms Sold | Number of Sexually Active Males | Number of Condoms Sold per Sexually Active Male |
| Haiti | 1,259,720 | 1,440,000 | 0.87 |
| Tanzania | 6,047,224 | 5,700,000 | 1.06 |
| Cameroon | 4,448,640 | 2,700,000 | 1.64 |
| Brazil | 20,788,986 | 9,800,000 | 2.76 |
- Social marketing proved to be an enormous stimulus to the commercial condom market in general.
For example, the Brazilian market, dominated by two large national manufacturers, was stagnant prior to the launch of the DKT condom. By aggressively promoting its brand in public and by challenging barriers to imported condoms, the DKT program was primarily responsible for a sudden growth that tripled the market to 135 million condoms by 1995. Moreover, it spurred competitive marketing activity that resulted in the market gaining five additional condom importers.
In both Brazil and Haiti (as well as in general), the programming costs, in terms of funding and of time, to achieve adequate logistical support in condoms sales were less than the amount required for the public sector to perform the task. In Brazil, in particular, where AIDSCAP/FHI invested significantly through JSI to enhance the government's delivery system, the constraints to effective delivery were so fundamental that improvements were considered marginal. One reason for this conclusion was the government's finally putting only limited quantities of commodities into the system.
- Social marketing can successfully target its marketing efforts with a dedicated sales force.
In Brazil, a country so large that AIDSCAP/FHI was able to focus its program on only two states, the CSM project could not rely on NGO sales agents because of a law barring NGOs, as nonprofit organizations, from the retail trade. As a result, AIDSCAP/FHI provided separate funds to the social marketing project to ensure that sales efforts were especially intense in the geographic areas of the NGOs. Social marketing projects (as any sales operation) usually concentrate their resources on the most efficient (i.e., lowest cost) sales. In Brazil, as in the United States, that would have meant large sales to chain stores or the largest retail outlets. With the incremental resources provided by AIDSCAP/FHI, the social marketing operation was able to deploy a dedicated sales force to stock low-priced condoms in areas served by NGOs, even in small outlets.
Other countries also deployed dedicated sales forces to increase access to target populations. In Nepal, for example, a separate sales force concentrated its effort on the highways from India through the Terai, a known route for HIV transmission, resulting in adequate stocking and sales substantially higher than anywhere in the country. To accomplish this, every retail outlet along the highway was mapped and eventually visited by a sales team. The number of outlets stocking condoms went from 3 (pharmacies) to 56 retail outlets (tea shops, liquor stores, and cigarette shops) in 3 years.
- The climate for mass media messages about HIV/AIDS and condoms has substantially improved over the past 5 years.
Bishop Desmond Tutu's endorsement of condom use on South African television not only shocked some viewers, but also surprised social marketers who for years had tried to gain access to the mass media. As recently as 1990, the word condom was prohibited in advertising by the government of Kenya, requiring a wide range of subtlety and creativity on the part of social marketers. Today, more explicit advertising is permitted there and in many other parts of the world. In Nepal, a condom cartoon character stars in TV ads, and 18-foot inflatable condom replicas appear at public events. This increased freedom to use the public airwaves has yet to be fully exploited.
- Encouraging condom use through mass media facilitates their adoption by marginalized groups.
The increased ability to portray condom users openly in the media as happy, successful, "normal" people enables those whose lack of acceptance in society has been a barrier to condom use. Target marketing has sometimes been misunderstood to mean developing brands and advertising messages that appeal directly or even exclusively to commercial sex workers and their clients or to men who have sex with men. That approach requires those whose behavior is condemned by society to identify themselves as practicing that behavior. With the media carrying the message that everybody uses condoms, members of marginalized minorities can purchase condoms without identifying themselves as members of such a group.
- Although condom social marketing has a positive impact on social norms, the degree to which it does and mechanisms through which it operates are not well understood.
Most developing countries are much less saturated with media messages than is the United States; as a result, the positive messages on condoms placed by social marketing are virtually the only messages about condoms publicly promulgated. When properly crafted, these messages may be even more persuasive than private conversations about condom use. Because messages encouraging positive behavior change have little competition, and because of the mass media's expanded ability to address the threat of HIV/AIDS more explicitly, more resources should be devoted to mass media today than in the past.
Challenges for the Future
Beyond Condoms
The ability of social marketing to move physical goods within the convenient reach of target audiences and to create an effective demand for them has yet to be fully exploited, at least in part because of donors' hesitations about becoming further involved in commodity supply. For example, using social marketing to make supplies of latex gloves available near medical facilities and promoting the idea that it is a client's responsibility to supply the gloves might be less costly than making the investments in public sector logistics systems required to ensure adequate supplies to physicians. As other HIV/AIDS prevention products become available, such as female condoms, appropriate virucides, and STI and HIV/AIDS drugs, social marketing may provide a more efficient means of delivery than traditional public health systems.
Prevention Marketing
Throughout the world, advertisements for toothpaste, soap, and cars show happy, attractive people seeking to enjoy the thrill of being alive, conspicuously helped by the product of the moment. The same approach has made condom use less problematic in areas with strong social marketing programs, and it could also be used to promote less tangible "products," such as safer sex. HIV/AIDS prevention programs need to tap the power of the media to influence behavior by marketing healthy sexual behavior as an attractive life-style.
Condom Supplies
Meeting the demand for condoms created by social marketing is a major challenge. For years, USAID has been the only donor providing significant condom supplies for public health and family planning programs. Although additional donors (notably the European Community and the German development agency) have recently entered this area, most are reluctant to support commodity supply -- particularly when the commodity is considered controversial.
The efficiency of social marketing projects and their ability to recover costs tempt donors to make them entirely self-sustaining. But it is donor support that allows social marketing to sell condoms at an affordable price. For example, in Nepal, where social marketing is an important component of the AIDSCAP/FHI program, the retail price for a condom is less than U.S. $0.01. In Brazil, on the other hand, subsidies are not available and government taxes and regulations discourage condom imports. There the cost is $0.30 per condom, largely because management is forced to sell them at a price that finances new supplies. This price makes it highly unlikely that Brazil's poorest citizens will buy condoms.
Increasingly, the world over, AIDS is a disease of the poor. In order to deliver the only physical means of protection against the virus, condoms need to be made available in greater numbers now. Condoms must also be made available to the poor at a price that is attractive to them.
