“All women and girls have the right, and must have the means, to decide freely and for themselves whether and when to have children,” reads the 2014 Progress Report from Family Planning 2020 (FP2020). FP2020, a global partnership formed at the London Summit on Family Planning in 2012, aims to enable 120 million more women and girls access to voluntary family planning by the year 2020.
“Since the London Summit, an unprecedented number of countries have demonstrated their commitment and leadership on family planning by developing national family planning strategies and committing new resources to support them,” wrote Melinda Gates. This government leadership is crucial for women’s rights and access to family planning and reproductive health (FPRH); however, with over 220 million women around the world who want to use family planning but cannot gain access, there is an enormous gap to be filled.
At the Center for Health Market Innovations (CHMI), we believe that innovators leveraging private health markets have a role to play. Here is how FPRH innovators profiled in our database of over 1,400 health market-based programs are leading the way.
What approaches are they using?
Almost half of the 246 FPRH innovations profiled on CHMI (121; 49%) employ one or both of two approaches: social marketing and social franchising. These approaches are often used together to provide access to voluntary, appropriate, and affordable family planning products for women.
- HealthKeepers Network (HKN) in Ghana employs local women in a door-to-door social microfranchise program. HKN trains “HealthKeepers” on how to manage simple but frequent ailments, sales techniques, and health promotion and products, including family planning.
For HealthKeepers who reported low condom sales due to shyness, HKN not only enacted a mentorship program to match them with peers who have higher condom sales but also linked them with an additional buyer of the product, Licensed Chemical Sellers. This door-to-door “Avon lady” approach is used by other FPRH innovators in the database such as LivingGoods and BanaPads.
Who are these innovators?
The three most frequently listed implementing organizations for the FPRH programs profiled in CHMI are Population Services International (PSI), PSI’s affiliate Marie Stopes International (MSI), and DKT International (DKT). All three promote social marketing and social franchising.
MSI further launched an Innovations Fund in 2012 to promote and pilot innovations generated from within its own teams and programs. For instance, the Fund has supported mHealth integration in existing programs, including an SMS-based client follow-up system to improve post-abortion family planning in Cambodia and another SMS-based platform that targets youth in Vietnam with customized health information, client follow-up and a voucher program.
In addition to these larger non-profits, CHMI has identified:
- Small-scale start-up organizations, such as Safermom, founded in 2014 to combat high maternal and infant mortality rates and poor access to vital reproductive health information and resources for women in Nigeria. Safermom delivers vital maternal health information using innovative, interactive, and personalized low-cost mobile technologies (SMS and voice calls in local languages) to the women in rural areas who need it.
- For-profit businesses, such as Penda Health, a social enterprise that provides high-quality primary healthcare services for hard to reach populations in Kenya. Penda initially aimed to focus on women’s reproductive health, but found that women prefer to receive their reproductive health services at clinics where they can also take their children and husbands when they are sick, prompting Penda to meet that need by expanding the scope of its services to include the full range of primary care.
How are they financing care?
In the CHMI database as a whole, 28% of programs are for-profit, as opposed to not-for-profit. Among FPRH innovators, this drops to 6.5% (or 16 programs), despite the 42% that list "Revenue," such as out-of-pocket or membership fees, as one of the program’s funding sources.
One possible explanation for this change is the income level of the populations targeted by these programs. 62 of the 83 programs (75%) that use social marketing also target the bottom 20% income level, a group which likely has a lower ability to pay for their products or services. Thus, despite the potential revenue generation, few may be able to generate enough revenue to sustain a for-profit model.
Despite this trend in not-for-profit models, 57 of these programs are testing innovative ways to finance care as one of their core offerings, of which reproductive health (RH) vouchers is the most popular approach.
RH vouchers are subsidized cards designed to stimulate demand for underutilized services, such as family planning, safe abortion, safe motherhood, or STI treatment. A recent evaluation by the Population Council showed that vouchers can be an effective way to help narrow the access gap between poor and non-poor women.
Several country programs of BlueStar clinics, MSI’s social franchising network, have been implementing RH vouchers as early as 2005. Recent findings from MSI show that vouchers can greatly improve uptake of contraceptive services and provide recommendations for others implementing voucher programs, including considerations for assessing context and program design, as well as practical considerations.
What is the future of innovation in FPRH?
Late last year, Pfizer, the Bill & Melinda Gates Foundation and the Children's Investment Fund Foundation announced an agreement to make Sayana Press available for $1 per dose. Sayana Press, a three-month, progestin-only injectable contraceptive product, has an innovative injection mechanism, which makes it light and easy to use and requires minimal training, making it especially suitable for community-based distribution—and potentially for women to administer themselves through self-injection.
Over half of the FPRH innovations profiled in the CHMI database have been founded in the last 10 years, and greater attention has been brought to this issue through recent initiatives like FP2020 and Sayana Press. It is clear that now is the time to innovate and gather evidence on the impact of Family Planning and Reproductive Health programs. Stay up to date with CHMI for updates on the programs referenced here, as well as hundreds of others worldwide, and how they are innovating to solve persistent challenges to providing access to FPRH services for women.
Picture: Lindsay Mgbor/Department for International Development