From Hot Spots to Holy Places: Group sales of health products contribute to women’s empowerment and better health in Mali

Togo Kadiatou Malle, president of Muso Yiriwa Ton in Mali, is now an ardent proponent of condoms and contraceptives.

This was originally published on the Knowledge4Health Blog on July 1, 2019.

The first five times the sales manager of Keneya Jemu Kan came looking for Madame Togo Kadiatou Mallé to talk about her women’s association selling condoms and other health products, she ran away and hid, so terrified was she of the prospect of having to work with condoms. 

But the sales manager’s persistence paid off. Eventually, they talked, and Madame Togo has become such an enthusiastic condom promoter, she is known as Mama Condom. She laughs about her fear of condoms. 

Madame Togo is president of Muso Yiriwa Ton (MYT), which means “women-empowering group” in the Bambara language, a women’s association based in the very poor Sabalibougou neighbourhood of Bamako, Mali. Her association – as well as other women’s associations – are a major reason for the success of Keneya Jemu Kan (“Communication Around Health”), or KJK, a project funded by the U.S. Agency for International Development and led by the Johns Hopkins Center for Communication Programs that seeks to reduce maternal, infant, and child mortality in Mali. Palladium leads the social marketing component of KJK.

MYT has more than 400 members, and roughly half of them sell the KJK’s male and female condoms, as well as Aquatabs (water purification tablets), Orasel Zinc (zinc tablets and oral rehydration solution to treat diarrhoea), and CycleBeads (a natural family planning method). MYT members sell an average of 107 cartons of Protector Plus condoms per month. That’s 64,200 condoms. The partnership helps to enhance economic prospects of its members. 

“It has become a source of life for many families,” said Madame Togo. “And it is improving health of the areas where they sell, in Commune 5 and beyond.”

Global contraceptive use rising but more progress needed to reach target

A DKT Nigeria counselor talks to a group of women in a low-income neighborhood of Lagos, Nigeria about their contraceptive options. Photo: David J. Olson

This was originally published on Global Health TV on January 30, 2018.

By July 2017, more than 309 million women and girls were using modern contraception in 69 focus countries identified by Family Planning 2020 (FP2020), a movement created in 2012 by four core partners, 38.8 million more than in 2012.

This information came out in FP2020’s annual report “The Way Ahead, 2016-2017,” released in December. It reported that use of modern contraception in these 69 countries from July 2016-July 2017 prevented 84 million unintended pregnancies, 26 million unsafe abortions and 125,000 maternal deaths. This is all great news.

It came with some less-than-great news. FP 2020 has set the goal of reaching 120 million new users in the eight years between 2012 and 2020 – or 15 million every year. By that measure, we should have reached 75 million new users by mid-2017, and 38.8 million is only 52% of that.

Clearly, we have a lot more work to do to reach the 120 million target.

Promoting contraceptives to adolescents in Mexico? Make the campaigns fun

Monserrat, Ariantne and Isis and their children visit a
RED DKT clinic in the Iztapalapa borough of Mexico
City to find a contraceptive to space the birth of their
next child. Photo: David J. Olson

This was originally published on Global Health TV on March 21, 2017.

MEXICO CITY, Mexico — I met the three young women at a reproductive health clinic in Iztapalapa, the most populous and fastest-growing borough of Mexico City, with a population of 1.8 million on the eastern side of the capital city.

Ariatne and Isis, both 20 years old, each have one child. Monserrat was their aunt, but didn’t look much older. She had three children. All of them were looking for a way to space the birth of their next child. One of them wanted to wait five years; another, ten years.

All of them had chosen intrauterine devices (IUDs) as their contraceptive, one of them told me, “because they are comfortable and secure.”

Although unplanned pregnancy is a big problem in Mexico (and the rest of Latin America), good sexual and reproductive healthcare is hard to come by in Mexico, especially for adolescents, according to a recent study.

Almost three-quarters of pregnancies among adolescents aged 15-19 in the region are unplanned, according to the Guttmacher Institute, and about half of those end in abortion. Among all women 15-19 who need contraceptives, 36% of them are not using a modern method. The unmet need is highest in Central America, where 46% of sexually active adolescents who want to avoid pregnancy are not using modern contraceptives.

DKT México, a non-governmental organization that uses social marketing to prevent HIV and promote contraception in Latin America and the Caribbean, has learned some lessons about how to promote contraception to young people after success in promoting condom use but failing to do the same with contraceptives after they took a more traditional approach.

The social marketing legacy of Phil Harvey

This originally appeared on the Huffington Post on December 15, 2015.

From 1992 to 2001, I did some of the most important – and fun – work of my life: I managed social marketing programs for the nonprofit PSI in Zambia, Bangladesh and Paraguay. Social marketing is a technique that uses the tools of social marketing to achieve a social outcome – in PSI’s case, that outcome is improved health. The programs I worked on were HIV prevention, family planning and child health but social marketing can also be applied to other disciplines as well.

I owe that singular experience to Phil Harvey, who founded PSI in 1970 to promote family planning through the social marketing mechanism. In 1989, he founded DKT International, another social marketing organization more tightly focused on reproductive health mainly in very large countries (in order to have cost-effective impact at greater scale). Harvey has also served, and continues to serve, for many years on the board of directors of Marie Stopes International, another organization that uses social marketing.

Phil Harvey is introduced as “a visionary, pioneer and titan in the world of social marketing” in this new video interview. Harvey describes his early work in India, the roots of social marketing, his creation of two social marketing organizations, his legal battle with the State of New York over reproductive health issues (that went all the way to the U.S. Supreme Court) and the impact of social marketing.

Social marketing contributes 20% of all contraception in developing countries (excluding China)

A DKT Indonesia midwife counsels a client in her clinic in Jember, East Java. In 2014, this network of nearly 5,000 midwife clinics helped DKT Indonesia become the Number 1 contraceptive social marketing program in the world.

This was originally published on the Huffington Post on December 1, 2015.

If there was still any doubt about social marketing’s ability to make a major contribution to family planning and HIV prevention, those doubts were dispelled in 2014, when 84 social marketing programs in 62 countries delivered 69 million couple years of protection (CYPs), according to the 2014 Contraceptive Social Marketing Statistics just published by DKT International. DKT says these 69 million CYPs represent an estimated 20% of all women using modern contraception in the developing world, excluding China. (A “couple year of protection” is the amount of contraception needed to protect one couple for one year).

“These are remarkable numbers and a testament to the many organizations and individuals who strive to make a wide range of health products and services available to women around the world,” said Chris Purdy, president and CEO of DKT International.

The report provides details of these 84 contraceptive social marketing programs, all of which are helping provide modern contraception and reduce unmet need for family planning among women and families in their countries, largely through the private sector.

The top 10 in contraceptive social marketing

Two salesmen from DKT India make a pitch for contraceptives to the owner of a pharmacy in the Mumbai slums. In 2013, DKT India was the ninth biggest contraceptive social marketing program in the world. 
Photo: David J. Olson

This was originally published on the Knowledge4Health Blog on Dec. 23, 2014.

Social marketing organizations around the world delivered more impact than ever before in 2013 —70 million couple years of protection (CYPs), an increase of 6.8% from the 65.5 million CYPs produced in 2012, according to the 2013 Contraceptive Social Marketing Statistics just published by DKT International. (A couple year of protection is the amount of contraception needed to protect one couple for one year; see note at end of article for more details).

The report provides details on 93 contraceptive social marketing programs in 66 countries, all of which are helping provide modern contraception and reduce unmet need for family planning among women and families in their countries.

The social marketing program producing the most CYPs in 2013 was DKT Indonesia, delivering 6.7 million CYPs, consisting of contraceptives sold through social marketing channels such as pharmacies, convenience stores and medical wholesalers. The second biggest program was the Government of India, with 5.8 million CYPs (although over 40% of these CYPs were for products given out for free, which was not the case with other programs in the Top 10). Here is the Top 10 list in contraceptive social marketing in 2013:

1. DKT Indonesia, 6.7 million CYPs

2. Government of India, 5.8 million CYPs

3. Social Marketing Company (SMC), Bangladesh, 4.44 million CYPs

4. Greenstar Social Marketing, Pakistan, 4.42

5. PSI India, 3.8 million CYPs

6. Society for Family Health, Nigeria, 3.4 million CYPs

7. Population Health Services India, 3.3 million CYPs

8. DKT Ethiopia, 3.1 million CYPs

9. DKT India, 2.89 million CYPs

10. Profamilia, Colombia, 2.87 million CYPs

In Brazil, a charity makes successful transition to social enterprise

A DKT Brazil promoter hands out samples of Prudence condoms in downtown São Paulo, Brazil on World AIDS Day. Photo: David J. Olson

This blog was originally published on Devex Impact on Nov. 28, 2014.

SÃO PAULO, Brazil — In its 24 years of existence, DKT Brazil has transformed itself from a charity entirely dependent on international donors to a social enterprise dependent only on its own business and marketing savvy.

Brazil has become one of the centers of the social enterprise world. In 2012, the Social Enterprise World Forum was held there. I’m reading more articles, like this one in the Guardian, which claims that social enterprise is becoming the norm, “a really valid option proposed for anyone wanting to start or grow a business in Brazil.”

When DKT Brazil was launched in 1990 as a condom social marketing organization, it considered itself a charity and received most of its funding from the U.S. Agency for International Development and other donors. But when it lost its USAID funding in 2003, it was forced to become financially sustainable.

It achieved 100% financial sustainability, and more. All of its Prudence condom products make money, yet many of them are within the contraceptive affordability index, which dictates that the cost of a year of contraception should not be more than 0.25% of a family’s disposable income. In fact, DKT’s cheapest condom is only 0.22%; even its most expensive brand does not reach 0.5%. DKT believes it prevented over 9,000 HIV infections in Brazil in 2013.

DKT Brazil believes it has lessons to offer other social enterprises in Brazil and elsewhere. DKT Brazil Country Manager Dan Marun offers three:

Social marketing poised to make major contribution to 2020 family planning goal

A Pakistani couple receives family planning counseling at a health center that is part of DKT Pakistan's Dhanak social franchising network.

This blog was originally published at Devex.com on Nov. 3, 2014.

Social marketing organizations are providing more contraception than ever before, but its leaders are determined to up their game even more and become major contributors to the international family planning goal of 120 million new women and girls in the next six years that was set by Family Planning 2020 (FP2020).

In 2013, social marketing organizations around the world delivered 70 million couple years of protection (CYPs), an increase of 7% from 2012, according to the 2013 Contraceptive Social Marketing Statistics published recently by DKT International. (A couple year of protection is the amount of contraception needed to protect one couple for one year; see note at end of article). The report provides details on the 93 contraceptive social marketing programs that produced more than 10,000 CYPs in 66 countries.

2013 FP2020 report is released

This week, FP2020 released its annual progress report, announcing that 8.4 million additional women and girls used modern contraception in 2013 as compared to 2012. The report notes that this accomplishment did not meet the goal of 9.4 million additional users in the first year but “is still a significant milestone.”

Condom flavors like strawberry and caipirinha key to social marketing success in Brazil

A print ad for DKT's new caipirinha condom brand.

This was originally published on the Huffington Post on June 10, 2014.

SÃO PAULO, Brazil — “DKT do Brasil,” the social marketing juggernaut of South America, started in 1991 with one variant of Prudence condoms (now called Prudence Clássico). Over 23 years, DKT has grown that product line into 40 variants, with its latest offering featuring the flavor and scent of caipirinha, the iconic Brazilian cocktail made from cachaça, lime and sugar.

Over that same time period, its condom sales increased from 30,840 in 1992 to 124 million in 2013. This is considerably more than the combined total sales of every other condom social marketing project in all Latin America — South America, Central America and the Caribbean — according to DKT contraceptive social marketing statistics.

And yet DKT do Brasil does not consider itself a commercial enterprise, but a social enterprise. All of its products make money, and yet all are within the contraceptive affordability index, which dictates that the cost of contraception should be less than 1% of a family’s annual income. In fact, its cheapest condom, Prudence Clássico, is only 0.22% and even its most expensive brand is less than 0.5%.

How has DKT do Brasil been able to become the largest social marketing operation in Latin America, and one of the largest condom distributors in Brazil, while remaining true to it mission of “improving lives by encouraging family planning, sexually-transmitted disease prevention, pleasure and well-being; offering products that are accessible, diverse, innovative and high quality in Brazil and South America”?

Social enterprise for health, Brazilian style

With the leaders of Saúde Criança at their headquarters in Rio de Janeiro.

This was originally published on Global Health TV on April 27, 2014.

RIO DE JANEIRO, Brazil — One is poised to become the condom market leader in Brazil, with 40 variants in its Prudence condom line. Its newest offering features the flavor and scent of caipirinha, the iconic Brazilian cocktail made from cachaça, lime and sugar. DKT believes it prevented over 9,000 HIV infections in 2013.

Another rescues the poorest and unhealthiest children from the urban slums of Rio de Janeiro, Sâo Paulo and other cities, and nurses them – and their families – back to health.  Since its creation, an estimated 50,000 people have benefitted from its work.

They are very different global health organizations, with very different operating models, but both call themselves social enterprises, Brazilian style, and both were created in 1991.

Ethiopia: An emerging family planning success story

Delegates at the International Conference on Family Planning pose for a photo in front of DKT Ethiopia's coffee ceremony tent.

This was co-written with Andrew Piller and originally published on Impatient Optimists on Dec. 10, 2013.

When global family planning practitioners gathered in November for the Third International Conference on Family Planning, there was a timely relevance for meeting in Ethiopia. Over the last two decades, Ethiopia has become a family planning success story, one of only a handful of countries in Africa to achieve that status.

 Positioning of population and family planning at the center of development is critical.In 2000, Ethiopia’s contraceptive prevalence rate for modern methods was only 6.3 percent, which, at that time, was lower than any other country in Eastern and Southern Africa except Eritrea. By 2011, the rate had increased to 27.3 percent. Over the same period, the total fertility rate (the average number of children born to a woman in her lifetime) had decreased from 5.5 to 4.8.

Years of investments put health workers on global stage

Two midwives in a low-income area of Jakarta, Indonesia that are part
of DKT's "Andalan" social franchising network.

This article was originally published in The Huffington Post on Sept. 23, 2013.

For almost 10 years, I managed health programs in Africa, Asia, and South America that harnessed social marketing techniques to produce tangible benefits for poor consumers. Our programs made low-cost products such as condoms, contraceptives, and oral rehydration salts available at reduced, affordable prices. We worked mostly through the private sector and were proud of our bottom-line health impact. We didn't think much about underlying health systems or how to improve them. And if we had, we probably would have dismissed health system strengthening as overly ambitious.

But I've been thinking more about health systems lately, as I have seen governments and their nongovernmental partners carefully and patiently nurse ailing systems to health. The payoffs are not immediate -- far from it -- but as we move away from the segmented solutions to global health that prevailed in the 2000s (such as in the cases of AIDS and malaria) and toward greater country ownership, there is a growing consensus that we need stronger health systems to make sustainable improvements in global health.

This means more, better trained, and better managed frontline health workers -- the backbone of health systems.

I've heard that mantra for the last few years but, in 2012 and 2013, I saw it play out repeatedly as I traveled to very different countries in Africa, Asia, and Latin America:

In Brazil, using Carnaval to fight HIV

A dancer at the World AIDS Day rehearsal I attended.

This piece was originally published by the ONE Campaign on Feb. 8, 2013.

SAO PAULO, Brazil — Brazilians are bracing for the six days of Carnaval. The annual bacchanalian festival held 40 days before Easter, begins this weekend across this country of almost 200 million people. Many will participate directly as musicians, dancers and support staff. Millions will watch the parades, in person or by television. Companies sponsoring Carnaval see it as an opportunity for promoting their brand and selling their products, and many will use Carnaval as a license to engage in worldly pleasures of all kinds before the deprivations of Lent.

But one company, DKT Brazil, is taking a different approach and using Carnaval to promote responsible behavior — using condoms, specifically its Prudence brand, to prevent HIV infection. Typical Carnaval sponsors are companies like Mercedes Benz, Cacau Show (chocolate), Bombril (cleaning products) and beer companies. This is apparently the first time a company has sponsored Carnaval for a social purpose.

Taking HIV prevention to the streets, and cyberspace, in Brazil

A DKT promoter hands out a condom sample on the streets of São Paulo.

This piece was originally published on the Huffington Post on Jan. 25, 2013.

SÃO PAULO, Brazil — On Dec. 1, World AIDS Day, "Prudence Trooper" repeatedly battled it out with HIV on the streets of downtown São Paulo. HIV was trying to infect pedestrians but Prudence Trooper defended them, because he had Prudence, one of the leading condom brands in Brazil, in his arsenal.

The two characters were mascots created by DKT Brazil, a social marketing enterprise that distributes Prudence condoms for HIV prevention and family planning, and are an example of the creative, in-your-face methods it uses to encourage young Brazilians to protect themselves against HIV, which currently affects more than 600,000 Brazilians.

Using sexiness to stop unsafe sex

Sexy condom ads like this helped DKT increase condom sales in Brazil.

This article was published originally by Fast Company's Co.EXIST blog on October 5, 2012.

Sex and sexuality have long been used to market a variety of consumer products in wealthy countries. But when it comes to HIV prevention and family planning in developing countries, global health practitioners have mostly shied away from using the titillating strategies so effective in the commercial world.

The Pleasure Project and a small group of like-minded nonprofit partners are trying to change that, by shaking up an international reproductive health community that tries to promote safer sexual behavior by influencing the most intimate aspects of the lives of people in developing countries. With their motto, “Putting the sexy back into safer sex,” the Pleasure Project is spreading that message far and wide. At the XIX International AIDS Conference in Washington, D.C., this summer, they held a session entitled “Pleasure at AIDS 2012: Everything You Wanted to Know About Pleasurable Safer Sex but Were Afraid to Ask” that explored whether pleasure and eroticism can be harnessed to enhance HIV prevention. The conclusion was that they can indeed, even though most campaigns don’t even try.

"Wise-Up" helps Ethiopian sex workers find new vocations

Munayie

NOTE: This was originally published on the Huffington Post on June 18, 2012.
 
SHASHEMENE, Ethiopia -- Three years ago, Munayie, 25, made her living as a commercial sex worker here in Shashemene, a city of over 100,000 in the lake resort area of southern Ethiopia, about 240 kilometers south of Addis Ababa. She wanted to do something else but sex work was the only thing she knew that brought in the money she needed to provide for herself and her 8-year-old son.

Eventually, she and other sex workers found their calling as café owners with support from "Wise-Up," a condom promotion program of the non-profit organization DKT Ethiopia that targets sex workers, their clients and gatekeepers, and other "most at-risk populations." Wise-Up is grounded in the belief that promoting condoms to these groups will reduce prevalence of HIV and other sexually-transmitted infections (STIs) because 1) prevalence is generally higher among these groups and 2) they act as "bridging" populations that spread HIV and STIs to the general population.

In 2009, Wise-Up created a cooperative of 15 sex workers and Munayie became its leader. In 2011, the cooperative opened a café and condom shop in Shashemene.

NGOs can also contribute to innovative financing

DKT advertises IUDs in Indonesia.

NOTE: This blog was originally published on Impatient Optimists, the blog of the Bill & Melinda Gates Foundation, on Feb. 2, 2012.

In difficult economic times like these, governments are looking for ways to cut their budgets. Foreign aid is often an easy target. Innovative financing—the idea of using a range of non-traditional tools such as micro-contributions, taxes, and public-private partnerships—has developed over the last 10 years as an alternative to traditional donor aid. Innovative financing mechanisms have raised $2 billion over three years, according to a 2010 report, mostly for health.

Most innovative financing has originated with governments—such as UNITAID and the International Finance Facility for Immunization—and private sector efforts such as Project RED, which engages in “cause marketing.”

But NGOs can also play a role. In fact, they have already been doing this through social entrepreneurs like Muhammad Yunnus (Grameen Bank), Bill Drayton (Ashoka), and Jacqueline Novogratz (Acumen Fund).

Markets have a role in malaria treatment

By sheer serendipity, I happened to pick up a copy of The Guardian (link text), my favorite British newspaper, in London last Thursday and saw an interesting piece on the challenges in providing malaria treatment by Sarah Boseley, the Guardian health editor. I thought Sarah captured very well the dire lack of Coartem malaria treatment in most of the country. But I was dismayed by the way she suddenly turned against the role of the market in providing such treatment at the very end of her story, even after admitting the failure of the public sector to do so and praising the ability of companies like Coca-Cola to make their products widely available.

So I felt compelled to challenge her dissing of the potential for markets to contribute to health care in developing countries, and today my letter was published in The Guardian.

And here is the story of my own encounter with malaria treatment in Uganda based on my trip to Uganda in 2008, and which I cited in my letter.