From September 17 to 18, 2024, FHM Engage with Maisha Meds hosted a workshop in Nairobi, Kenya to explore opportunities for the private sector to expand access to modern contraception in Kenya. Maisha Meds is a digital health organization that builds business software used by over 1,500 private pharmacies and clinics across Kenya. 

During the event, participants (including from the Ministry of Health, Population Services (PS) Kenya Social Marketing, Revital Healthcare, and Sai Pharmaceuticals) highlighted the already substantial and growing role of private actors in the family planning (FP) market as the country increases domestic sources of health financing. While the private sector is significant, it currently, predominantly provides short-term contraceptives, with emergency contraception (EC) leading sales. Methods like depot medroxyprogesterone acetate (DMPA; a self-injected contraception), condoms, and combined oral contraceptives (COCs) are largely supported by social marketing organizations (SMOs), while donations of long-acting contraceptives from the public sector challenge the commercial viability of these products.

During the workshop, Maisha Meds presented wholesale facility level pricing data that revealed the presence of products in the private sector sold at below ex-manufacturer pricing levels, likely present through either policy allowances, donor subsidies, or informal channels. Maisha Meds' data revealed intense competition in the Kenyan EC market. A separate Maisha Meds presentation went in detail into the possibility of local manufacturing of FP commodities, which presents both opportunities and challenges.

An SMO called DKT International Kenya posed key questions highlighting important dynamics in the FP market: is the market shaped by women’s preferences or by market structures shaping behaviors? How challenging will it be to shift the current dynamic, where long-term methods are dominated by the public sector and short-term methods by the private sector? Does this dynamic matter for public health goals? What does the government aim to achieve by supporting greater private sector involvement?  These are important questions because they get at the “why” which then informs the “how.”

Then, PS Kenya – a market leader in socially marketed commodities – highlighted that both demand creation and brand building are compulsory for the success of a new product. Initial investment is high as supplies build brand awareness and list their products in trade. Monopoly of the supply chain does not favor the consumer. On the path to commercial viability, one does not always have to increase the price; they noted that one should relook at other cost saving elements such as packaging, 

The workshop discussions also highlighted several challenges facing the FP market, namely advertising restrictions on contraceptives; the presence of public sector products in the private sector through both policy allowances and informal "suitcase sales"; and intense competition in the EC market.

Several additional factors were identified as hindering the commercial market, including consumer ability to pay. This is a significant constraint particularly for mid-tier brands and higher-priced commodities like DMPA-SC. SMO market leaders possess strong brand equity, making it difficult for newer, low to mid-priced brands to gain traction. Delays in product registration by the Pharmacy and Poisons Board (PPB) – reported to take over two years – further complicates market entry.

Philips - Kenya emphasized the importance of new partnerships in introducing family planning products, such as DMPA-SC. These include integrating family planning services into pharmacy chains, accrediting pharmacies as FP providers, offering Ministry of Health (MoH)-approved training for healthcare providers, and providing direct digital training for consumers to enhance access and awareness. These partnerships aim to strengthen the role of pharmacies in the FP landscape while ensuring quality service delivery.

During the workshop, discussions also touched on potential growth scenarios for the private FP market, focusing on the financial impact of increased private sector participation. For oral contraceptive pills (OCPs), the current private sector value stands at $5.796 million. Under a low-growth scenario, where the share of private sector clients rises from 42.3 percent to 50.7 percent, the value would increase by $764,000 annually. In a high-growth scenario, where nearly 65 percent of clients shift to the private sector, the dollar value for OCPs could increase by $2.3 million. Overall, the current total private market value is $33 million. If the client base grows within the private sector without a change in the method mix, the total market value could increase by $2.6 to $8 million annually, depending on the growth trajectory.

Local manufacturing of FP commodities presents both opportunities and challenges. While some products like EC are relatively easier to produce, others, such as DMPA intramuscular (IM), require advanced capabilities like a sterile fill-finish line and prequalification by the World Health Organization. DMPA subcutaneous (SC), soon going off-patent, may see increased demand, creating a potential market for local manufacturers. However, more complex products like COCs, implants, and intrauterine devices (IUDs) require sophisticated manufacturing processes, making them harder to produce locally. Additionally, global competition, particularly for condoms and implants, and a market dominated by donor and government procurement, present challenges for the commercial viability of local production. Developing local capacity would require substantial investment in technology, quality assurance, and regulatory approvals to meet global standards.

In conclusion, after robust discussions on whose role it is to grow the private sector’s contribution for FP, the consensus was that all workshop participants – from government, private sector, partners in development – all have a role to play. Participants proposed a number of solutions including platforms to address incentives for businesses in Kenya through subsidies for local manufacturing, removal of taxes on health products and technologies, innovative partnerships, and financing for FP to increase access. But one poignant question remains: How can the business environment be more conducive and what licenses need to be consolidated to improve the ease of doing business?

Banner image: A client passes by a PS Kenya desk during the World Contraceptives Day to enquire more on family planning products. Photo accessed on USAID flickr.

FHM ENGAGE WEBINAR

Unlocking Financial Pathways for Health Entrepreneurs: Accelerating Health Market Growth in Kenya

Thursday, September 5, 2024 | 8:30 a.m. to 9:30 a.m. EDT/ 3:30 p.m. to 4:30 p.m. EAT | Virtual

Click here to watch the recording

One of the most pressing challenges for health entrepreneurs in Kenya is a lack of access to adequate financing to support and scale reproductive and maternal health products and services. USAID’s Frontier Health Markets (FHM) Engage in collaboration with Strathmore University Business School, and SNDBX Capital is implementing activities to address barriers to financial access for private health businesses providing maternal health services in Kenya. The "Health Enterprise Financing Program" (HEFP) is designed to enhance eligibility for financing by addressing gaps in business planning, management, and knowledge on structuring business operations to de-risk lending, as well as building expertise in negotiating and securing debt and other forms of financing. Additionally, the Program features a "Village" Support Ecosystem that fills the gap in networks needed to support business growth. This community of health entrepreneurs fosters collaboration, provides access to experts, and creates new partnerships to enhance service delivery.

The webinar that took place on Thursday, September 5, 2024 provided a comprehensive look at how innovative financing models are driving health market growth and improving access to essential reproductive and maternal health services in Kenya. The HEFP is successfully supporting entrepreneurs to 1) fill gaps in business planning and management, 2) structure operations to reduce lending risks, and 3) build expertise in negotiating and securing debt and other forms of financing. Business growth is further fostered through a collaborative network of health entrepreneurs, experts, and new partnerships. Panelists, health entrepreneurs that participated in HEFP this past year, shared that after going through the program, they received expressions of interest from local banks and equity investors, totaling over $2 million in potential funding. 

Click here to watch the webinar recording.

Moderator and Presenters: 

• Dana Tilson, FHM Engage Project Director, moderator
• Judy Mboya, FHM Engage Advisor, Private Sector Development
• Prof. Francis (Frank) Wafula, Associate Professor, Strathmore University Business School
• Dr. Rowena Njeri, Program Lead, Strathmore University Business School
• Mr. Wohoro Ndohho, CEO, SNDBX Capital

Strathmore University Business School (SBS), one of FHM Engage’s network implementing partners (NIPs), is a leading institution in Kenya with a strong reputation for training healthcare managers through its academic and executive programs at its Institute of Healthcare Management. SBS has partnered with SNDBX Capital, a one-stop shop for entrepreneur growth solutions.

Questions? Please reach out to FHM Engage, fhm-engage@fhm-engage.org

Banner photo: A traditional midwife who collaborates with the community health worker to bring pregnant women to deliver in hospitals, goes for a home visit, Bungoma, Kenya. 2016. Photo Credit: Allan Gichigi/MCSP

One of the most pressing challenges for health entrepreneurs in Kenya is a lack of access to adequate financing to support and scale maternal health products and services. While health outcomes have improved in Kenya over the past two decades, funding is vital to maintain the health resources necessary to ensure sustained, adequate health services for millions of Kenyans. In particular, there is need to prioritize strengthening the capacity of private health facilities, which make up about half of all health facilities in Kenya, to provide quality maternal health services. Findings from the 2023 Kenya health facilities census found that less than half of all health facilities in the country are offering maternity services with only a third of the facilities offering emergency obstetric care. Still, many potential investors are reluctant to invest in the healthcare sector, due to the perceived risks, complexity, and uncertainty involved. To empower health entrepreneurs with the skills and knowledge they need to attract and secure funding, USAID’s Frontier Health Markets (FHM) Engage is proud to announce the creation – and recent first course completion –  of the Health Entrepreneurship Financing Program, a groundbreaking initiative that aims to bridge this financing gap. 

The Health Entrepreneurship Financing Program was co-developed by FHM Engage, Strathmore University Business School, and SNDBX International. Strathmore is an FHM Engage network implementing partner (NIP) and a leading institution in Kenya with a strong reputation for training healthcare managers through its academic and executive programs at its Institute of Healthcare Management. SNDBX International is an entrepreneur support hub and a one-stop shop for entrepreneur growth solutions. Program faculty included experts in policy, strategy, leading healthcare organizations, finance, accounting and tax, sales and marketing, e-commerce, legal, governance and risk management in healthcare, managing the health workforce, and supply chain.

On March 4, 2024, the Health Entrepreneurship Financing Program launched with the aim to bolster the business operations and management expertise of 26 health entrepreneurs nationwide to prepare them for growth and to set them up to qualify for financing from local banks. The entrepreneurs were selected as they faced hurdles in sustaining and expanding their ventures due to limited access to financial solutions, which ultimately hindered their ability to tackle diverse health issues, including maternal and child health, infectious diseases, mental health, and digital health.

When the Health Entrepreneurship Financing Program concluded on May 3, 2024, the entrepreneurs reported significant improvements in their fundraising abilities, networking skills, and overall confidence. Participants had established peer-to-peer support strategies during the program, which included visits to each other’s facilities and accelerated the sharing of best practices, cross-learning, and even catalyzed mentoring for other budding entrepreneurs.

Most significantly, as a result of the Health Entrepreneurship Financing Program, participants received expressions of interest from a number of local banks and an equity investment partner, amounting to over $2 million in potential funding. Moreover, the program created an industry buzz across the networks of health providers including the Kenya Association of Private Hospitals and the Rural Hospitals Association, on investor readiness programs across the continent. This has contributed to raising awareness and advocacy for health entrepreneurship as a key driver of health system improvement and social impact in Kenya.

Overall, the Health Entrepreneurship Financing Program allows health enterprises to gain sufficient capacity to access financing opportunities by building a bridge between lenders and borrowers. The program also fosters a supportive ecosystem for health entrepreneurship in Kenya through the “Health Enterprise Support Ecosystem Village,” which allows for continued access to the program’s faculty and SNBX’s independent professional industry experts.

FHM Engage and Strathmore University will continue to build on this success by developing a framework based on learnings from this first program to expand to a second set of participants targeting maternal, newborn, and child health outcomes. The next program is slated to run in July and August.

Banner photo: Participants of the Health Entrepreneurship Financing Program and a program faculty member thank each other. Photo credit: FHM Engage.

FHM Engage uses a market development approach (MDA) to understand a country’s health market system. The MDA allows us to diagnose root causes of market under-performance, such as restricted supply of and consumer demand for health products and services. FHM Engage supports local public and private market actors to design locally informed strategies and solutions that improve market systems, including core functions of supply and demand and supporting functions that strengthen the enabling environment for market growth.

As a critical foundational step to the MDA, FHM Engage compiled detailed market descriptions in India, Kenya, Liberia, Madagascar, Nepal, Nigeria, Pakistan. Review them here:

INDIA

FHM Engage India Market Description 2023

FHM Engage India Market Description 2023 (Abridged)

Health Market Description Brief on Family Planning in India

KENYA

FHM Engage Kenya Market Description 2023

LIBERIA

FHM Engage Liberia Market Description 2023

FHM Engage Liberia Market Description 2023 (Abridged)

MADAGASCAR

In Madagascar, we completed three market descriptions: Family Planning; Maternal & Child Health; Nutrition

NEPAL

FHM Engage Nepal Market Descriptions 2023 

NIGERIA

In Nigeria, we compiled six market descriptions in the two states of Ebonyi and the Federal Capital Territory (FCT): Ebonyi Child Health; Ebonyi Family Planning; Ebonyi Maternal Newborn Health; FCT Child Health; FCT Family Planning; FCT Maternal Newborn Health

PAKISTAN

FHM Engage Pakistan Market Description 2023

Related Resources:

‘How-to’ Guidance: Executing the Diagnosis Phase of a Market Development Approach

MDA Overview Briefs:

What is the Market Development Approach (MDA) Process for Family Planning, and Maternal, Newborn, and Child Health? Brief #1 of 4 in a series on the MDA

What is the Market System Framework and Its Role in Developing Family Planning, and Maternal, Newborn, and Child Health Markets? Brief #2 of 4 in a series on the MDA

What are Key Terms Used in a Market Development Approach for Health? Brief #3 of 4 in a series on the MDA

The Meaning and Importance of Stewardship in Developing Family Planning, and Maternal, Newborn, and Child Health Markets. Brief #4 of 4 in a series on the MDA

MDA Course Curriculum:

Market Development Approach (MDA) 2023 course curriculum

Course brief #1: What is the market development approach process for family planning, and maternal, newborn, and child health?

Course brief #2: What is the market system framework and its role in developing family planning, and maternal, newborn, and child health markets

Course brief #3 What are key terms used in a market development approach for health?

Course brief #4: The meaning and importance of stewardship in developing family planning, and maternal, newborn, and child health markets

We are pleased to begin sharing the Healthy Markets Community of Practice newsletters on our Highlights page. Please see recordings of all past HMCoP sessions and newsletters on the HMCoP page of this website. Sign up for future convenings or subcribe to their e-news by emailing Elizabeth Peña (FHM Engage) epena@FHM-Engage.org

 Healthy Markets Community of Practice

FHM Engage is the Secretariat for the Healthy Markets Community of Practice (HMCoP). The current co-chairs are USAID (represented by Andrea Bare) and UNFPA (represented by Ben Light). The HMCoP is an evolution from the Total Market Approach Technical Working Group (TMA TWG) which has been operational since 2014.

January Meeting

The January meeting of the Healthy Markets Community of Practice (HMCoP) was the second session focused on Kenya. We would like to thank our FHM Engage Private Sector Development Advisor Judy Mboya for all her hard work in helping to organize this meeting. 

As co-host of the HMCoP, USAID Senior Private Sector Advisor Andrea Bare started the meeting by introducing Jane Ngugi, Project Management Specialist for USAID Kenya.  

USAID Kenya has worked to develop a private sector engagement strategy that aligns with the global USAID policy and is pursuing partnerships with different private sector actors across the value chain from local manufacturing to service delivery in order to improve health outcomes. USAID Kenya is working to identify and to work more closely with entities that have market shaping solutions which will allow the private sector to play a role in health areas that have been historically public. This work will also focus on leveraging private sector expertise. USAID is working with different partners across five key areas, which include local manufacturing, optimized private sector capacity and expertise to expand coverage and quality, access to finance, strengthening government oversight, and engagement with the private sector. 

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

Judy Mboya, Private Sector Advisor for FHM Engage, provided a brief overview along with highlights from the first Kenya meeting that occurred in October. The October meeting showcased trends in Kenya's family planning private sector market. One of note is the overall decline in total fertility marked by an increase in uptake in contraception for rural women but with a decline in uptake for urban women. Judy also shared some key constraints, such as challenges around demand generation and financing. The meeting included speakers from organizations that are involved in changing how health products and services are delivered, health finance, and those who are working to improve contraceptive commodity availability. Presentations focused on innovation in the delivery of health products and services, leveraging technology, health financing, and sustainably increasing the delivery of implants through the private sector.

Nancy Njoki, Program Lead for Girl Effect, gave an overview of Girl Effect and their work in Kenya. Girl Effect is an organization that equips adolescent girls and young women with tools to address potential health concerns. They develop content that appeals to young people and use multiple platforms to directly engage girls. Girl Effect is creating safe spaces, sharing facts, and answering questions in a fun and truthful manner about health, nutrition, education, and relationships. Girl Effect partnered with MSD (Merck & Co.) to understand and identify key barriers and enablers for girls 15 to 24 on contraceptive uptake. Their intervention also worked with young people to co-create a digital minimum viable product (MVP) – a smart chatbot – for adolescent girls with sexual reproductive health (SRH) needs and to access contraceptives. In Kenya this MVP is called Wazzii and provides users a private online space to ask about sensitive issues they may otherwise not feel comfortable discussing.  The platform offered direct access to health professionals, which was attractive to new users to this service as they did not have to leave the platform. Through this four-month pilot, Girl Effect has been able to demonstrate success and will look to keep improving on Wazzii. 

Chemeli Priscah Cheruiyot, Head of Research Projects for Jacaranda Health, presented on a mobile health or mHealth approach to improve postpartum family planning (PPFP) among Kenyan mothers. Jacaranda Health is a USAID-funded maternal and newborn health nonprofit organization based in Nairobi that considers ways to improve uptake of PPFP among Kenyan mothers. Their mobile technology approach includes an AI-enabled digital health service, that aims to help new and expectant mothers better navigate the health system. The service includes three pieces, 1) a sequence of gestation state specific messages that empowers mothers with information to seek care at the right time and the right place, 2) an AI-enabled clinical help desk that reads and responds to incoming questions from mothers and starts a referral chain if a risk factor is identified, and 3) a comprehensive data structure that routinely prompts mothers to share feedback on the experiences of care which is then shared back to the hospitals. This approach is working to address nuanced behavioral barriers to PPFP through short messaging service (SMS). To date, the platform has reached approximately two million mothers across Kenya.  The mHealth approach has discovered that interactive flows that offer choices based on behavioral preferences have the highest engagement among women and men.  Additionally, messages sent out to mothers before and after delivery to enhance preparedness are also effective. These insights are key to helping determine future messaging and adapting to the needs of mothers. 

Serah Malaba, Chief Impact Officer for Tiko Africa, gave an overview on the use of an innovative financing instrument to expand access to both SRH and HIV interventions among adolescents and young people in Kenya. Tiko Africa, formerly known as Triggerise, is a global nonprofit organization headquartered in South Africa that uses innovative technology, real-time data, and behavioral insights to support adolescents and young people to make positive choices. The Tiko platform connects partners to provide end users with greater access to SRH products and services. Once users are enrolled, they are able to access services at both private and public facilities, including private clinics and pharmacies. With a Tiko membership, adolescents are able to access services through the private sector that are fully subsidized by donor funds. A crucial part of this approach centers on the development impact bond (DIB) that is being used to implement the program and underscores the critical role of the private sector’s investments in SRH services. The objective of the DIB is to reduce the incidence of unintended pregnancies, new HIV infections, and AIDS-related deaths among Kenyan adolescent girls by increasing uptake of SRH/HIV services and commodities. This is a tool which goes beyond a traditional grant mechanism and is aimed at addressing the lack of access to quality SRH services. The DIB is a scalable approach which encourages innovation and efficiency and allows donors and service providers to focus on social impact maximization. 

Sylvia Wamuhu, Director of Franchise and Partnerships for Population Services (PS) Kenya, spoke about the USAID Private Sector Engagement (PSE) program in Kenya. This is a health systems strengthening mechanism that is being implemented by three partners including PS Kenya. The purpose of the project is to improve health outcomes through increased patient choice of quality health products and services in the private sector. The private sector is critical in Kenya as 50 percent of the population uses it to access services. Their vision is a transformed health market delivered through country-led and country-owned partnerships that increase and optimize private sector resources to expand health options equitably and sustainably for the Kenya population. The project focuses on three areas, 1) identifying, testing, and expanding sustainable options for private sector distribution of health products and services, 2) improving quality and efficiencies in provision of private health sector products and services, and 3) strengthening support for local manufacturing of health products.  across five main health areas (malaria, HIV, tuberculosis, maternal newborn and child health, and family planning or FP). In the area of FP, the program will support capacity building, FP commodities security, and health insurance for FP.  By 2026, the Kenya Government will be expected to fund commodities fully without donor support, so it is crucial that these gaps be addressed. 

Pius Mutua, Global Operations Manager for MS Kenya (MSK), focused on the private sector strategy of MSK. Kenya has one of the most elaborate private sector networks, whereby the private facilities account for 50 percent of the health facilities available within the country and approximately 40 percent of the FP services are provided by the private sector. Most Kenyans seeking services generally encounter the private sector as their first point of contact. Through their collaboration with local partners, MSK has been able to increase their number of adolescent clients from 15 percent to 49 percent. MSK has worked to identify and understand the underlying market constraints that prevent full access to contraceptives. From their analysis of the market, MSK has identified five constraints, 1) inadequate family planning commodity security,  2) lack visibility of the private sector via data and information, 3) limited enforcement and regulation of quality standards in the private sector, 4) limited demand for family planning and SRH services due to misinformation and harmful norms, and 5) lack of financial support in accessing family planning (i.e., via insurance schemes, via the private sector).  In order to address these constraints, MSK has been part of a consortium working towards establishing a viable private sector supply chain mechanism.

To end, we extend a great thanks to all who participated in this session focused on Kenya, particularly to those that took the time to speak and prepare slides. We are excited that there was such a lively discussion amongst presenters and participants, and we are pleased with the continued engagement. We hope that those who have joined our sessions over the past year have come away with a greater understanding of FP and reproductive health market development and private sector approaches.

Resources

We have a web page! On the new USAID Health Market Links website, managed by FHM Engage, you can find our past session recordings, slide decks, or revisit past newsletters. See the HMCoP page here:

Healthy Markets CoP | FHM Engage (healthmarketlinks.org)

Future Meetings

The next HMCoP convening will focus on India and is scheduled for February 27, 2024; and a calendar invite has been sent. Please reach out if you have a country you would like to propose. If you would like to take part in or contribute to any future sessions, 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). 

Photo of rural healthcare in coastal Kenya from actionchange.org.

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 October represented FHM Engage, Afya Research Africa, Kasha, ThinkWell, MYDAWA, Jhpiego, Bayer, and DKT.

The October meeting of the Healthy Markets Community of Practice (HMCoP) focused on Kenya. We would like to thank our FHM Engage Private Sector Development Advisor Judy Mboya for all her hard work in helping to organize this meeting. As co-host of the HMCoP, USAID Senior Private Sector Advisor Andrea Bare introduced the agenda and the speakers. This meeting will be the first of two sessions and will serve as the starting point for our discussion as the HMCoP plans to hold another session on Kenya early next year. In the next part of the meeting speakers gave brief presentations on their work. 

Judy Mboya, Private Sector Advisor for FHM Engage, provided context for the family planning (FP) market in Kenya through an overview of FHM Engage’s recent market description findings. In Kenya, there has been both an overall decline in total fertility and an increase in the modern contraceptive prevalence rate (mCPR) among rural women. Meanwhile the total fertility rate (TFR) has remained relatively stagnant for urban women and there has been a decrease in the mCPR among married and unmarried urban women between 2014 and 2022. Data from Kenya’s Demographic and Health Surveys (DHS) shows a significant increase in women using implants but a decline in injectable use as well as a high use of traditional methods among unmarried women in urban areas. The country has a robust health infrastructure with over half of health facilities owned and managed by the private sector with nearly 40 percent of modern FP products offered through a private service delivery point and almost all emergency contraceptives (EC) are provided by the private sector. Despite the high level of private sector facilities, nearly 400,000 women in urban areas and over 1 million women in rural areas, who are at risk for pregnancy, are not using contraceptives. Starting in June 2024, the Government of Kenya will be responsible for financing 100 percent of family planning commodities. Current challenges around demand generation, supply, commodity financing, information, and regulation in the current FP market will become more acute if the financing gap is not met. 

Maeve Rafferty, Project Manager for MYDAWA, gave an overview of MYDAWA and its work. MYDAWA is the first end-to-end telehealth and e–pharmacy licensed by the Kenya Medical Practitioners & Dentist Board and the Pharmacy & Poisons Board in Kenya. The company is focused on ensuring better health outcomes for people across Kenya and they work to achieve this through four main approaches: 1) incorporation of omnichannel access: leveraging technology to offer coordinated healthcare solutions to enable patients to identify health issues before they become too serious, 2) expansion of telehealth consultations: offering patient-centered care, 3) positioning themselves as a trusted brand partner: offering information and resources to help patients take an active role in their health journey, 4) focus on timely last mile delivery: providing convenient access to affordable and good quality health and personal care products by maintaining control of their own supply chain, and 5) low-cost pharma contractual manufacturing. Since October 2022, MYDAWA has been involved in the testing of an online approach to HIV screening through the “ePrEP Kenya” Pilot. MYDAWA delivers daily oral PrEP (HIV pre-exposure prophylaxis) and PEP (HIV post-exposure prophylaxis) to clients through their sexual wellness page and self-screen for HIV risk. In collaboration with multiple partners, MYDAWA has developed an online pathway for online PrEP/PEP delivery. The interim results have been positive and have demonstrated that online PrEP and PEP services can be provided at reasonable costs and customers are willing to pay for delivery of these services. 

Elizabeth Ombech, Director of Operations for Afya Research Africa (ARA), presented on their Ubuntu-Afya model, which establishes medical centers in partnership with communities. ARA works in three complementary areas of healthcare; providing care, health technology, and research. One challenge that ARA is working to address is that rural Kenyan communities are rarely considered for private healthcare enterprise and public health resource allocation. ARA’s Ubuntu-Afya model establishes private medical centers in partnership with communities. Normally, these  communities also operate a supplementary enterprise –  often centered around financial services – so that the revenue from the supplementary enterprise can subsidize the cost of running the medical center. ARA currently operates in counties where there are high rates of teenage pregnancy, so they target adolescents and young women on sexual and reproductive health (SRH) and FP related topics and work to address their barriers to access. ARA’s engagement creates awareness and generates demand for these SRH/FP products and services at an affordable price. ARA has been able to gather feedback from adolescents and young girls who have stated that the main barriers they face to accessing products and services are a lack of privacy, friendly staff, information, and choice.  Through this feedback, ARA is addressing these barriers with locally available solutions. Overall, across ARA’s Ubuntu-Afya kiosks there has been a 42 percent increase in FP uptake between 2022 and 2023. 

Edna Anab, Kenya Health Lead for Kasha, gave an overview of Kasha’s Access to Health Platform. Kasha is a last mile distribution platform that provides pharmaceutical, household goods, and consumer health products to low-income consumers in Africa. These products may be distributed directly and discreetly to consumers or may be distributed through pharmacies, retailers, facilities and then into communities.  Kasha operates an omnichannel distribution system and an agent network that optimizes ordering, generates sales, and provides health services and information. Kasha also builds awareness of and demand for health products and services through agent engagement and community events and through their online tools which have, thus far, been able to reach 5.2M people. Kasha conducts FP demand generation both online (via the social media platforms, Instagram and Facebook) and offline (through Ministry of Health approved materials) and operates an FP referral service so that patients may be referred to partners for short-term FP methods and also DMPA (depot medroxyprogesterone acetate). In addition, Kasha’s model provides private health providers with training so they can best assist customers/patients in their health journey. 

Geredine Kandie, Technical Advisor for ThinkWell, spoke on FP financing in the private sector. ThinkWell is a health systems organization that uses tailor made health financing approaches to help low- and middle-income countries achieve universal health coverage (UHC). Kenya’s health purchasing landscape is complex and evolving with financing for the private sector coming from four main sources: 1) the Social Health Insurance Authority, 2) private insurance, 3) out of pocket payments, and 4) some donor funding. In Kenya, 40 percent of facilities are privately owned and provide about 49 percent of all health services. Private providers contribute to around 40 percent of the FP services offered in the private sector; however, these are mainly short-term methods. To improve consumer choice, the private sector must be incentivized to take up long acting and reversible methods. The current lack of choice means that even wealthy women must use the public sector, and this further disenfranchises poor women. Kenya’s new health financing reforms present an opportunity to engage the private sector in achieving UHC. From the financing lens, more needs to be done to change the provider payment method so that providers are incentivized to invest in offering a wider array of family planning products. 

Levis Otundi, Country Manager for Jhpiego, focused on Kenya's roadmap for private sector provision of contraceptive implants which are currently underutilized. Today, free, publicly procured contraceptive implants dominate the market and are provided to public and private facilities. However, the private sector is expected to lose access to free commodities as Kenya’s health financing landscape is changing. By 2025, the Ministry of Health will need to fully fund FP commodities. It’s estimated that if the private sector had a similar share of the implant market as other methods, users could double in size to over 500,000 annually. Building on previously identified global barriers and recommendations, Jhpiego is working to identify specific constraints and opportunities that the private sector is facing for the provision of implants. In September 2023, Jhpiego conducted a workshop with stakeholders who identified four main barriers, namely: 1) lack of a private sector supply chain for contraceptive implants, 2) lack of measures to offset the anticipated cost increase once public sector commodities are withdrawn, 3) insufficient labor capacity and motivation and 4) the need for government stewardship. With these constraints in mind, Jhpiego has identified strategic priorities to sustainably increase the delivery of implants in the private sector and expand its coverage of affordable implants as part of the method mix to address consumer needs in support of FP2030 goals. 

Willis Ogutu, Institutional Health Supplies Partnership Manager for Bayer,  gave an overview of Bayer and their partnership with Zuri Health. Bayer works to help provide 100M women in low and middle income countries (LMIC) with access to modern contraception by increasing availability, adding further options in long-acting reversible contraceptives to the method mix to meet unsatisfied demand, increasing self-reliance, helping build donor-independent markets, leveraging partnership programs to increase awareness, and applying best-practice knowledge. Bayer has partnered with Zuri Health to grow the private sector and develop Zuri’s reach and impact. Together, they are aiming to reach 1.3M people through mobile, internet, and social media. In the coming six months, the project aims to support 48,750 women of reproductive age in Kenya to access modern contraception methods through a mix of online and offline interventions including tech-Hub, healthcare service providers, pharmacies, clinics. It should be noted that Zuri is not restricted in its partnership with Bayer and encourages other organizations to join with Zuri to contribute to this work to continue developing the private sector. 

Dr. Stephen Githinji, National Sales Manager for DKT, gave an overview of their operations in Kenya. DKT is a global organization with over 30 years of experience in social marketing of FP, HIV/AIDS prevention, and reproductive health products and is also the world’s largest private provider of FP, HIV/AIDS prevention and safe abortion products and services. DKT established operations in Kenya in 2017 and is working to increase availability of SRH products through expanded distribution networks and improved method mix availability. This is accomplished by increasing demand and inspiring new contraceptive users through advertising and educational campaigns. DKT is working to strengthen the supply chain to increase the availability of contraception and improve method mix variety while also ensuring the quality of products and services at every point on the supply chain. DKT utilizes their warehousing, order processing, and delivery services to provide products to pharmaceutical distributors, general trade distributors, and NGOs. These products then go on to a variety of outlets that include pharmacies, clinics, hotels, and petrol stations. The organization has continued to grow since 2017 which they hope to continue not only in Kenya but throughout the rest of the region.

To end, we extend a great thanks to all who participated in this session on Kenya, 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 we are pleased with the continued thoughtful dialogue and connections being made throughout these sessions. 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 and look forward to continued participation in future sessions. 

Resources

We have a web page! On the new USAID Health Market Links website, managed by FHM Engage, you can find our past session recordings, slide decks, or revisit past newsletters. See the HMCoP page here:

Healthy Markets CoP | FHM Engage (healthmarketlinks.org)

Also, 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 or feedback you would like to share.

Future Meetings

The next HMCoP convening will focus on Ghana and is tentatively scheduled for December 14, 2023; a calendar invite is forthcoming. Upcoming sessions will include Sierra Leone, India, and a return to Kenya. If you would like to take part in or contribute to any of these sessions, or you would like to make us aware of an organization or project, please email Elizabeth Peña (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). 

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).