Last month, our FHM Engage team in Madagascar cohosted with the Association for the Private Health Sector (Groupement du Secteur Privé de la Santé or GSPS) and worked to produce in collaboration with the Ministry of Public Health and USAID/Madagascar, the second edition of the Madagascar Private Health Sector Exhibition or the «Salon du Secteur Prive de la Sante 2024» in Antananarivo. Propelled by the event’s theme of "Let's work together for better health for all,” organizers aimed to use this event to promote private health market stakeholders – in particular those working on maternal and child health, family planning, nutrition, and other priority health areas – among state institutions and donors.

The event included:

• 49 exhibitors from the healthcare sector presenting their products and services
• Four discussion panels with technical experts
• 11 conference sessions on the latest innovations and research
• A "Business to Business" meeting for private healthcare providers with financial institutions  
• Eight capacity building sessions and technical training for private providers in maternal and child health
• Other events for partnerships agreements and networking activities.

The event attracted 1, 428 participants and multiple market actors. Both national and international stakeholders including the West African Federation of Alliances of the Private Sector of Health (Fédération Ouest Africaine du Secteur Privé de la Santé  or FOASPS) and APOLLO Hospitals contributed to the success of this event.

Related Resources:

• Snapshot of Accomplishments: Madagascar (Oct 2022 to March 2023)
• FHM Engage Madagascar health market description on Family Planning
• FHM Engage Madagascar health market description on Maternal & Child Health
• FHM Engage Madagascar health market description on  Nutrition
• Webinar: The Importance of Stewardship in Strengthening Health Markets in Liberia, Madagascar, and Pakistan

Media coverage in French & Malagasy:

• NY VAOVAO 06-06-2024 | KOLO TV   (starts at 53:08)
• Radio Don Bosco - [Vaovao hariva] Alakamisy 6 jona 2024 (rdb.mg) (starts at 16:00)
• https://www.facebook.com/tiatanindrazana.1960/videos/1390503064991401/?mibextid=rS40aB7S9Ucbxw6v

Banner photo: Participants of the 2nd Annual Private Health Sector Exhibition in Madagascar listen to the official opening of the trade fair along with guests from USAID and the Ministry of Health. Photo credit: FHM Engage.

On March 28, 2024, FHM Engage hosted a webinar to answer: What is stewardship? Who “does” stewardship? Why is stewardship important in market development? How do we improve stewardship to strengthen health markets?

The technical showcase explored the concept of stewardship in the context of health market development. Speakers from Liberia, Madagascar, and Pakistan shared how FHM Engage used a market description approach (MDA) in these countries to landscape a full range of market actors and identify key stakeholders to play a stewardship role. Presenters explained how FHM Engage is strengthening the capacity of these market actors in different ways, through a variety of activities, to steward the health markets effectively in each country and improve market performance to ensure the delivery of safe, affordable, appropriate health products and services.

Moderator/Presenters:

• Dana Tilson, Project Director, Moderator
• Abena Amoakuh, USAID Opening Remarks
• Monte Achenbach, Technical Director
• Sophie Parwon, Chief of Party, Liberia
• Davy Robson, Product Specialist, Madagascar
• Laila Gardezi, Senior Technical Advisor, Pakistan

Related Resources:

Webinar slides

Webinar recording

The Healthy Markets Community of Practice (HMCoP) is a group dedicated to generating awareness of market development and private sector engagement work happening in different countries and for participants to leave with a greater understanding and appreciation of the country’s health market. The speakers for September represented MOMENTUM, Society for Family Health, SwipeRx, inSupply Health, IQVIA, and Maisha Meds.

The September meeting of the Healthy Markets Community of Practice (HMCoP) focused on pharmacies and drug shops (PDS) and their utilization as platforms for provision of family planning (FP) products and services.  To start the session, co-host USAID Senior Private Sector Advisor Andrea Bare introduced the participants to this month's theme and its importance to the HMCoP. Previous work done by SHOPS Plus showed that in 36 USAID-focus countries, 41 percent of women get their method from pharmacies or drug shops.  In other words, in USAID-focus countries, one in three women get their FP products and services from the private sector. 

The September meeting of the Healthy Markets Community of Practice (HMCoP) focused on pharmacies and drug shops (PDS) and their utilization as platforms for provision of family planning (FP) products and services.  To start the session, co-host USAID Senior Private Sector Advisor Andrea Bare introduced the participants to this month's theme and its importance to the HMCoP. Previous work done by SHOPS Plus showed that in 36 USAID-focus countries, 41 percent of women get their method from pharmacies or drug shops.  In other words, in USAID-focus countries, one in three women get their FP products and services from the private sector. 

Following the comments from Mr. Nasiruzzaman, HMCoP Lead Facilitator and FHM Engage Chief of Party for Tanzania Farhan Yusuf introduced the agenda and the speakers for the first presentation. 

In the next part of the meeting, speakers gave rapid presentations on their work.

Dr. Velonirina Andrianifahanana Program Manager, PSI, presented on MOMENTUM Private Healthcare Delivery (MPHD) which focuses on strengthening child health (CH)/FP quality of care among drug shop providers in Madagascar. In Madagascar, drug shops are the primary source of pharmaceutical products but cannot currently provide CH or FP services and are also sparse in rural and remote areas. To bridge this gap, the project is working with the Ministry of Health to develop an accredited drug shop program (ADDOs) to expand and improve the quality of CH/FP service offerings. To accomplish this, MPHD developed a global curriculum for integrated CH and FP services which includes comprehensive content that encompasses diarrhea, malnutrition, malaria, FP counseling, and referrals. The project also includes training, supervision, and evaluation. MPHD is currently providing training to approximately 60 drug shops in two regions and supervision is or will be occurring monthly or quarterly with supplemental digital coaching. Later, the evaluation will consist of a 12-month study to assess the feasibility and effectiveness of the training and follow-up supervision, monitoring of client satisfaction, and costing of the intervention components. 

Dr. Uchenna Okafor, Project Director, Society for Family Health (SFH), presented his study to identify the major economic, socio-cultural, and behavioral drivers for and barriers against demand for FP products and services using hybrid e-pharmacy channels in Lagos State, Nigeria. The study sought to answer three important questions: 1) Who are the current and potential customers/users of hybrid e-pharmacy platforms? 2) How does the e-pharmacy platform currently inspire and attract FP clients? 3) To what extent are e-pharmacists and telemedicine providers willing and able to provide FP products and services through hybrid e-pharmacy models? To answer these questions SFH interviewed 30 pharmacists and telemedicine providers. Through these interviews, the study found that e-platform users tended to be younger, female, and reside in urban areas while non e-pharmacy users tended to be older (over 45), male, reside in rural/peri-urban areas, and have low levels of education. E-Pharmacists reported that there is a higher demand for condoms and oral contraceptives due to low levels of stigmatization, lack of awareness of alternatives, peer influence, affordability, and convenience. It was found that a lack of uptake of other methods like intrauterine devices (IUDs) and injectables was due to low levels of awareness of other methods, peer influence, fears of insertion/injections on the part of both providers and patients, and anchoring (meaning clients were biased towards a product so e-pharmacists found it hard to promote alternatives). Several operational and logistical barriers exist that inhibit e-pharmacists from engaging with clients including network issues, incorrect client contact information, and low stock levels. This study recommends improving client experiences through AI chatbots or use of video calls as well providing free delivery and tutorial videos to enhance and improve e-pharmacy platforms and FP service delivery. 

Josselyn Neukon, Senior Vice President Public Health, SwipeRx gave an overview of SwipeRx, an all-in-one app for pharmacy professionals. Created in 2017, SwipeRx is the largest digital network of pharmacies in Southeast Asia and connects 260,000 users, of which 78 percent identify as women, from more than 55,000 pharmacies across six countries, where four in ten users work in rural pharmacies. The app allows pharmacy professionals to connect with each other, find accurate drug and health information, access free continuing professional development training, order pharmacy supplies, and access practical tools to improve the efficiency of their operations. Commercial and global health partners work with SwipeRx to access the pharmacy channel with speed and scale that is not feasible using offline methods to increase pharmacy contributions to primary health care, infectious diseases, NCDs, and market development. The impact of SwipeRx can be seen through its effect on both pharmacy capacity and pharmacy supply chain. In terms of pharmacy capacity, in 2022 more than 66,000 users accessed education modules through the app. Also, data collected in 2023 demonstrated that pharmacists educated through the app are more likely to adhere to recommended clinical care, client counseling, and waste management practices. In terms of pharmacy supply chain in Indonesia, SwipeRx is the largest purchasing network and is used by over 8,000 pharmacies across 116 cities and districts, representing 25 percent of all registered pharmacies. In Vietnam and Cambodia, it partners with manufacturers and quality assured health products and connects users and commercial suppliers. By focusing on the pharmacy supply chain, SwipeRx is able to leverage its network to improve availability and affordability of essential medicines and other health products at discounted prices. 

Laura Nabwire, Practice Lead inSupply Health, presented their health market test project that focuses on strengthening pharmacy provision of contraceptives in Kenya. inSupply Health is an East Africa health advisory firm and a subsidiary of JSI Research & Training Institute that focuses on improving health outcomes through strengthening health systems and supply chains. The goal of the market test project is to develop and test the viability and scalability of a pharmacy business model with a focus on contraceptive products, particularly self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC). Objectives are to 1) increase the number of women accessing FP products and services at pharmacies, 2) document the value for pharmacies to offer DMPA-SC and other self-care products, and 3) expand the network of pharmacies implementing viable business models that offer quality counseling, training, and FP products. Several barriers exist when it comes to the pharmacy business model including large dependence on the public sector, low demand from customers, and no clear viable path of profitability. Unfavorable government policies need to be addressed, but in the last five years key policy changes have created a more favorable environment for pharmacists to operate.  Currently the project is in its second of three phases, solution testing to bring business models to scale. Some key solutions identified to address current problems in pharmacies include the creation of a client retention program, creating safe (private) spaces, pharmacy mentorship, branding, and continuous product availability.

Rashid Khan, Biostatistician, IQVIA spoke on networking the supply chain to drive access, efficiencies, and product choice. The IQVIA platform connects companies to distributors and distributors to pharmacies and drug shops. The platform has a wide-reaching network and currently has more than 30,000 pharmacies and over 450 distributors. This platform brings all the distributors and all the pharmacies together onto the same platform and then enables them to interact with each other. The platform also processes approximately 17,000 orders a day which translates to $300M annually. IQVIA operates in India, Saudi Arabia, and the United Arab Emirates with project pipelines in Jordan and Kenya. The manufacturer, distributor, and PDS network is complicated and requires that IQVIA address the challenges that are faced by each of the different stakeholders in the supply chain including overstocking/understocking, leakages, restricted market reach, and limited visibility between orders and delivery. IQVIA also looks to support implementation and functional outcomes for platform users. Functional outcomes include increased geographical reach, access to multiple suppliers, streamlining of pricing, and help to reduce stock outs. In addition, the platform drives adoption by focusing on infrastructure, cost, and interoperable systems. By keeping costs distributed across the supply chain, requiring minimal infrastructure to join, and integrating existing systems, IQVIA is able to increase uptake of the platform. 

Dan Rosen, Director of New Business, Maisha Meds, focused on trends of FP imports in Madagascar. Maisha Meds builds innovative software and data solutions, programs, and capabilities across Sub-Saharan Africa to improve healthcare. Maisha Meds focuses on three types of solutions: 1) a digital point of sale tool which helps pharmacies track sales and manage inventory, 2) loyalty programs that provide discounted testing and medication to patients, and 3) proprietary data that is combined with alternative source of supply chain data to build a picture of consumption across the value chain. Demonstrated key impact metrics include better health outcomes for patients treated via the loyalty programs and approximately $25M raised in grant funding to support growth of its solutions. Facility data allows them to track choice product mix, prices, margins, and subnational variation. Margin analysis allows Maisha Meds to see which part of the supply chain is in need of intervention. The data that Maisha Meds uses in terms of their FP analysis is most useful when it comes to emergency contraceptives (EC), oral contraceptives (OC), injectables, IUDs, and misoprostol/mifepristone, but not for condoms and implants. Benefits include that the data is able to show the price to patients and then the markup at retail facilities and is able to give the sub-national overview of healthcare commodities consumption. Limitations are that the data is not fully representative of the market, is limited to four countries, does not capture 100 percent of the market, and is not easy to use. 

To end, we extend a great thanks to all who participated in this session focusing on pharmacies and drug shops, particularly to those that took the time to speak and prepare slides. We are excited that there was such a positive response to this meeting and are pleased that we are continuing to facilitate connections and shared learning. We hope that participant engagement remains high and that organizations continue to share the progress of their work so that we may continue to facilitate this collective learning. We look forward to continued participation in future sessions. 

Resources

To access additional resources on some of the topics mentioned during this meeting use the links below: 

• Presentation SFH E-Pharma4FP.pptx

• SwipeRx Strengthens Pharmacy Contributions to National Health Systems January 2023.pdf

• Scaling Digital Quality Improvement through Pharmacies SwipeRx April 2023.pdf

• Using Technology to Scale Family Planning Capacity Contraceptive Choice through Community Pharmacies SwipeRx July 2023.pdf

• Scaling-Impact-in-Asia-2022-Case-Study_SwipeRx_CIIP-Accenture-SMU.pdf

Future Meetings

The next HMCoP convening will focus on Kenya. The meeting is scheduled for October 31, 2023 and a calendar invite has been sent out.  If you would like to take part in or contribute to this or another HMCoP session, or you would like to make us aware of an organization or project, please email Elizabeth Peña at (epena@fhm-engage.org) or Judy Mboya (jmboya@fhm-engage.org).

Questions?

Please email Judy Mboya (jmboya@fhm-engage.org or Elizabeth Peña (epena@FHM-Engage.org). 

La réunion de juillet de la Communauté de pratique des marchés sains (HMCoP) s'est concentrée sur Madagascar et a été la première réunion à utiliser la traduction simultanée. Dans notre objectif de donner la priorité à la localisation, cet outil a facilité la participation des acteurs locaux dans le pays. Certains intervenants ont également pu se réunir dans le bureau de FHM Engage Madagascar pour présenter leur travail ensemble, ce qui a favorisé la collaboration et le travail en réseau. Nous tenons à remercier Sarindra Ramanitrivonony, responsable de FHM Engage à Madagascar, pour tout le travail qu'elle a accompli en vue de l'organisation de cette réunion.

Pour commencer la session, Kuyosh Kadirov, Health Development Officer de l’USAID, a annoncé qu'il transmettrait la gestion du HMCoP à Andrea Bare, Senior Private Sector Advisor (conseillère principale du secteur privé).

Après cette annonce, Farhan Yusuf, facilitateur principal du HMCoP et chef de partie de FHM Engage pour la Tanzanie, a présenté l'ordre du jour et le thème de la session autour duquel les intervenants ont encadré leurs présentations, à savoir la contribution du secteur privé à la réalisation des objectifs de la planification familiale (PF) 2030 à Madagascar.

La suite de la réunion a consisté en des présentations de plusieurs orateurs qui ont présenté leurs travaux:

 Olivier LeTouze, consultant en description de marché de FHM Engage Madagascar, a présenté le contexte du marché de la planification familiale à Madagascar par le biais de la description de marché de la planification familiale (PF) à Madagascar. Les résultats révèlent que les jeunes femmes urbaines mariées (15-24 ans) ont des besoins non satisfaits importants, en particulier par rapport aux jeunes femmes rurales, pour les raisons suivantes :

• L'arrêt brutal de la commercialisation sociale subventionnée des produits de PF, qui a laissé les prestataires de santé du secteur privé sans moyen d'acheter des produits.
• Le manque de disponibilité des contraceptifs dans le secteur privé. La chaîne d'approvisionnement est concentrée et compte peu d'acteurs du secteur privé, qui se méfient de la nature incertaine du marché des contraceptifs et ne sont donc pas prêts à s'engager.
• Les réglementations et les taxes liées à l'importation et à la fourniture de contraceptifs sont lourdes et difficiles à comprendre ou à prévoir.

Les efforts visant à soutenir le marché de la santé ayant été principalement orientés vers le renforcement du secteur public, le secteur privé à but lucratif a été négligé.

Le Dr Vololoniaina Rasoanandrasana, représentant du ministère de la Santé publique, a partagé la façon dont Madagascar prévoit d'atteindre ses objectifs de PF pour 2030 (en augmentant le taux de prévalence des contraceptifs modernes pour les femmes mariées à 60 %, en réduisant le taux de besoins non satisfaits en PF à 8 % et en atteignant un indice synthétique de fécondité de 3) et les 9 engagements que Madagascar a pris pour atteindre ces objectifs et les 6 stratégies pour mener à bien les engagements. Actuellement, le secteur privé est intégré dans le groupe de travail technique sur la PF et est impliqué dans les activités de plaidoyer pour la mobilisation des ressources. Le secteur privé est également impliqué dans la mise en œuvre des activités de sensibilisation et dans des domaines tels que le financement où il travaille à combler le manque de produits contraceptifs. Cependant, des efforts supplémentaires doivent être faits pour utiliser le secteur privé.

Oliva Harivololona, présidente de l'Association des cabinets privés d'accouchement de Madagascar (ASCAP), a décrit les cliniques privées (ou maisons de naissance) de Madagascar appelées "Cabinet d'accouchement", qui sont gérées par une ou plusieurs sages-femmes et visent à garantir la santé familiale par le biais de conseils en PF et d'autres services (tels que les consultations pré et post-natales, le dépistage et le traitement des infections sexuellement transmissibles, et les services de santé maternelle et reproductive pour les jeunes). Dans ces cliniques, les clientes des services de PF ont montré une préférence pour les contraceptifs injectables et oraux. Pour ces clients, en particulier ceux des zones rurales, l'accès aux services de santé est un problème, tout comme le manque d'information, de communication et d'éducation en matière de santé. Dans le même temps, les prestataires de services luttent pour la qualité des services et l'accès aux produits. Le secteur privé, en particulier les prestataires privés, doit améliorer les services, l'accès aux services et aux produits, et renforcer la formation pour répondre aux besoins non satisfaits en matière de PF.

Rijalalaina Rasolofonirina, directrice nationale adjointe de Marie Stopes Madagascar (MSM), a expliqué pourquoi les services de PF pour les jeunes doivent être abordés. Tout d'abord, une personne sur deux à Madagascar a moins de 18 ans - Madagascar compte environ 1,5 million d'adolescents - et 81 % d'entre eux vivent dans des zones rurales. 496 000 de ces adolescents ont besoin de PF chaque année. 37 % des femmes sont mariées avant l'âge de 18 ans, les taux de fécondité des adolescentes sont élevés et les complications liées à la grossesse et à l'accouchement sont la principale cause de décès chez les 15-19 ans. Le taux de prévalence contraceptive est de 34 % pour les adolescentes de 15 à 19 ans et de 42 % pour les jeunes de 15 à 24 ans. Pour s'attaquer à ces facteurs, il faut mettre en place des interventions conçues pour les jeunes:

• Multiples canaux de prestation de services pour maximiser la portée et cibler différents segments avec différents services.
• Un large éventail d'agents d'orientation "connectés", allant des enseignants aux connecteurs adolescents, fournissant un continuum de soins (des premiers conseils aux soins de suivi) par l'intermédiaire d'un centre d'appel 411.
• Des prestataires formés à l'approche jeune permettant aux adolescents d'avoir un choix informé et volontaire en matière de contraception.
• Des systèmes de données de routine, ventilées par âge, permettant des interventions adaptatives et ciblées.
• Les solutions proposées (dérogations, bons ou services gratuits) pour que le coût ne soit pas un obstacle.

Les progrès restent lents en raison des restrictions liées à la fourniture de services de santé génésique aux mineurs sans le consentement des parents, du manque d'informations précises et complètes sur la santé génésique et le planning familial, des normes sociales et culturelles et des ressources limitées qui empêchent la fourniture de services de santé génésique de qualité aux jeunes. Le MSM collabore avec le secteur privé sur les points suivants 1) l'intégration des prestataires privés dans les programmes d'assurance maladie, 2) le renforcement des capacités des prestataires privés à offrir des services de PF, et 3) l'esprit d'entreprise par le renforcement de la gestion de la chaîne d'approvisionnement afin d'éviter les ruptures de stock. En fin de compte, l'amélioration de l'accès des jeunes à la planification familiale est cruciale pour les avantages éducatifs, économiques et démographiques.

Laury Francia Rasoanirina, responsable du programme PSI Madagascar, a décrit la clinique mobile ACCESS, financée par l'USAID, qui opère dans 11 régions de Madagascar. Grâce à une stratégie définie par les principales parties prenantes, l'USAID et le ministère de la Santé publique, la clinique a formé 20 prestataires de santé, emploie 20 agents de création de la demande et de promotion des services, et collabore avec 10 organisations régionales de marketing social.

Yvan Ranaivoson, directeur de l'Institut de technologie et de gestion de l'éducation (ITEM), a expliqué comment le secteur privé malgache pouvait devenir plus efficace en se concentrant davantage sur les aspects suivants:

• Besoins - comprendre la qualité, la quantité et les conditions des formations proposées au secteur privé.
• Curriculum - se concentre sur la durée, le sujet et les méthodes utilisées pour créer des formations.
• Exécution - par l'intermédiaire des bureaux régionaux de formation; comment les matériels et les dispositifs sont-ils utilisés pour mener à bien les formations.
• Évaluation et supervision - quel suivi sera effectué pour démontrer l'efficacité des formations.

Le Dr Vero Randriamalala, représentant de la Fédération des mutuelles de santé, a décrit la Fédération "Miara-miahy". Cette organisation faîtière à but non lucratif a été créée en 2019 et compte neuf membres actifs de mutuelles - un type d'arrangement d'assurance à but non lucratif - dans 22 régions de Madagascar pour faciliter l'accès à des soins de qualité et abordables pour l'ensemble de la population. Elles offrent 15 types de services, dont les soins primaires, l'accouchement, la planification familiale et la santé préventive. L'organisation cherche à accroître la sensibilisation à la PF en identifiant des ONG partenaires pour la santé sexuelle et reproductive (SSR)/FP afin d'alléger les dépenses des fonds mutuels. Les résultats les plus récents montrent que 715 326 personnes étaient couvertes par les mutuelles à la fin du mois de juin 2023, 65 % des membres sont des femmes, 60 % des membres sont en âge de procréer et 50 % sont des jeunes couples. Malgré ce succès, des problèmes restent à résoudre comme l'indisponibilité des produits de PF dans certaines zones, les barrières psychosociales (réticence du mari à utiliser la PF, culture, etc.), et le financement limité des mutuelles pour intervenir dans les zones isolées.

Faly Razanalison, spécialiste du programme Santé et droits sexuels et reproductifs (SRHR)/PF UNFPA Madagascar a clôturé les présentations en expliquant comment l'UNFPA offre un soutien technique à Madagascar à travers 1) le plaidoyer, la politique, le dialogue et le soutien ; 2) la gestion des connaissances ; 3) le développement des capacités ; 4) la fourniture de services ; et 5) la coordination, le partenariat et la coopération. De 2022 à 2023, l'UNFPA a travaillé sur:

• Renforcer la chaîne d'approvisionnement.
• Améliorer la disponibilité des méthodes et des choix.
• Mobiliser un financement durable pour la PF à partir de sources nationales ou autres.
• Accroître la disponibilité et l'accès des femmes et des jeunes filles dans les régions les plus isolées grâce à des fonds d'amorçage.
• Augmentation du stockage et de la distribution des produits de santé génésique et de PF, y compris dans les points de distribution du dernier kilomètre dans 23 régions.
• Renforcer les partenariats public-privé afin d'utiliser des drones pour la distribution du dernier kilomètre.
• Formation du personnel de santé.
• Fournir une assistance technique par le biais de l'achat par des tiers avec un financement de la Banque mondiale pour l'achat de produits de PF avec la plateforme d'achat de l'UNFPA.

L'UNFPA utilise également des cliniques mobiles, fournit des services aux jeunes, y compris une éducation sexuelle complète et une éducation par les pairs, ainsi qu'un programme de sages-femmes qui offre un soutien à la formation. L'UNFPA démontre que de multiples approches sont nécessaires pour atteindre les objectifs de PF 2030 à Madagascar.

Pour terminer, nous remercions chaleureusement tous les participants à cette session sur Madagascar, en particulier ceux qui ont pris le temps de s'exprimer et de préparer des diapositives. Comme nous n'avons pas eu assez de temps pour explorer pleinement tous les sujets présentés, le HMCoP envisage d'organiser une session de suivi sur Madagascar. Veuillez contacter Andrea Bare (abare@usaid.gov) ou Jessica Jones (jjones@chemonics.com) si vous souhaitez participer à cet événement.

Dans l'ensemble, nous sommes ravis que cette réunion ait suscité une réaction aussi positive. Nous avons été heureux de constater que les orateurs étaient passionnés par leurs sujets, que la participation de la HMCoP reste élevée et que les membres continuent à s'engager de manière réfléchie dans ces réunions chaque mois. Nous espérons que les organisations continueront à partager l'avancement de leurs travaux afin que nous puissions continuer à faciliter cet apprentissage collectif et nous nous réjouissons de la participation continue aux futures sessions.

Ressources

Nous aimerions connaître l'avis de ceux d'entre vous qui ont participé au projet HMCoP. Profitez de cette enquête pour nous faire part de vos réflexions et nous indiquer les changements que vous souhaiteriez voir apporter.

Réunions futures

Le prochain pays de concentration de la HMCoP sera le Liberia et est prévu pour le 30 août. Si vous souhaitez participer ou contribuer à cette session, veuillez envoyer un courriel à Elizabeth Peña (epena@FHM-Engage.org) ou à Farhan Yusuf (fyusuf@FHM-Engage.org).

Questions?

Veuillez envoyer un courriel à Elizabeth Peña (epena@FHM-Engage.org) ou à Jessica Jones (jjones@chemonics.com).

The Healthy Markets Community of Practice (HMCoP) is a group dedicated to generating awareness of market development and private sector engagement work happening in different countries and for participants to leave with a greater understanding and appreciation of the country’s health market. The speakers for the July represented FHM Engage, Madagascar Ministry of Public Health, the Association of Private Birthing Practices in Madagascar, Marie Stopes Madagascar, PSI Madagascar, The Institute of Education Technology and Management, the Federation of Mutual Health Insurance – “Miara-miahy,” and UNFPA

The July meeting of the Healthy Markets Community of Practice (HMCoP) focused on Madagascar and was the first meeting to utilize simultaneous translation. In our aim to prioritize localization, this tool facilitated participation from local actors in the country. Some speakers were also able to gather in the FHM Engage Madagascar office to present their work together, which fostered collaboration and networking. We would like to thank our FHM Engage Chief of Party for Madagascar, Sarindra Ramanitrivonony, for all her work in helping to organize this meeting. 

To start the session Kuyosh Kadirov, Health Development Officer USAID, announced he would be handing over the stewardship of the HMCoP to Senior Private Sector Advisor Andrea Bare.

Following this announcement, HMCoP Lead Facilitator and FHM Engage Chief of Party for Tanzania, Farhan Yusuf, introduced the agenda and the theme of the session around which speakers framed their presentations, namely Private Sector Contribution to Achieving Family Planning (FP) 2030 goals in Madagascar.

The next part of the meeting consisted of presentations from multiple speakers who gave rapid presentations on their work.   

Olivier LeTouze, FHM Engage Madagascar Market Description Consultant, provided context for the family planning market in Madagascar through the Madagascar Family Planning (FP) Market Description. Findings reveal that young married urban women (15-24 years old) have significant unmet need, particularly when compared to young rural women, due to: 

• An abrupt discontinuation of subsidized social marketing of FP products, which has left private sector health providers with no way to buy products.
• A lack of availability of contraceptives in the private sector. There is a concentrated supply chain with few private sector players, who are wary of the uncertain nature of the contraceptive market and therefore unwilling to commit.
• Regulations and taxes related to importing and supplying contraceptives are burdensome and difficult to understand or predict.

As efforts to support the health market have been mainly oriented towards strengthening the public sector, this has left the private for-profit sector neglected. 

Dr. Vololoniaina Rasoanandrasana, Representative of the Ministry of Public Health, shared how Madagascar plans to achieve its 2030 FP objectives (by increasing the modern contraceptive prevalence rate for married women to 60 percent, reducing the rate of unmet needs in FP to 8 percent, and reaching a total fertility rate of 3) and the 9 commitments Madagascar has made to achieve these goals and the 6 strategies for completing the commitments. Currently, the private sector is integrated into the FP technical working group and is involved in advocacy activities for resource mobilization. The private sector is also involved in the implementation of awareness-raising activities and in areas like financing where they work towards filling the gap in contraceptive products. However, more work must be done to utilize the private sector.

Oliva Harivololona, President of the Association of Private Birthing Practices in Madagascar (ASCAP), described Madagascar's private clinics (or birth centers) called “Cabinet d’accouchement,” which are run by one or more midwives and work to ensure family health through FP counseling and other services (such as pre-and post-natal consultations, screenings and treatment for sexually transmitted infections, and maternal and reproductive health services to young people). In these clinics, FP clients have demonstrated a preference for injectable and oral contraceptives. For these clients, particularly those in rural areas, access to health services is an issue, as is insufficient information, communication, and education on health.  Meanwhile, service providers struggle with quality of service and access to products. The private sector, particularly private delivery practices, need to improve services, access to services and products, and increase training to address unmet FP needs. 

Rijalalaina Rasolofonirina, Deputy Country Director Marie Stopes Madagascar (MSM) explained why FP services for youth must be addressed. First, 1 in 2 people in Madagascar is under the age of 18 – Madagascar has approximately 1.5 million adolescents –  and 81 percent live in rural areas. 496,000 of these adolescents need FP annually. 37 percent of women are married before the age of 18 and teenage fertility rates are high, and pregnancy and childbirth complications are the leading cause of death among those aged 15 to 19. The contraceptive prevalence rate is 34 percent for adolescent girls 15 to 19 years old and 42 percent for young people 15 to 24 years old. To address these factors there must be interventions designed for youth, such as:

• Multiple service delivery channels to maximize reach and target different segments with different services.
• A wide range of "connected" referral agents, from teachers to teen connectors, providing a continuum of care (from initial advice to follow-up care) via a 411-call center.
• Providers trained in the youth approach allowing adolescents to have an informed and voluntary choice in terms of contraception.
• Routine data systems, disaggregated by age, allowing adaptive and targeted interventions.
• Proposed solutions (waivers, vouchers, or free services) so that the cost is not an obstacle.

Progress remains slow due to restrictions around providing reproductive health services to minors without parental consent; a lack of accurate and comprehensive information about reproductive health and family planning; social and cultural norms; and limited resources inhibiting quality reproductive health service provision to young people. MSM is working with the private sector on: 1) integration of private providers into health insurance programs, 2) capacity building of private providers in the offering of FP services, and 3) in entrepreneurship through strengthening supply chain management to avoid stockouts. Ultimately, improving young people's access to family planning is crucial for educational, economic, and demographic benefits.

Laury Francia Rasoanirina, Program Manager PSI Madagascar described the USAID-funded ACCESS Mobile Clinic that operates across 11 regions of Madagascar. With a strategy defined by key stakeholders, USAID, and the Ministry of Public Health, the clinic has trained 20 health providers, employs 20 demand creation and service promotion agents, and collaborates with 10 regional social marketing organizations. 

Dr. Yvan Ranaivoson, Director of The Institute of Education Technology and Management (ITEM)  highlighted how the private sector in Madagascar could become more effective with greater focus on:

• Needs- understanding the quality, quantity, and condition of trainings being offered to the private sector. 
• Curriculum- focusing on the duration, subject, and the methods used to create trainings. 
• Delivery- working through the Regional Training Bureaus; how are the materials and devices used to carry out trainings.
• Evaluation and supervision- what follow up is going to be done to demonstrate the effectiveness of trainings. 

Dr. Vero Randriamalala, Representative of the Federation of Mutual Health Insurance described the “Miara-miahy” Federation. This non-profit umbrella organization was started in 2019 and has nine active member mutuelles – a type of nonprofit insurance arrangement – in 22 regions across Madagascar to facilitate access to quality and affordable care for the entire population. They offer 15 types of services, including primary care, childbirth, family planning, and preventive health. The organization is looking to increase awareness of FP by identifying NGO partners for sexual and reproductive health (SRH)/FP to alleviate the expenses of the mutual funds. The most recent results show that 715,326 people were covered by mutuals at the end of June 2023, 65 percent of members are women, 60 percent of members are of childbearing age, and 50 percent are young couples. Despite this success, there are problems that still need to be addressed like unavailability of FP products for certain areas, psycho-social barriers (e.g., a husband's reluctance to use FP, culture, etc.), and limited funding for mutuals to intervene in isolated areas. 

Faly Razanalison, Sexual Reproductive Health and Rights (SRHR)/FP Program Specialist UNFPA Madagascar capped off the presentations by explaining how UNFPA offers technical support in Madagascar through 1) advocacy, policy, dialogue, and support; 2) knowledge management; 3) capacity development; 4) provision of services; and 5) coordination, partnership, and cooperation.  From 2022-2023, UNFPA worked on: 

• Strengthening the supply chain.
• Enhancing the availability of methods and choices.
• Mobilizing sustainable funding for FP from domestic or other sources.
• Increasing availability and access by women and girls in the most isolated regions through seed funds.
• Increasing storage and distribution of reproductive health (RH)/FP products including at last mile distribution points in 23 regions.
• Strengthening public-private partnerships to use drones for last mile distribution.
• Training health workers. 
• Providing technical assistance through third-party procurement with World Bank funding for the purchase of FP products with the UNFPA procurement platform. 

UNFPA is also utilizing mobile clinics, provides youth services including comprehensive sex education and peer education, and a midwife program that offers support for training. UNFPA demonstrates how multiple approaches are needed to reach Madagascar’s FP 2030 goals. 

To end, we extend a great thanks to all who participated in this session on Madagascar, particularly those that took the time to speak and prepare slides. As we did not have enough time to fully explore all of the topics that were presented, the HMCoP is considering holding a follow-up session on Madagascar. Please contact Andrea Bare (abare@usaid.gov) or Jessica Jones (jjones@chemonics.com) if you are interested in participating in this event.

Overall, we are excited that there was such a positive response to this meeting. We were pleased to see that speakers were so passionate about their topics, that HMCoP participation remains high, and that members continue to thoughtfully engage in these meetings every month. We hope that organizations continue to share the progress of their work so that we may continue to facilitate this collective learning and look forward to continued participation in future sessions. 

Resources

We are interested in hearing from those of you that have been engaged in the HMCoP. Please use this survey as an opportunity to let us know your thoughts and if there are any changes you would like to see. 

Future Meetings

The next HMCoP country of focus will be Liberia and is scheduled for August 30th. If you would like to take part in or contribute to this session, please email Elizabeth Peña at (epena@FHM-Engage.org) or Farhan Yusuf (fyusuf@FHM-Engage.org).

Questions?

Please email Jessica Jones (jjones@chemonics.com) or Elizabeth Peña (epena@FHM-Engage.org).