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Using Market Analysis to Help Ethiopia Achieve its Health and Development Goals. This analysis was conducted by the USAID | DELIVER PROJECT, Task Order 4 . What is a market analysis?.

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slide1
Using Market Analysis to Help Ethiopia Achieve its Health and Development Goals

This analysis was conducted by the USAID | DELIVER PROJECT, Task Order 4

slide2

What is a market analysis?

A tool to analyze utilization of services and define strategies to segment, focus and improve access to family planning:

  • Utilizes Demographic Health Surveys (DHS)
  • Groups clients by characteristics, needs, and/or common preferences to understand their family planning needs
  • Analyzes use, demand, and provision of contraceptives in the total market (public, NGO, and commercial)
  • Uses this data to help inform multi-sectoral strategies to extend family planning services to those in need
countries face challenges when trying to expand family planning coverage
Countries face challenges when trying to expand family planning coverage
  • FP services: easier to reach and wider choice in urban communities; rural/marginalized communities – little or no access
  • Need for coordination among providers of family planning services (public, private, NGOs, SMOs, FBOs, Donors)
  • Little coordination between supply side (logistics, procurement, distribution) and demand and access side (FP service providers and customers)
  • Lack of adequate services for varied segments of the population (young vs. older, educated vs. non-educated, etc.)
  • When to charge? When to provide free? Confusion over user fees vs. free products and services
how can a market analysis help address these challenges
How can a market analysis help address these challenges?
  • By better understanding client needs
  • By better understanding family planning coverage and demand
  • By better understanding the potential for different sectors to meet this demand/need
  • By identifying gaps and overlaps in coverage between different service providers, and even within one sector
  • By identifying ways to more efficiently distribute resources between providers to cover the family planning market more equitably
a little background
A little background
  • Ethiopia is the second most-populous country in sub-Saharan Africa, with an estimated population of 86.9 million (PRB 2012)
    • Population is growing at a rate of 2.6% (PRB 2012)
    • 83% of population lives in rural areas
  • Very high birthrate- 34 births per 1,000 total population (PRB 2012)
  • Under 5 mortality is 88 deaths per every 1000 live births and infant mortality is 59 per 1000 live birth. (EDHS 2011)
  • Maternal mortality is 676/100,000 live births (EDHS 2011)
    • (lifetime risk of dying in childbirth is 1 in 27)
  • Nevertheless, Ethiopia has made significant gains in in strengthening family planning and reproductive health
    • Ethiopian’s Government commitment to family planning continues as a key strategy for improving health and development
ethiopia has achieved remarkable gains in expanding family planning service provision
Ethiopia has achieved remarkable gains in expanding family planning service provision
  • Impressive gains in modern contraceptive use by all women (women in union and those who are sexually active)
  • A decrease of ~ 10%

in unmet need since

2000

  • TFR has significantly

decreased in recent

years

slide8

If we have already had success, why should we do a market analysis in Ethiopia?

  • To understand where we’ve made the most progress in family planning coverage in recent years
  • To identify areas where we can do a better job to meet demand, that are not published in the DHS report
  • To use this data to join together and identify new strategies to reach our family planning goals
  • To support the GoE in achieving socioeconomic development goals and improve living conditions for families, mothers, and children of the future
slide10

Defining Terms: Key Terms Used in Presentation

  • Participatory market analysis approach using EDHS demand and other supply data to better understand and satisfy customer needs/preferences
  • CPR percentage of women of reproductive age (15-49 years) who are practicing or whose sexual partners are practicing any method form of contraception
  • Method Mix distribution of different contraceptive methods used by target population
  • Unmet Need percentage of WRA who do not want to become pregnant but are not using contraception
slide11

Defining Terms: Quintile Analysis

Based on goods and services at the household level population is divided into five equal groups.

These quintiles are used as a proxy indicator of socioeconomic status.

20% of households with the highest socioeconomic indicators

Richest

Richer

Middle

Poorer

20% of households with the lowest socioeconomic indicators

Poorest

slide12

Defining the Population Analyzed

Marital Status

(V502)

Never in union

Currently in union/living with a man

Formerly in union/living with a man

In the DHS women (15-49) are independently categorized as:

Recent sexual activity

(V536)

Never had sex

Active in last 4 weeks

Not active in last 4 weeks*

For purposes of this analysis “women” refers to women in union and those who are sexually active (in the last 4 weeks).

slide14

Family planning use has nearly doubled in a short period although is still below the 66 percent by 2015 GoE target

slide16

There is a huge disparity in use between the poorest and the richest women; although unmet need is consistently high in most quintiles

slide18

Family planning use (including traditional methods) is much higher among women with education and in urban areas

slide21

An estimated 3.3 million women have an unmet need for FP. Most of these women reside in Oromiya, Amhara and SNNP

Estimated number of women (15-49) with unmet need by region in 2011(% unmet need)

Oromiya

30%

Amhara

22%

SNNP

25%

Somali 24%

Tigray 22%

Addis Abba 11%

Afar

16%

Ben-Gumz

24%

Dire Dawa

22%

Gambela

17%

Harari

24%

slide22

Of these 3.3 million women with unmet need, an estimated 300,000 are adolescents (15-19)

Estimated number of women (15-19) with unmet need by region in 2011 (% unmet need)

Oromiya

36%

Amhara

32%

SNNP

33%

Tigray 27%

Somali 25%

Afar

31%

Ben-Gumz

32%

Gambela

22%

Unmet need among adolescent women in Afar, Amhara, and Harari is 10-15 percent points higher than the average for all women

Addis Abba 11%

Harari

34%

Dire Dawa

21%

slide24

Primary method continues to be injectablesalthough implants use has risen while orals have declined in recent years

Method Mix

CPR=29%

CPR= 15%

slide25

Injectables are the most commonly used among all age groups. Use of long acting and permanent methods increase with age.

slide26

Injectables are most commonly used among all groups. Urban and more educated women use a greater variety of methods than others.

slide27

There has been significant increase among users obtaining products from health posts/health extension work

slide28

Public sector provides most products although condoms and pills are also obtained in pharmacies. Pills IUDs and injections are also obtained in private facilities.

slide29
The majority of women regardless of wealth or residence receive their contraception from government sources
slide30

The public sector is also the main provider throughout the regions with health posts and HEWs largest in SNNP and health centers predominant in some regions

^ Regional results for Somali should be interpreted with caution as sampling was not representative

slide31
There is a large potential for future clients. More than half of those who are not currently using a method intend to do so in the future
most common reasons for non use

Most women who are not using consider they are not at risk because they have recently had a baby and/or they do not use because they have a fear of side effects

Most Common Reasons for Non-Use*
slide34

There are still significant differences in use between regions despite use increasing in most areas between years

slide36

Unmet need has also declined at to varying degrees by region

No difference between 2005 and 2011

No Difference=p>0.05

slide37

Rate of decline in unmet need is similar in most regions although Tigray, Afar and Somali lag behind

No Difference=p>0.05

slide38

Defining Terms: Total Demand and Demand Satisfied

Total Demand for Family Planning

All women who are using or have a need for family planning. Women who need FP are not using but are:

sexually active

fertile

and report they do not want any more children or want to delay the birth of their next child

Demand Satisfied

The percent of the total demand which is met through method use.

slide39
Total demand is higher and has been best satisfied in the urban areas although major improvement has occurred in the rural areas

**p≤0.001

slide40

Total demand among the adolescent population (women 15-19) is higher in urban areas but demand satisfied has declined since 2005. Rural areas made significant improvement between years.

**p≤0.001

slide41
Total demand is higher and is been best satisfied in richer quintiles but all quintiles have seen major improvement
slide42

Demand generation is important to reach the GoE targets for 2015. In most regions demand was less than 50% in 2005

slide43

While total demand for family planning improved in 2011 particularly in Gambellamore is needed

slide45

Much more of this demand has been satisfied in 2011 with major improvement in Amhara and Gambella

slide47

There are five specific areas throughout the country where the rural population uses modern methods at similar rates

2011 National Average

22.5% mCPR

slide48

There are five specific areas throughout the country with similar patterns for demand satisfied among the rural population

slide50

Key take away points from this analysis

  • Fertility rates have declined; although, they have stagnated in urban areas
  • Contraceptive prevalence for all women (women in union + sexually active) has increased substantially in a short period of time (7% in 2000 to 14% in 2005 to 28% in 2011)
  • Least wealthy and non-educated women of all ages are using at a lower rate than the rest of the population
  • Injectables are still the most common method being used but use of long-acting and permanent FP methods has increased (4% in 2005 to 15% in 2011)
  • Highly educated and richer women are using more traditional methods than less educated and poorer women
slide51

Key take away points from this analysis

  • Nearly 90 percent of all women with unmet need live with in Oromiya, Amhara and SNNPR regions.
  • In Amhara, Afar and Harari young women (15-19) have 10-15% higher unmet need compared with other women in the same region
  • The public sector continues to provide most products (84% of market), although condoms and pills are also obtained in pharmacies while private facilities are providing pills, IUD and injections.
    • Almost ⅓ of users are obtaining products from health posts/HEW (vs. ~1/5 in 2005)
slide52

Key take away points from this analysis

In Dire Dawa, Addis Adaba, Harari, Amhara, Afar, Tigray- health centers are the most popular source for methods. In SNNPR, Ben-Gumz, and Oromiya most women obtain methods from health post/HEW. In Gambela, most women obtain their methods at private facilities.

The most wealthy women are obtaining most of their methods from the public sector.

Most women (56%) who are currently not using any method intend to use FP in the future

The most common reasons for women who are not current using are because: they recently had a baby, are breastfeeding and/or have a fear of side effects.

slide53

Key take away points from this analysis

Demand for FP as well as satisfying this demand has improved substantially since 2005 in the rural areas

In urban areas, especially among youth (15-19), demand and demand satisfied has stagnated or decreased

Least wealthy women of all ages have less of their demand satisfied than the rest of the population

A few geographic areas and segments (urban youth, for example) have a high total demand for contraceptives (66% or more) and others lag behind

There are areas throughout the country, located across regional boundaries, that display similar use and demand patterns

slide54

Recommendations

  • Use in urban areas, especially among the youngest women, has not increased at the same rate as in rural areas.
    • Study use preference and determination factors to better develop messages and services that meet their needs.
    • Consider developing strategies that extend services to youth in urban areas and maintain or increase use among all populations living in urban areas.
  • Women with unmet need are concentrated in regions with the highest population.
    • Consider developing services to satisfy the large number of women with unmet that are concentrated in these areas.
slide55

Recommendations

  • Most women across all age groups are primarily using injectables.
    • Continue to support efforts to strengthen the capacity of the public sector to provide LAPMs and counsel women on more appropriate methods for their point in their childbearing life cycle.
  • Gambela and Tigray display use and need patterns that are different from other regions.
    • Consider further studying these populations to better understand the factors that affect women’s use in these regions
slide56

Recommendations

  • Most wealthier women, although they may have an ability to pay for family planning, are obtaining their methods from the public sector.
    • Consider carrying out ability and willingness to pay studies to see whether these women could be shifted to NGO or private sector facilities to obtain services.
    • Continue efforts to partner with the private sector to expand and coordinate their services with the public sector and attract wealthier clients to services that are better customized to their needs
benefits of further strengthening family planning
Benefits of further strengthening family planning
  • Increased CPR is indicative of increased levels of service provision, an increase in the availability of contraceptives, and overall, a more robust supply chain.
  • These services leave families less vulnerable to unintended pregnancies and births; and reduce abortion rates, maternal and infant deaths, and sexually transmitted infections, including HIV.
  • Yet, more work needs to be done to meet Ethiopia’s family planning and development goals
  • Accelerating these gains can make a powerful contribution toward the country’s economic growth, poverty reduction, and helping Ethiopia achieve its Millennium Development Goals.
for a better future thank you
For a better future! Thank you.

This analysis was conducted by the USAID | DELIVER PROJECT, Task Order 4