1. Use of private sector approaches and ICT as a
scale-up strategy for family planning:
Focus on India
Priya Jha, Katherine Lavoie, Victoria Jennings,
Meredith Puleio, Rebecka Lundgren
APHA–2009

2. Presenter’s statement
I have no relationships to disclose.

3. Scaling up requires a multi-sectoral
approach
• Public sector
• NGOs
• Private sector (includes social
marketing and private sales)
• Communication technologies

4. Private sector is primary source of
health care
• Free services of national health program
inadequate due to underfunding, poor quality
and lack of reach
• 65% of households report primary source of
health care as private sector
 The main provider of care among private
providers is a private doctor or clinic

5. Private sector is most common source of
temporary family planning methods
Pill IUD Injectable Condoms
(%) (%) (%) (%)
Public medical 15.3 45.6 11.2 13.3
sector
NGO <1 1.0 <1 <1
Private medical 63.7 51.8 82.7 45.8
sector
Other (shop, 20.2 <1 4.7 40.4
spouse, friend,
etc.)
Source: NFHS-3

6. What do we mean by private sector?
• Private medical sector – includes formal
(registered) and informal (unregistered) sector
– Private hospital/clinic
– Private doctor – OB/GYN, General Practitioner, other
– Ayurvedic practitioners / homeopaths
– Traditional healers
– Pharmacy/drugstore
– Dai (traditional birth attendant)
• Other private sector
– Retail shops, online sales, etc.

7. CycleBeads: Significant private
sector potential
• Low cost
• Available in large
quantities through
manufacturer
• Visual appeal
• Supported by simple
explanatory materials
• Promising results in
other countries

8. Other experiences worldwide
• Private sector nurse midwives
in Peru
• Pharmacy sales in DR Congo,
Rwanda, Mali, Ecuador
• Philippines: A growing market
– Licensed local distributor
– Initiation of marketing through
pharmacy chain
– Sold by private nurse midwives
and NGOs
• U.S.A.: Internet and retail sales
(Whole Foods, etc.)

9. Be advised when working with the private
sector…
Characteristics of Marketing considerations:
private medical • Profit potential
sector: • Demand
• Heterogeneous • Willingness to pay
• Variable quality • Potential to affect
• Limited regulation condom sales
• Sustainability • How to position the
concerns after product
training • How to market the
product

10. Private sector strategies in India

11. Strategic selection of local
CycleBeads manufacturer
• Largest contraceptive manufacturer in
country
• Offer a range of family planning products and
other health care products
• A “Government of India enterprise” with
distribution networks across country
• Product lines for free distribution, social
marketing, and private sector retail
• Internet sales for condoms

12. Engaging private doctors and
medical professional associations
• Participate & present
at scientific meetings
• Train OB/GYNs and
medical practitioners
at project sites
• Involve private
doctors and leaders
of associations in
partners meetings,
stakeholder
interviews, etc.

13. Preparing for sales through
Abt Associates’ “Saathiya”
Youth-Friendly Network
• Trained pharmacists and private
doctors
• Trained helpline counselors
• Developed promotional
materials
• Conducted willingness-to-pay
study
• Hosted outreach activities to
build awareness and generate
demand

14. Plans are being developed for:
• Social franchising through
“Merrygold” –branded
network of private clinics
• Voucher program to
obtain family planning
products from private
clinics
• Social marketing pilot
project
• Advertisements and
editorial columns in
magazines
• Internet sales

15. Information and Communication
Technology

16. Mobile phones
• 4.1 billion users worldwide; 2/3 of this in developing
countries
• Majority of subscribers men and women ages 15-49
• 3 billion use SMS
• India has fastest growing telecom market in the
world – more than 492 million cell phone users by
end of 2009

17. “mHealth”
• Limited resources and fragile health systems in many
developing countries are not adequate to meet the
needs of people for health information.
• Uses of SMS technology for health have been
successful at reaching people with the information
they need.
– Information about opportunities for free exams or treatment
(e.g., One World’s Mobile4Good in Kenya)
– Reminders for people to take medicines at regular intervals
(e.g., SIMpill® Medication Adherence System in South Africa
and Botswana).

18. CycleTel™
• mHealth solution
• Based on the Standard
Days Method (SDM)
• Woman sends the
date of her menses
• User receives text
messages with fertility
status
• Additional messages
support correct use,
info on other RH issues

19. Proof-of-concept testing:
Lucknow, Uttar Pradesh
Phase Objectives
1) Focus group • Understand phone use patterns
discussions • Determine potential interest among
target audience
• Explore appropriate messaging and
preferences for the service
2) Cognitive Verify comprehension of messages
interviews
3) Manual testing • Assess feasibility of use, satisfaction
with ~30 couples with service, and correct use
• Troubleshoot problems
• Determine how to improve the
service

20. Preliminary results:
54 focus group participants
• Need and demand for CycleTel exists
• Messages should be precise, non-technical
• Men interested in receiving messages
• People are willing to pay for the service (15-35
rupees/month)
“This is an idea that can
change your life.”
-Male participant

21. Next steps…
• Completion of proof-of-concept testing
• Software development
• Pilot testing
• Scale up within India; replication of
process in other countries

22. Conclusions
• Private sector and information technology
approaches show potential to maximize
diffusion and reach the tipping point quickly. ,
These approaches should form part of the
scale-up plan
• Apply the guiding principles of the ExpandNet
model during scale up: participatory, systems
approach, evidence based, quality,
sustainability, and rights-oriented

23. References
• Holtz, C. Global health care: issues and policies. Sudbury, MA: Jones
and Bartlett, 2008.
• India To Have 492 Million Mobile Phone User By End-2009.
5/17/09 http://www.thebestdigital.com/india-to-have-492-million-
mobile-phone-user-by-end-2009.html
• International Institute for Population Sciences (IIPS) and Macro
International. 2007. National Family Health Survey (NFHS-3), 2005–
06. India: Volume II. Mumbai: IIPS.
• Jordans, F. World’s Poor Drive Growth in Global Cell Phone Use.
http://abcnews.go.com/Technology/wireStory?id=6986939
• Out-of-pocket spending on health care high: Report.
http://www.thehindubusinessline.com/2008/12/10/stories/200812
1051490600.htm
• Waters H, Hatt L, Peters D. Working with the private sector for child
health. Health Policy and Planning 2003; 18(2): 127-137