2018 Family Planning Market Report

Publication date: 2018

FAMILY PLANNING MARKET REPORT D E C E M B E R 2 0 1 8 A C K N O W L E D G E M E N T S : This report was produced as part of the landmark FP2020 Global Markets Visibility Project that the Clinton Health Access Initiative, Inc. (CHAI) launched in early 2014 in conjunction with the Reproductive Health Supplies Coalition (RHSC). The shipment data provided by suppliers is the foundation of the report’s analyses, and allows CHAI to address information gaps and construct a more comprehensive view of the reproductive health commodities market. We would like to thank current participating suppliers (Bayer, CR Zizhu, Cipla, Cupid, Female Health Company, Helm AG*, Merck (MSD), Mylan, Pfizer, Pregna, PT Tunggal, Shanghai Dahua, SMB, and Techno Drugs), as well as our partner, the Concept Foundation, for their support in collecting and aggregating data from the Generic Manufacturers for Reproductive Health (the GEMS Caucus). We are also grateful to our colleagues from the Coordinated Supply Planning Group (CSP), John Snow Inc. (JSI), United Nations Population Fund (UNFPA), the United States Agency for International Development (USAID), the Global Health Supply-Chain – Procurement and Supply-Management (GHSC-PSM), and FP2020, for their invaluable feed- back during the development and refinement of various market analyses. * HELM AG was a participating supplier in the FP2020 Global Markets Visibility Project for the FP 2015, 2016 and 2017 Market Reports. In September 2017, HELM AG sold its wholly-owned subsidiary company, HELM Medical GmbH, to Sanavita Pharmaceuticals GmbH. Refer to page 17 for more information on HELM AG and other participating suppliers. SUPPLIER SHIPMENT ANALYSIS DONOR SPEND ANALYSIS FUTURE OUTLOOK DISCUSSION WITH KEY STAKEHOLDERS GLOBAL MARKETS VISIBILITY PROJECT ACKNOWLEDGEMENTS APPENDIX A – 69 FP2020 COUNTRIES MARKET VOLUMES BY METHOD AND COUNTRY, 2011–2017 APPENDIX B – DATA SOURCES APPENDIX C – ESTIMATING THE VALUE OF THE FP2020 PUBLIC SECTOR MARKET APPENDIX D – ESTIMATING TOTAL FP2020 DONOR-SPEND APPENDIX E – ADDITIONAL MARKETS VISIBILITY APPENDIX F – KEY TERMS AND DEFINITIONS APPENDIX G – ACRONYMS 3 13 15 16 17 19 33 34 40 41 46 47 3 COMPARED TO 20113, THE VALUE OF THE FP2020 PUBLIC SECTOR MARKET4 IN 2017 SAW A CONTINUATION OF THE DOWNWARD TREND EVIDENCED SINCE 2011. THIS SUBSTANTIAL DECLINE OVER THIS SIX-YEAR PERIOD IS PRIMARILY DRIVEN BY AN OVERALL DECREASE IN THE SHIPMENTS OF ORALS (COMBINED AND PROGESTIN ONLY) AND INJECTABLES5, AND, TO SOME EXTENT, OFFSET BY AN INCREASE IN SHIPMENTS OF IMPLANTS. CYPs6 SHIPPED DECLINED AT A SIMILAR RATE OVER THE SAME PERIOD, DRIVEN MAINLY BY A DECREASE IN IUDs AND ORALs (COMBINED AND PROGESTIN ONLY) AND SOMEWHAT OFFSET BY AN INCREASE IN IMPLANTS. The 2018 Family Planning Market Report covers the total FP2020 public sector market– defined as volumes purchased by institutional buyers (USAID, UNFPA, Social Marketing Organizations, etc.) and Ministry of Health (MOH) or government-affiliated procurers for the 69 FP2020 focus countries1. The report covers all product-based modern methods based on historical supplier-reported shipment data collected from 14 suppliers2 for female con- doms, implants, injectables, IUDs, orals (combined and progestin only), and emergency oral contraceptives. Findings for male condoms are based on data from the Reproductive Health Interchange. This section analyzes trends in shipment volumes, value in USD, and CYPs shipped in the total FP2020 public sector market from 2011 to 2017. Analyses are based on the supplier shipment data from the 14 suppliers participating in this report for all product-based methods except for male condoms; analyses for male condoms are based on data from the Reproductive Health Interchange (RHI). 1. Defined as countries with a 2010 gross national income per capita less than or equal to $2,500. 2. Participating suppliers represent >97 percent of cumulative volumes within each method from 2011 to 2017 of the Reproductive Health Interchange (RHI), with the exception of IUDs and emergency oral contraceptives, which represent >51 percent; see Appendix C.1 for further details. Additionally, the total quantities of the Market Report have on average been greater than total quantities seen in RHI for each method; see Appendix C.5 for further details. 3. 2011 is the first year of data collected and provides a picture of the value of the market before the London Family Planning Summit in 2012. 4. The FP2020 Public Sector Market in this report is defined as volumes purchased by institu- tional buyers (USAID, UNFPA, SMOs, etc.) and Ministry of Health (MOH) or government-affiliat- ed procurers for the 69 FP2020 focus countries (defined as countries with a 2010 gross national income per capita less than or equal to $2,500). 5. Injectables data from Pfizer include all institutional procurement at the Global level, but do not include government-funded orders received and processed in individual countries. 6. Couple Years of Protection (CYP) is the estimated protection provided by contraceptive methods during a one-year period e.g. 120 condoms provide a couple protection for one year. See Appendix C.8 for further details. 7. The currency reported is in US dollars, unless otherwise noted. 8. The largest decline in the overall value in a single year was recorded from 2015 to 2016 from The value of the public sector market in the 69 FP2020 focus countries has decreased from $277 million7 in 2011 to $186 million in 2017. The de- crease in value was more pronounced from 2015 to 20168; prior to 2016, the value was relatively flat9 (Exhibits 1 & 2).10 2017 represented the largest decline in total couple years of protection (CYPs) shipped, an estimate of the duration of contraceptive protection provided through products shipped, in a single year since 2011. CYPs fell from 110 million in 2011 to 78 million in 2017, well below the range of 104 million to 123 million CYPs shipped from 2011 to 2016. This decline was primarily driven by a decline in shipments of orals (combined and progestin only) from 2011 to 2016, and IUDs from 2016 to 2017. (Exhibit 3) Although CYPs shipped from long-acting reversible contraceptive (LARC)11 methods have declined 3 percent annually12 from 57 million in 2011 to 47 million in 2017, CYPs shipped from short-acting methods13 have declined faster at 8 percent annually from 53 million in 2011 to 32 million in 2017. As a result, LARCs continue to dominate the CYP mix14, driven by implant shipments. (Exhibits 1, 3, 5) SU PP LI ER S HI PM EN T AN AL YS IS $274 million to $192 million. This was due to a decline in shipments across all methods (with the exception of IUDs), and most notably a sharp decline among injectables. The prices for injectables and orals remained relatively stable from 2015 to 2016, indicating the decrease was driven by volume. 9. Prior to 2016, the value of the market remained relatively stable, with the exception of an increase in 2012 driven by increased implant shipments prior to the 2013 reduced price. From 2011 to 2017, the value of the implant market saw an annual increase of only three percent compared to the annual increase of 18 percent in shipment quantities, due to the implant price reductions in 2013, which allowed more implants to be purchased with the same amount of funding. 10. Other than implants, there have not been significant changes in price for other methods of contraceptives; hence, changes in the value of the market are mostly attributed to changes in shipment volumes. Prices used to calculate the value of the market for each method by year are listed in Appendix C. 11. Long-acting and reversible contraceptive methods include IUDs and implants. 12. Where percentage changes are discussed, the Compound Annual Growth Rate (CAGR) is used unless otherwise noted. 13. Short-acting methods include male and female condoms, injectables, orals (combined & progestin only) and emergency oral contraceptives. 14. CYP mix refers to the percentage distribution of CYPs shipped by method. 4 15. It should be noted that the observed trend occurred over a single year and may be attributed in part to the nature of shipment data and factors such as shipment timing and other procurement factors further explored on page 16. As also discussed in the Commodity Gap Analysis, general procurement trends “may also reflect a number of factors in addition to user consumption, such as the volume necessary to fill supply pipelines and maintain adequate inventory levels from central warehouses to individual service delivery points. Procurement quantities may take into account the volume of supplies already present or on order, inventory holding policies along the supply chain, and wastage or “leakage” of supplies at various levels. Constraints on funding, price, incentives, plans to expand programs in the future, and prefer- ences by donors or the government itself for particular methods or products may also influence what type, and what volume, of supplies to procure. The most pronounced trend observed from the 2017 supplier shipment data was a single-year decline from 2016 to 2017 in IUD shipments which accounted for most of the decline in CYPs shipped. At a cost per CYP of $0.10, IUDs are by far the most cost effective method. As a result, the total value of the market remained relatively unchanged. During this period, the market share of LARCs decreased by only 10 percent while the CYP mix for LARCs declined at a faster rate of 18 percent.15 (Exhibit 1, 3, 4, 5) In 2017, 10 countries represented just over half of the total value of the FP2020 public sector market.16 This trend, which includes five core coun- tries17, has remained relatively stable over the past four years. (Exhibits 6, 7, 8) SU PP LI ER S HI PM EN T AN AL YS IS 16. (in alphabetical order) Burkina Faso, Democratic Republic of Congo, Ghana were part of the top 10 countries which accounted for over 50 percent of the value in the FP2020 public sector market in 2016; however, they are not part of the top 10 countries by value in 2017. 17. (in alphabetical order) Bangladesh, Ethiopia, Nigeria, Uganda and Zimbabwe have consis- tently appeared in the top 10 markets from 2013 to 2017. 5 SU PP LI ER S HI PM EN T AN AL YS IS EXHIBIT 1: VALUE OF THE FP2020 PUBLIC SECTOR MARKET (USD) $0M $50M $100M $150M $200M $250M $300M $350M $400M 2017201620152014201320122011 To ta l M ar ke t S ize (M ill io ns U SD ) $58M $103M $4M $95M $5M $89M $10M $54M $52M $53M $87M $5M $49M $2M $78M $13M $40M $4M $79M $1M $93M $13M $44M $3M $81M $2M $78M $9M $47M $4M $98M $1M $60M $11M $45M $78M $5M $31M $2M $41M $11M $25M $70M $2M $33M $2M $46M $10M $23M Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female $277M $362M $273M $288M $274M $192M $186M METHOD YOY* 2016-2017 CAGR** 2011-2017 Condoms – Female -6% -2% Condoms – Male -8% -10% Implants -10% 3% Injectables 12% -4% IUDs -55% -12% Orals – Combined & Progestin Only 9% -16% Orals - Emergency -22% 8% Total -3% -6% * Year over year (YOY) ** Compound Annual Growth Rate (CAGR) Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2018; [3] UNFPA Contraceptive Price Indicator, 2011–2017; [4] IAP Implant Price Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding 6 SU PP LI ER S HI PM EN T AN AL YS IS EXHIBIT 2: TOTAL FP2020 MARKET VOLUMES (MALE CONDOMS EXCLUDED)* METHOD YOY 2016-2017 CAGR 2011-2017 Condoms – Female 1% 2% Implants -10% 18% Injectables 16% -4% IUDs -55% -13% Orals – Combined & Progestin Only 7% -14% Orals - Emergency 6% 13% 0 M 100 M 200 M 300 M 400 M 500 M 2017201620152014201320122011 Sh ip m en t V ol um es (M ill io ns ) Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female 3M 10M 6M 9M 6M 8M 6M 9M 10M 10M 9M 10M 311M 319M 283M 5M 94M 17M 267M 5M 114M 25M 172M 6M 97M 25M 22M 50M 6M 114M 3M 11M 109M 19M 73M 20M 421M 414M 426M 320M 211M 8M 5M 22M 58M 6M 122M 221M 473M *Male condoms are shown separately because the source of the shipment data is RHI whereas all other methods are supplier-reported. See Appendix C for further details MALE CONDOM SHIPMENT VOLUMES (BILLIONS) 2011 2012 2013 2014 2015 2016 2017 YOY 2016-2017 CAGR 2011-2017 1.62 1.84 1.57 1.49 1.36 1.00 1.03 3% -7% Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2018 Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding 7 SU PP LI ER S HI PM EN T AN AL YS IS 0 M 30 M 60 M 90 M 120 M 150 M 2017201620152014201320122011 CY Ps S hi pp ed (M ill io ns ) Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female 10M 17M 18M 20M 31M 46M 11M 0.3M 23M 0.2M 11M 41M 28M 18M 0.2M 12M 37M 19M 0.2M 0.2M 22M 0.1M 13M 42M 21M 27M 0.5M 0.2M 15M 47M 21M 0.2M 18M 0.2M 14M 110M 110M 29M 26M 21M 8M 0.3M 14M 0.2M 9M 47M 12M 8M 0.3M 0.2M 8M104M 78M 119M123M 123M EXHIBIT 3: CYPs SHIPPED TO THE FP2020 PUBLIC SECTOR MARKET METHOD YOY 2016-2017 CAGR 2011-2017 Condoms – Female 1% 2% Condoms – Male 3% -7% Implants -10% 18% Injectables 17% -4% IUDs -55% -13% Orals – Combined & Progestin Only 7% -14% Orals - Emergency 6% 13% Total -25% -5% Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2018; [3] USAID, "Couple-Years of Protection (CYP)", May 2018 Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding 8 METHOD UNITS PER CYP UNIT COST COST PER CYP 2011 2012 2013 2014 2015 2016 2017 2011 2012 2013 2014 2015 2016 2017 Condoms - Female 120.00 $0.56 $0.55 $0.54 $0.53 $0.52 $0.49 $0.46 $67.02 $66.42 $65.04 $63.36 $62.40 $59.28 $55.32 Condoms - Male 120.00 $0.03 $0.03 $0.03 $0.03 $0.03 $0.03 $0.02 $3.34 $3.52 $3.56 $3.57 $3.51 $3.03 $2.70 Injectables - 1 month 13.00 $0.84 $0.85 $0.84 $0.85 $0.85 $0.85 $0.85 $10.92 $11.05 $10.95 $11.05 $11.05 $11.05 $11.05 Injectables - 2 month 6.00 N/A N/A $1.30 $1.30 $1.15 $1.15 $1.15 N/A N/A $7.80 $7.80 $6.90 $6.90 $6.90 Injectables - 3 month* 4.00 $0.82 $0.82 $0.78 $0.79 $0.78 $0.80 $0.77 $3.27 $3.27 $3.12 $3.17 $3.13 $3.20 $3.09 Orals – Combined 15.00 $0.31 $0.30 $0.28 $0.30 $0.28 $0.26 $0.27 $4.70 $4.44 $4.26 $4.43 $4.20 $3.95 $4.01 Orals – Progestin Only 15.00 $0.32 $0.32 $0.31 $0.31 $0.32 $0.33 $0.32 $4.84 $4.85 $4.64 $4.60 $4.80 $4.92 $4.76 Orals – Emergency 20.00 $0.34 $0.49 $0.44 $0.30 $0.37 $0.35 $0.26 $6.74 $9.74 $8.84 $5.92 $7.40 $7.02 $5.14 Implants - 3 Year* 0.40 $18.20 $17.92 $8.50 $8.50 $8.50 $8.50 $8.35 $7.28 $7.17 $3.40 $3.40 $3.40 $3.40 $3.35 Implants - 5 Year 0.26 $19.43 $18.05 $8.50 $8.50 $8.50 $8.50 $8.50 $5.11 $4.75 $2.24 $2.24 $2.24 $2.24 $2.24 IUDs 0.22 $0.43 $0.43 $0.43 $0.48 $0.47 $0.46 $0.47 $0.09 $0.09 $0.09 $0.10 $0.10 $0.10 $0.10 EXHIBIT 4: COST PER CYP BY METHOD PER DURATION OF USE (USD) SU PP LI ER S HI PM EN T AN AL YS IS Cost of Product per Year of Use in 2017 (USD) $0 $10 $20 $30 $40 $50 $60 Condoms - Female Injectables - 1 month Injectables - 2 month Orals - Emergency Orals – Progestin Only Orals – Combined Implants - 3 Year Injectables - 3 month Condoms - Male Implants - 5 Year IUDs $0.10 $2.24 $2.70 $3.09 $3.35 $4.01 $4.76 $5.14 $6.90 $11.05 $55.32 Sources: [1] UNFPA Contraceptive Price Indicator, 2011–2017; [2] USAID, “Couple-Years of Protection (CYP)", [3] IAP Implant Price Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding *Weighted average price. Weighted average price is calculated based on prices and volumes available in the UNFPA Contraceptive Price Indicator. The 3-month injectable price is based on DMPA IM and DMPA SC; the 3 year implant year price is based on Levoplant and Implanon NXT. 9 0% 20% 40% 60% 80% 100% 2017201620152014201320122011 M ar ke t S ha re Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female $277M $362M $273M $288M $274M $192M $186M 21% 29% 1% 26% 1% 25% 3% 15% 19% 1% 30% 1% 29% 3% 17% 18% 1% 27% 1% 32% 5% 15% 32% 2% 18% 1% 29% 5% 15% 40% 2% 16% 1% 21% 6% 13% 38% 1% 18% 1% 25% 5% 12% 2% 35% 0.4% 22% 4% 16% EXHIBIT 5: CONTRACEPTIVE SHIPMENT MIX (IN TERMS OF VOLUMES), CYP MIX (IN TERMS OF CYPs SHIPPED), AND MARKET SHARE (IN TERMS OF DOLLARS) OF THE FP2020 PUBLIC SECTOR MARKET SU PP LI ER S HI PM EN T AN AL YS IS 0% 20% 40% 60% 80% 100% 2017201620152014201320122011 CY P M ix Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female 9% 14% 34% 17% 0.4% 22% 0.1% 12% 16% 34% 17% 0.2% 20% 0.1% 12% 17% 34% 15% 0.2% 23% 0.2% 10% 25% 37% 9% 0.3% 19% 0.2% 9% 43% 19% 0.1% 17% 0.2% 12% 110M 123M 110M 119M 123M 27% 45% 7% 0.3% 12% 0.2% 8% 33% 27% 10% 0.4% 18% 0.2% 11% 104M 78M Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2018; [3] UNFPA Contraceptive Price Indicator, 2011–2017; [4] USAID, “Couple-Years of Protection (CYP),” May 2017; [6] IAP Implant Price. Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding 10 EXHIBIT 5: CONTRACEPTIVE SHIPMENT MIX (IN TERMS OF VOLUMES), CYP MIX (IN TERMS OF CYPs SHIPPED), AND MARKET SHARE (IN TERMS OF DOLLARS) OF THE FP2020 PUBLIC SECTOR MARKET (CONTINUED) SU PP LI ER S HI PM EN T AN AL YS IS SHIPMENT MIX (IN TERMS OF VOLUMES) 2011 2012 2013 2014 2015 2016 2017 Condoms - Female 1.0% 0.8% 0.9% 1.3% 1.5% 1.8% 1.8% Condoms - Male 79.4% 79.6% 79.2% 77.8% 80.9% 83% 82% Implants 0.2% 0.2% 0.3% 0.3% 0.6% 0.8% 0.7% Injectables 3.6% 4.7% 4.7% 5.9% 5.8% 4.1% 4.6% IUDs 0.5% 0.4% 0.4% 0.5% 0.6% 0.8% 0.4% Orals - Combined & Progestin Only 15.2% 13.8% 14.3% 13.9% 10.2% 9.4% 9.7% Orals - Emergency 0.1% 0.5% 0.2% 0.3% 0.4% 0.5% 0.5% Total Volumes 2.04 B 2.32 B 1.98 B 1.92 B 1.68 B 1.21 B 1.25 B 0% 20% 40% 60% 80% 100% 2017 Market Share2017 CYP Mix 2016 Market Share2016 CYP Mix Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female 104M $192M 78M $186M 27% 40% 2% 16% 1% 21% 6% 13% 45% 7% 12% 0.3% 0.2% 8% 33% 27% 10% 18% 0.4% 0.2% 11% 38% 1% 18% 25% 1% 5% 12% Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2018; [3] UNFPA Contraceptive Price Indicator, 2011–2017; [4] USAID, “Couple-Years of Protection (CYP),” May 2018; [6] IAP Implant Price. Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding 11 EXHIBIT 6: MARKET SHARE OF FP2020 PUBLIC SECTOR BY REGION (USD) SU PP LI ER S HI PM EN T AN AL YS IS 0% 20% 40% 60% 80% 100% 2017201620152014201320122011 M ar ke t S ha re Country Not Specified Asia & Pacific Latin America & Caribbean Sub-Saharan AfricaMiddle East & North Africa $277M $362M $273M $288M $274M $192M $186M 2% 38% 4% 43% 14% 2% 30% 3% 56% 9% 2% 29% 4% 57% 8% 2% 32% 1% 54% 11% 2% 23% 1% 60% 13% 2% 19% 2% 68% 9% 3% 19% 1% 65% 12% *The “Countries Not Specified” represents the proportion of shipment volumes to procurer warehouses where the final FP2020 destination is not specified. See Appendix C for further details. VALUE OF THE FP2020 PUBLIC SECTOR MARKET BY REGION (USD) 2011 2012 2013 2014 2015 2016 2017 Asia & Pacific $105 M $110 M $80 M $93 M $64 M $36 M $35 M Latin America & Caribbean $4 M $6 M $6 M $5 M $6 M $5 M $5 M Middle East & North Africa $10 M $9 M $10 M $4 M $3 M $4 M $2 M Sub-Saharan Africa $120 M $202 M $155 M $154 M $164 M $131 M $122 M Total Regions $239 M $328 M $251 M $256 M $237 M $175 M $164 M Countries Not Specified $38 M $34 M $21 M $32 M $37 M $17 M $23 M Total $277 M $362 M $273 M $288 M $274 M $192 M $186 M * Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2018; [3] UNFPA Contraceptive Price Indicator, 2011–2017; [4] IAP Implant Price Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding 12 SU PP LI ER S HI PM EN T AN AL YS IS EXHIBIT 7: TOP 10 COUNTRIES IN TERMS OF VALUE, 2017 11% 48% 5% 5% 6% 5% 5% 4% 4% 4% 3% Ethiopia Nigeria Myanmar Tanzania Zimbabwe Bangladesh Zambia Uganda Mozambique Kenya Other FP2020 Countries Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2018; [3] UNFPA Contraceptive Price Indicator, 2011–2017; [4] IAP Implant Price Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding EXHIBIT 8: VALUE OF 10 LARGEST FP2020 PUBLIC SECTOR COUNTRIES COMPARED TO VALUE OF ALL OTHER COUNTRIES COMBINED $0M $50M $100M $150M $200M $250M $300M $350M $400M 2017201620152014201320122011 Top 10 Countries Other FP2020 Countries $277M $362M $273M $288M $274M $192M $186M $155M $122M $89M $104M $97M $90M $140M $133M $134M $154M $124M $150M $217M $145M M ar ke t S ize (M ill io ns U SD ) * Top countries defined by 2017 data. Top 10 countries are, in alphabetical order, Bangladesh, Ethiopia, Kenya, Mozambique, Myanmar, Nigeria, Tanzania, Uganda, Zambia, and Zimbabwe. * 13 EXPENDITURES BY THE TWO LARGEST INSTITUTIONAL PROCURERS OF FAMILY PLANNING COMMODITIES, USAID AND UNFPA, HAVE REMAINED FLAT OR DECREASED SINCE 2012. DO NO R SP EN D AN AL YS IS This section looks at data from the “Overview of Contraceptive and Condom Shipment” reports by USAID and data from the Pro- curement Services Branch of UNFPA to understand historical spend by the two major institutional procurers for the 69 FP2020 public sector markets. From FY201218 to FY2015, the annual value19 of all contraceptives shipped by USAID, excluding male and female condoms20, to the 69 FP2020 coun- tries remained relatively flat between $58 million and $77 million. The FY2016 shipped value of $46 million was 37 percent less than in FY2015, and the value in FY2017 of $34 million was 25 percent less than FY2016. These decreases were attributed to a transition from the USAID | DE- LIVER project21 to the GHSC-PSM project22. As cited in USAID’s “Overview of Contraceptive and Condom Shipments” FY2017 report, programs had prepared for this change by increasing shipments in FY2015.23 (Exhibit 9) Overall, from 2012 to 2017, the value24 of contraceptives procured by UNFPA decreased by 2 percent annually. From 2012 to 2015, procurement values remained flat between $108 million and $120 million. While a substantial 27 percent decrease was observed in 2016, the value of UNFPA’s procurement increased by 25 percent in 2017, although not reaching pre-2016 levels. (Exhibit 10) 18. USAID Fiscal Year (FY) runs from Oct. 1 to Sept. 30. 19. USAID values are based on shipment data for FP2020 countries and are inclusive of prod- uct and freight costs. Values are taken from the USAID annual “Overview of Contraceptive and Condom Shipments” reports from FY2011 to FY2017. 20. The FY2017 report is reflective of Family Planning funding and does not include HIV/AIDs funded condoms; thus, we have excluded female and male condom values for 2011 to 2017 to compare a consistent data set across years. 21. The USAID | DELIVER project was implemented by John Snow Inc. and worked to strength- en supply chains, delivering technical assistance and medicines and health supplies including contraceptives, to developing countries around the world from 2006–2016. Available at: https://www.jsi.com/JSIInternet/IntlHealth/techexpertise/display.cfm?tid=1000&id=79&xid=2055 22. USAID awarded the current contract for procuring and delivering medicines and commodi- ties and providing supply-chain technical assistance to countries in 2015: It is called the Global Health Supply-Chain - Procurement and Supply-Management Project (GHSC-PSM). https:// www.usaid.gov/news-information/congressional-testimony/may-17-2018-sdaa-global-health- irene-koek-supply-chain 23. USAID, Overview of Contraceptive and Condom Shipments available at https://pdf.usaid. gov/pdf_docs/PA00T4T9.pdf 24. UNFPA procurement values reflect all contraceptive procurement conducted by UNFPA for FP2020 countries including fresh production (purchase orders) and requests satisfied using stock; values are inclusive of product costs and exclude services such as freight, sampling, inspection, and testing. Values are provided by UNFPA Procurement Services Branch. 14 DO NO R SP EN D AN AL YS IS EXHIBIT 9: USAID CONTRACEPTIVE (EXCLUDING MALE AND FEMALE CONDOMS) SHIPMENT VALUES TO FP2020 COUNTRIES (USD) EXHIBIT 10: UNFPA PROCUREMENT VALUE - CONTRACEPTIVES TO FP2020 COUNTRIES (USD) $0M $10M $20M $30M $40M $50M $60M $70M $80M 2017201620152014201320122011 Sh ip m en t V al ue s to F P2 02 0 (M ill io ns U SD ) USAID $77M $73M $66M $58M $73M $46M $34M $0M $20M $40M $60M $80M $100M $120M 2017201620152014201320122011 UNFPA $48M $109M $120M $110M $108M $79M $99M Sh ip m en t V al ue s to F P2 02 0 (M ill io ns U SD ) Sources: [1] USAID Worldwide Contraceptive and Condom Shipments FY 2011 – 2017; [2] UNFPA PSB Procurement Values 2011 – 2017 Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding 2016-2017 YOY: -25% 2012-2017 CAGR: -14% 2016-2017 YOY: 25% 2012-2017 CAGR: -2% 15 FU TU RE O UT LO OK THE UNCERTAINTY SURROUNDING THE AVAILABILITY OF FUTURE FUNDING CONTINUES TO IMPACT THE MARKET FOR FAMILY PLANNING COMMODITIES IN A SIGNIFICANT WAY. Uncertainties over longer-term donor funding remains a critical factor in determining the health of this market. The 2017 UNFPA Supplies annual report highlights new donor contributions and commitments which, if realized, could significantly improve the availability of financ- ing for contraceptive commodities in 2018.25 However, there is uncer- tainty around overall family planning funding26. The 2018 RHSC Global 25. UNFPA Supplies Annual Report 2017, available at https://www.unfpa.org/unfpa-supplies-an- nual-report-2017 26. Uncertainty around overall family planning funding includes funding from the U.S gov- ernment. Family planning and reproductive health (FP/RH) funding totals $633 million in the Senate-approved FY19 State & Foreign Operations appropriations bill, compared to the FY18 enacted level of $608 million, the House FY19 level of $461 million, and the FY19 Request of $331 million. Henry J. Kaiser Family Foundation, June 2018. Available at: https://www.kff.org/ news-summary/senate-appropriations-committee-approves-fy19-state-and-foreign-opera- tions-sfops-appropriations-bill/ Contraceptive Commodity Gap Analysis identified growing funding gaps every year until 2020. Should the funding challenges remain unaddressed, the family planning contraceptive product market could decline further and, subsequently, the number of users on modern methods of contraception could cease to grow or even decrease. 16 DI SC US SI ON W IT H KE Y ST AK EH OL DE RS CHAI CONSULTED A NUMBER OF SUPPLIERS, DONORS, AND OTHER FAMILY PLANNING PARTNERS TO DISCUSS THE TRENDS OBSERVED IN THE REPORT. Those consulted voiced concern that the value of the FP2020 public sector market had not rebounded to pre-2016 levels. Many also raised concerns with regard to the continued decrease in donor spending since the 2012 London Family Planning Summit where many donors committed to increase spending. They also pointed to growing funding gaps for contraceptive products. Certain stakeholders proposed explanations for the more promi- nent observed trends from the supplier shipment data. For example, suggested reasons for the IUD shipment decline from 2016 to 2017 included: the devaluation of the Egyptian Pound against the U.S. dollar27 leading to decreased international procurement of health products including IUDs in Egypt, the discontinuation of USAID’s funding support for contraceptive products in Pakistan28,29, and cyclical procurement patterns for the remaining top markets. As for the decrease observed in implant shipments from 2016 to 2017, supplier production capacity constraints were cited as contributing reasons at a Coordinated Supply Planning (CSP) meeting30. The very nature of the supplier shipment data may also impact year-to- year trends. For instance, total annual volumes provided by suppliers are recorded when they are shipped, which differ in timing from when orders are procured. As a result, some orders procured in certain years may ship in subsequent years based on manufacturing lead times and thus one-year fluctuations are not necessarily a result of programmatic shifts. As also discussed in the Commodity Gap Analysis, general procure- ment trends “may also reflect a number of factors in addition to user consumption such as the volume necessary to fill supply pipelines and maintain adequate inventory levels from central warehouses to individual service delivery points. Procurement quantities may take into account the volume of supplies already present or on order, inventory holding policies along the supply chain, and wastage or “leakage” of supplies at various levels. Constraints on funding, price, incentives, plans to expand programs in the future, and preferences by donors or the government itself for particular methods or products may also influence what type and what volume of supplies to procure.”31 For the above outlined reasons, this report focuses on multi-year trends as opposed to single-year trends. 27. The Egyptian Pound was devalued in late 2016. https://www.businessinsider.com/egypt-un- pegs-the-egyptian-pound-from-us-dollar-2016-11 28. USAID, Overview of Contraceptive and Condom Shipments FY 2016. “Order requests for FY 2016 declined in values and quantities for all six contraceptive methods compared with FY 2015: orals, injectables, implants, intrauterine devices (IUDs), male condoms, and female condoms. When looking at the past three years, only IUDs show a year-over-year decline. This decline is attributed to a decline in orders from Pakistan as the government begins to take responsibility for procuring products.” Available at: https://www.usaid.gov/sites/default/files/ documents/1864/C-C_FY16.pdf 29. USAID, Overview of Contraceptive and Condom Shipments FY 2017. [On IUDs] “Asia’s pre- cipitous decline in FY17 of 97 percent can be attributed mainly to Pakistan, which had no order requests after having accounted for the most orders of all countries the previous two years. This reflects the government plan to begin taking responsibility for procuring commodities there.” Available at: https://pdf.usaid.gov/pdf_docs/PA00T4T9.pdf 30. USAID Global Health Supply Chain Program, Procurement and Supply Chain Management, Fiscal Year 2018, Q3 Report https://www.ghsupplychain.org/sites/default/files/2018-09/GH- SC-PSM_2018_Q2.pdf 31. 2016 Commodity Gap Analysis, RHSC. Available at https://www.rhsupplies.org/uploads/ tx_rhscpublications/Global_Contraceptive_Commodity_Gap_Analysis_2016.pdf 17 GL OB AL M AR KE TS V IS IB IL IT Y PR OJ EC T AC KN OW LE DG EM EN TS About the Global Markets Visibility Project The Global Markets Visibility Project is a landmark initiative that has, since 2015, provided the reproductive health community with detailed assessments of the public sector family planning market across the 69 FP2020 countries. The initiative provides insightful and strategic out- puts for donors, MOHs, implementing organizations, and suppliers to develop and implement more effective strategies for enabling women in the world’s 69 poorest countries to use family planning products and services. This report is a joint collaboration with the Reproductive Health Sup- plies Coalition (RHSC). The initial 2015 report comprised data from 11 manufacturers. Each manufacturer entered into a formal MOU with CHAI or provided their information through collaborations with the Generic Manufacturers Caucus for Reproductive Health (GEMs) and i+solutions. Since then, coverage has expanded and today there are 14 suppliers participating in the project. Donors, suppliers, and partners expressed strong interest to continue this project, build on our progress, and strengthen the family planning community’s market knowledge. About the Participating Suppliers Bayer Bayer is a Germany-based life science company with core competencies in health care and agriculture. Its contraceptive product portfolio in- cludes contraceptive implants, LNG-IUS, combined oral contraceptives, and injectables. CR Zizhu China Resources Zizhu Pharmaceutical Co., Ltd. (CR Zizhu) is a manufac- turer of reproductive health products based in China. Its contraceptive product portfolio includes emergency oral contraceptives and com- bined oral contraceptives. CR Zizhu also manufactures misoprostol and several APIs including levonorgestrel. Cipla Cipla Limited is an India-based generic manufacturer with over 1,500 products in the areas of respiratory diseases, HIV/AIDS, malaria, MDRTB, and reproductive health. Its contraceptive product portfolio includes emergency oral contraceptives and combined oral contraceptives. It also manufactures misoprostol. Cupid Cupid Limited is a manufacturer of both male and female condoms based in India. Its services include contract manufacturing (e.g., Playboy condoms, Trust condoms) and research and development, as well as the marketing and manufacturing of its own branded products. Female Health Company Female Health Company is the global public sector division of Veru Healthcare focusing on urology and oncology, headquartered in Miami, Florida, USA. The Female Health Company is the manufacturer of the FC2 female condom and focuses on the global public health sector business. FC2 is approved by the US FDA and WHO pre-qualified for offering dual protection against sexually transmitted infections and unintended pregnancy. Mylan Mylan is a U.S. based healthcare company with over 7,500 marketed products. Its contraceptive product portfolio includes oral (combined, progestin only, and emergency) and injectable contraceptives, IUDs, and tubal rings used for female sterilization32. Helm AG Helm AG is a Germany-based, family owned multifunctional distribution company specializing in: chemicals (feedstocks and derivatives), crop protection, active pharmaceutical ingredients and pharmaceuticals, and fertilizers. Until 2017, its main contraceptive product was a 3-month injectable (DMPA). HELM AG was a participating supplier in the FP2020 Global Markets Visibility Project for the FP 2015, 2016 and 2017 Market Reports. In Sep- tember 2017, HELM AG sold its wholly-owned subsidiary company, HELM Medical GmbH, to Sanavita Pharmaceuticals GmbH, a firm based in Germany whose parent company is Braun Beteiligungs GmbH. Following the transaction, HELM AG discontinued its IUD and Injectables business units and consequently, the FP 2018 report does not contain shipment volumes for IUDs or Injectables from HELM AG. Sanavita Pharmaceuti- cals will assume responsibility for HELM's male condoms business unit. No supplier shipment data for male condoms from HELM or Sanavita is shown or used for analyses in this report — all shipment data for male condoms in this report is derived from the RHI database. Merck (MSD) Merck is a U.S.-based healthcare company which operates as MSD outside of the USA and Canada. Its contraceptive product portfolio includes contraceptive implants (Implanon) NXT (which includes a prefilled sterile applicator), oral contraceptives (Exluton and Marvelon) for FP2020 public sector markets, and oral contraceptives (Cerazette, Ex- luton, Marvelon, and Zoely), contraceptive implants (Implanon) NXT and the contraceptive vaginal ring (NuvaRing) for non-FP2020 markets. Market Definition, Scope, and Coverage The total FP2020 public sector market referenced in this report only includes data for the public sector in the 69 FP2020 countries, which is defined as volumes purchased by institutional buyers (USAID, UNFPA, SMOs, etc.) and MOH or government-affiliated procurers. Although significant efforts have been deployed to collect as much data as possible, it should be noted that this report does not represent the entirety of institutional purchases for the FP2020 public sector, as it includes data from the majority, but not all of the suppliers associated with these markets. 32. The procurement of products used for sterilization such as tubal rings is not covered in this report. This report's scope is limited to product-based modern methods of contraception. 18 GL OB AL M AR KE TS V IS IB IL IT Y PR OJ EC T AC KN OW LE DG EM EN TS Pfizer Pfizer is a U.S.-based healthcare company. Its contraceptive product portfolio includes 3-month injectable DMPA IM (Depo-Provera) and 3-month injectables DMPA SC (Sayana Press). Pregna Pregna is a manufacturer of contraceptive products based in India. Its contraceptive product portfolio includes LNG-IUS (Eloira), IUDs, and tubal rings used for female sterilization. PT Tunggal PT. Tunggal Idaman Abdi (PT Tunggal) is a pharmaceutical manufacturer focusing on reproductive healthcare based in Indonesia. Its contra- ceptive product portfolio includes a monthly injectable, a 3-month injectable, a combined oral contraceptive, and an emergency oral contraceptive. Shanghai Dahua Shanghai Dahua Pharmaceutical Co., Ltd (Dahua) is a manufacturer of contraceptive implants based in China. On June 30th, 2017, the World Health Organization (WHO) pre-qualified Dahua’s Levoplant (formerly known as Sino Implant II) for three years of use. SMB SMB is a manufacturer of medical devices, including IUDs and surgical sutures, based in India. Its key contraceptive product is IUDs, including Copper T 380A, TCu 380Ag, TCu 380 Plus, and SMB Cu 375. Techno Drugs Techno Drugs Ltd. is a manufacturer of both human and veterinary medicines based in Bangladesh. Its contraceptive product portfolio includes combined oral contraceptives and injectables. For injectables, Techno Drugs has also served as a supplier to Helm AG previously. 19 APPENDIX A 33. Female condoms are aggregated with male condoms by country in order to protect data confidentiality. 34. Other FP2020 shipment volumes include shipments to procurer (USAID, UNFPA, SMOs) warehouses in non-FP2020 countries, such as Belgium, Denmark, France, Germany, Neth- erlands, Norway, Sweden, Switzerland, UK, and USA. Although these volumes were shipped 69 FP2020 COUNTRIES MARKET VOLUMES BY METHOD33 AND COUNTRY34, 2011–2017 EXHIBIT A.1: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2011 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 19,572,826 0 1,395,200 67,000 807,674 Bangladesh 112,426,800 422,109 18,984,000 475,000 138,631,121 Benin 13,249,064 48,600 10,300 21,000 0 Bhutan 2,880,000 0 475,200 1,600 88,002 Bolivia 1,570,360 2,350 0 35,000 210,000 Burkina Faso 0 2,000 0 0 1,597,501 Burundi 14,673,200 44,600 0 39,000 33,335 Cambodia 1,764,000 19,000 0 20,000 20,000 Cameroon 0 11,500 0 31,000 50,200 Central African Republic 6,410,600 500 200 0 91,403 Chad 1,567,600 15,000 52,000 1,000 0 Comoros 1,008,000 1,024 26,800 100 0 Democratic Republic of Congo 73,252,800 8,500 350,000 26,000 1,295,595 Congo Rep 20,566,352 10 1,412,400 500 391,905 Cote d'Ivoire 34,967,400 0 630,800 10,000 2,613,145 Djibouti 590,240 0 0 1,500 0 Egypt Arab Rep 50,400 17,500 4,780,000 2,135,000 3,000,000 Eritrea 7,804,000 5,100 0 5,500 61,672 Ethiopia 146,223,384 382,704 5,471,200 420,000 7,752,440 Gambia 1,585,000 100 10,000 500 433,337 Ghana 5,514,000 57,674 3,044,000 0 0 Guinea 7,932,400 1,000 546,240 11,000 233,335 Guinea-Bissau 1,555,000 5,000 0 0 5,001 Haiti 54,534,096 0 976,800 0 200,001 Honduras 19,202,400 0 148,000 22,453 943,300 India 0 0 193,201 1,959,570 8,661,563 Indonesia 210,000 0 0 316,721 50,001 Iraq 0 0 0 75,000 2,633,250 Kenya 48,266,720 505,209 1,370,032 0 15,136,914 Korea Dem Rep 1,267,200 0 0 36,150 139,500 Kyrgyz Republic 5,202,600 0 0 160,000 0 Lao PDR 8,484,208 6,200 650,000 0 922,112 Lesotho 8,356,936 2,000 65,000 0 63,000 Liberia 22,048,800 3,000 423,200 0 0 to non-FP2020 countries, the end shipment destination of these volumes would likely be the 69 FP2020. As a result, these non-FP2020 volumes were included in the total shipments to 69 FP2020 countries after it was confirmed that the specific non-FP2020 volumes were associated with institutional purchases. APPENDIX A AP PE ND IC ES 20 APPENDIX A EXHIBIT A.1: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2011 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Madagascar 24,254,800 124,318 1,913,600 4,500 324,550 Malawi 11,886,001 46,452 540,000 0 50,000 Mali 1,000 53,600 1,292,625 41,501 0 Mauritania 3,600,000 3,728 6,000 5,500 533,336 Mongolia 10,002,880 1,000 0 0 321,000 Mozambique 96,394,000 5,010 1,241,400 41,000 5,393,262 Myanmar 56,563,712 4,000 0 0 6,918,499 Nepal 33,641,000 0 327,600 10,000 250,000 Nicaragua 13,356,000 0 332,100 50,000 842,001 Niger 10,000 4,612 814,000 2,800 400,000 Nigeria 78,948,652 32,900 3,157,500 209,000 1,055,335 Pakistan 249,431,800 25,300 5,862,000 200,000 400,299 Papua New Guinea 2,500,000 2,000 0 0 1,663,200 Philippines 740,800 0 0 0 6,639,745 Rwanda 30,211,488 0 1,768,400 18,600 0 Sao Tome and Principe 2,190,600 0 852,075 200 47,129 Senegal 11,400,000 10,350 0 3,000 220,000 Sierra Leone 4,515,800 91,700 0 35,500 1,206,269 Solomon Islands 30,000 0 0 0 24,000 Somalia 0 0 0 0 0 South Sudan 4,161,000 0 0 0 0 Sri Lanka 779,600 10,000 0 80,000 2,191,240 Sudan 10,591,344 3,500 0 2,000 1,167,875 Tajikistan 10,105,072 5,440 0 150,000 0 Tanzania 29,772,456 240,104 6,176,400 25,000 1,410,170 Timor-Leste 57,600 1,100 0 3,500 145,002 Togo 14,392,368 16,500 0 6,400 12,663 Uganda 82,319,600 86,688 2,089,800 83,785 334,220 Uzbekistan 5,414,112 0 0 1,500,000 600,000 Vietnam 15,049,000 9,000 1,180,000 1,772,000 0 West Bank and Gaza 4,521,600 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 829,440 6,625 2,001,875 30,000 3,971,120 Zambia 58,807,168 0 1,544,200 0 748,000 Zimbabwe 126,944,000 61,900 782,500 2,600 14,836,223 Other FP2020 Shipment Volumes 6,937,864 692,800 385,700 145,850 76,285,355 Total Volumes 1,643,097,143 3,099,307 73,282,348 10,293,330 314,055,800 AP PE ND IC ES Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2018. 21 EXHIBIT A.2: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2012 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 12,418,680 3,000 619,300 30,000 199,470 Bangladesh 26,736,000 512,800 18,562,000 515,000 146,646,964 Benin 21,806,400 16,500 0 19,000 0 Bhutan 3,456,000 0 70,000 0 97,899 Bolivia 121,000 25,300 0 6,000 3,000 Burkina Faso 16,741,200 117,100 1,369,900 16,500 2,348,935 Burundi 6,272,000 120,000 996,000 175,000 608,160 Cambodia 748,656 29,676 307,600 58,650 1,125,338 Cameroon 3,162,000 12,300 0 20,000 17,840 Central African Republic 3,415,400 13,600 198,400 1,000 1,031,664 Chad 70,000 25,800 30,000 3,000 0 Comoros 576,000 500 15,000 0 17,199 Democratic Republic of Congo 148,830,600 46,800 1,344,000 39,000 4,210,965 Congo Rep 7,018,400 300 800,000 0 0 Cote d'Ivoire 37,371,000 16,456 700,000 0 2,455,000 Djibouti 519,680 0 0 500 96,000 Egypt Arab Rep 2,185,920 45,000 5,000,000 338,000 4,746,366 Eritrea 100,000 100 0 0 21,600 Ethiopia 173,877,714 1,471,188 16,429,200 257,200 8,545,593 Gambia 1,000 5,000 1,000 0 24,000 Ghana 7,605,000 196,460 2,172,000 0 120,000 Guinea 4,428,640 7,000 713,000 2,600 1,650,800 Guinea-Bissau 730,000 10,000 14,000 22,000 4,641 Haiti 69,799,680 6,000 1,607,200 1,000 346,560 Honduras 9,772,992 0 691,900 19,400 1,810,800 India 0 0 134,494 2,973,600 5,750,000 Indonesia 250,000 0 0 588,850 0 Iraq 0 0 0 0 3,252,000 Kenya 151,368,000 176,556 9,631,025 25,000 4,503,281 Korea Dem Rep 2,592,000 0 51,000 30,000 351,999 Kyrgyz Republic 26,602,800 0 5,600 255,000 482,880 Lao PDR 2,865,600 1,600 605,000 13,000 2,676,480 Lesotho 1,749,200 0 110,000 0 0 Liberia 6,286,945 18,000 0 0 4,860 Madagascar 3,151,400 174,336 2,896,200 0 2,881,680 Malawi 19,956,960 182,744 4,922,400 6,000 125,791 Mali 6,433,920 55,000 168,800 18,000 2,314,375 APPENDIX A AP PE ND IC ES 22 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2018. APPENDIX A EXHIBIT A.2: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2012 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 20,000 0 13,400 0 0 Mongolia 6,073,000 5,120 120,000 0 652,797 Mozambique 98,478,960 30,000 2,490,000 0 6,419,170 Myanmar 9,785,112 0 1,501,600 18,000 6,864,858 Nepal 66,400,720 88,000 237,600 104,600 0 Nicaragua 4,229,280 0 450,400 11,896 822,055 Niger 24,400 3,108 200,600 10,000 740,850 Nigeria 199,399,440 328,212 14,321,300 872,634 3,025,137 Pakistan 252,501,000 70,768 857,600 90,700 226,701 Papua New Guinea 600,000 26,500 800,000 600 6,335 Philippines 2,001,600 1,536 200,000 447,514 14,565,234 Rwanda 15,724,568 20,060 776,400 0 105,000 Sao Tome and Principe 1,682,600 6,100 15,000 5,000 125,400 Senegal 14,407,000 77,056 1,478,400 14,000 1,002 Sierra Leone 1,122,000 0 250,000 15,990 739,073 Solomon Islands 0 0 0 0 0 Somalia 0 2,000 0 0 20,000 South Sudan 2,400,000 5,004 0 0 0 Sri Lanka 0 74,800 250,000 1,800 2,167,010 Sudan 3,335,968 25,040 0 9,000 3,968,200 Tajikistan 1,800,600 0 41,500 140,000 432,480 Tanzania 52,549,408 351,500 4,155,900 47,000 2,105,540 Timor-Leste 2,592,000 5,450 0 2,000 128,571 Togo 43,054,408 26,000 322,400 0 27,000 Uganda 89,421,536 396,829 6,249,200 76,896 114,400 Uzbekistan 3,635,000 0 445,000 800,000 1,121,280 Vietnam 52,546,800 23,976 900,000 800,000 138,999 West Bank and Gaza 0 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 3,801,888 24,000 180,000 95,000 3,443,504 Zambia 39,274,440 38,300 2,010,800 0 1,655,200 Zimbabwe 99,270,000 113,600 634,200 6,050 14,254,948 Other FP2020 Shipment Volumes 15,667,176 721,200 12,500 84,400 68,013,625 Total Volumes 1,860,819,691 5,753,275 109,078,819 9,086,380 330,356,509 AP PE ND IC ES 23 EXHIBIT A.3: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2013 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 23,181,800 0 1,550,000 0 17,001 Bangladesh 10,111,950 0 14,200,000 0 76,298,840 Benin 6,790,800 44,200 32,400 32,000 180,000 Bhutan 295,200 0 0 2,000 126,420 Bolivia 3,457,460 34,500 500,000 70,000 429,840 Burkina Faso 1,411,200 257,196 215,650 28,000 565,200 Burundi 640,833 0 1,000,000 0 574,080 Cambodia 2,160,000 51,399 0 2,000 4,320,008 Cameroon 0 30,300 12,800 57,659 1,494,720 Central African Republic 10,449,800 6,000 183,000 1,500 1,003,797 Chad 1,337,200 44,100 628,400 13,000 2,701,920 Comoros 1,252,800 1,600 93,300 500 48,720 Congo Dem Rep 81,658,344 187,168 1,219,300 118,000 2,384,472 Congo Rep 20,000 800 273,500 500 2,457,988 Cote d'Ivoire 18,607,800 14,000 240,000 2,500 4,584,370 Djibouti 2,288,000 0 7,600 500 8,640 Egypt Arab Rep 100,800 10,801 1,000,164 2,340,100 0 Eritrea 100,000 600 0 0 50,400 Ethiopia 75,766,296 981,740 6,159,396 160,000 15,082,178 Gambia 1,001,800 5,000 110,000 0 253,160 Ghana 34,302,000 144,348 1,025,500 10,000 451,280 Guinea 9,150,400 13,000 0 4,000 0 Guinea-Bissau 1,759,600 21,400 20,600 5,500 42,840 Haiti 51,940,800 1,700 1,646,400 2,000 223,920 Honduras 11,505,600 5,056 670,000 0 1,879,920 India 0 0 18,260 650,800 17,671,399 Indonesia 0 113,500 0 727,409 0 Iraq 0 0 0 0 3,000,000 Kenya 945,600 635,043 12,635,755 1,250 6,269,302 Korea Dem Rep 2,462,400 0 0 15,000 96,000 Kyrgyz Republic 5,299,200 0 15,000 0 570,300 Lao PDR 655,200 0 279,200 5,000 178,962 Lesotho 37,442,000 100 120,000 15,000 238,800 Liberia 17,500,000 15,200 244,800 0 400,320 Madagascar 4,547,768 239,980 5,733,542 0 2,376,836 Malawi 74,791,080 193,048 1,742,327 15,610 1,590,523 Mali 20,041,008 87,700 1,197,198 0 0 APPENDIX A AP PE ND IC ES 24 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2018. APPENDIX A EXHIBIT A.3: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2013 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 12,548,900 5,120 156,700 0 726,480 Mongolia 4,633,152 17,744 80,000 35,000 435,482 Mozambique 30,528,579 127,000 3,072,000 16,000 8,425,200 Myanmar 5,459,032 0 821,000 23,000 10,240,559 Nepal 6,370,788 10,000 655,200 30,000 0 Nicaragua 4,003,200 300 339,000 7,500 1,094,813 Niger 3,394,000 90,016 503,400 0 3,183,760 Nigeria 88,696,740 344,663 2,142,300 0 2,303,072 Pakistan 315,871,100 45,492 9,151,200 200,400 0 Papua New Guinea 19,924,800 38,790 0 4,000 1,313,583 Philippines 0 85,056 1,485,000 0 9,331,385 Rwanda 14,132,000 27,000 928,000 0 1,477,200 Sao Tome and Principe 5,000 500 0 0 6,000 Senegal 10,385,200 0 1,159,000 26,000 0 Sierra Leone 11,122,800 36,600 733,000 18,000 1,652,870 Solomon Islands 0 0 0 500 0 Somalia 0 1,000 0 0 148,700 South Sudan 8,601,000 10,940 0 500 775,200 Sri Lanka 0 93,000 233,500 110,000 2,068,050 Sudan 2,389,600 30,572 0 0 2,456,292 Tajikistan 7,096,200 0 0 105,000 0 Tanzania 29,769,000 309,621 0 55,000 2,009,270 Timor-Leste 57,600 2,100 0 0 225,863 Togo 11,465,520 68,000 606,500 0 108,960 Uganda 185,409,800 471,635 12,243,775 143,000 142,000 Uzbekistan 9,553,400 0 300,000 800,000 1,367,760 Vietnam 31,968,000 56,136 870,000 1,700,000 71,665 West Bank and Gaza 3,998,304 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 6,082,704 56,192 1,126,284 471,459 17,423,472 Zambia 86,409,000 75,000 1,656,900 0 2,669,480 Zimbabwe 111,075,000 244,180 2,460,400 3,500 24,101,441 Other FP2020 Shipment Volumes 54,175,200 678,000 251,400 84,430 46,980,070 Total Volumes 1,588,100,358 6,064,136 93,748,651 8,113,117 288,310,783 AP PE ND IC ES 25 EXHIBIT A.4: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2014 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 17,329,040 3,000 109,600 5,500 424,560 Bangladesh 0 0 15,500,000 400,000 88,795,560 Benin 3,993,400 61,300 462,400 50,500 1,011,681 Bhutan 1,440,000 0 0 0 156,150 Bolivia 877,250 27,500 0 0 0 Burkina Faso 12,588,200 298,500 1,476,400 12,900 2,346,480 Burundi 0 207,900 1,500,200 6,860 470,200 Cambodia 2,995,200 30,588 520,000 55,000 4,417,848 Cameroon 10,545,460 69,400 0 2,000 639,339 Central African Republic 200,000 3,500 142,300 0 155,024 Chad 3,738,240 41,100 644,800 0 0 Comoros 0 500 0 0 59,997 Democratic Republic of Congo 163,406,800 50,212 267,600 14,000 964,695 Congo Rep 9,243,540 2,108 21,400 105,000 468,597 Cote d'Ivoire 21,745,600 75,700 1,698,200 15,500 4,770,310 Djibouti 0 0 3,800 0 15,000 Egypt Arab Rep 468,000 140,032 365,000 591,111 0 Eritrea 0 500 20,000 0 108,000 Ethiopia 44,350,736 495,112 12,226,888 430,500 5,894,456 Gambia 1,440,000 9,048 160,000 0 67,860 Ghana 45,105,600 120,696 6,003,800 20,250 2,630,160 Guinea 8,955,000 20,800 45,800 0 194,400 Guinea-Bissau 2,426,400 31,000 25,000 0 8,280 Haiti 57,184,080 0 1,199,200 4,000 0 Honduras 18,254,736 40,000 119,400 21,500 2,860,830 India 0 0 10,094 2,039,273 13,244,150 Indonesia 12,000 0 0 768,575 0 Iraq 5,078,880 0 0 5,039 1,513,029 Kenya 36,198,800 481,336 2,681,620 0 3,617,640 Korea Dem Rep 0 0 0 0 96,000 Kyrgyz Republic 0 0 40,000 0 0 Lao PDR 2,793,456 3,024 382,000 0 1,141,200 Lesotho 44,934,736 600 1,000 0 26,640 Liberia 9,574,000 0 457,000 0 352,080 Madagascar 27,001,200 77,440 8,058,500 0 1,057,362 Malawi 55,827,800 104,324 6,531,650 0 630,006 Mali 32,271,400 100,600 1,190,600 21,000 2,673,306 APPENDIX A AP PE ND IC ES 26 EXHIBIT A.4: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2014 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 43,000 1,200 35,000 0 83,520 Mongolia 882,720 0 0 25,000 158,420 Mozambique 44,553,600 22,000 6,868,050 0 129,600 Myanmar 14,708,640 5,000 6,087,300 20,000 13,108,816 Nepal 13,462,400 44,700 3,795,800 35,149 2,558,000 Nicaragua 0 0 95,150 0 0 Niger 504,000 171,024 762,200 3,500 1,918,800 Nigeria 68,370,144 323,168 7,747,600 141,100 920,802 Pakistan 253,485,000 34,080 10,367,600 2,163,550 0 Papua New Guinea 11,238,800 42,000 1,322,400 10,000 1,125,519 Philippines 0 149,023 2,000 0 18,456,458 Rwanda 5,403,000 32,816 1,727,200 0 60,480 Sao Tome and Principe 7,160 0 0 0 39,600 Senegal 30,213,112 33,600 1,149,600 42,000 691,000 Sierra Leone 6,756,880 0 414,600 0 549,360 Solomon Islands 7,000 0 0 0 34,560 Somalia 28,800 28,000 60,000 8,500 68,880 South Sudan 5,205,600 15,000 0 0 24,999 Sri Lanka 0 63,000 406,800 0 6,619,680 Sudan 2,628,000 29,440 6,600 0 1,589,396 Tajikistan 7,438,096 0 43,600 40,000 193,440 Tanzania 31,370,600 458,644 1,492,400 75,000 2,421,591 Timor-Leste 0 10,500 181,400 0 205,359 Togo 7,278,801 48,200 63,000 0 69,104 Uganda 134,701,296 479,202 6,172,050 0 533,130 Uzbekistan 4,809,600 0 0 1,457,500 0 Vietnam 0 43,322 0 0 0 West Bank and Gaza 0 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 2,367,360 25,088 306,500 48,000 2,338,860 Zambia 54,777,800 136,600 2,532,100 3,500 1,576,800 Zimbabwe 129,833,000 149,100 0 3,000 14,795,070 Other FP2020 Shipment Volumes 47,544,044 1,405,100 390,400 171,201 61,284,336 Total Volumes 1,517,598,007 6,245,627 113,893,602 8,815,508 272,366,420 APPENDIX A Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2018. AP PE ND IC ES 27 EXHIBIT A.5: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2015 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 4,728,000 4,500 0 30,000 300,000 Bangladesh 0 50,000 15,100,000 0 24,000,000 Benin 12,169,800 222,536 125,500 66,500 525,600 Bhutan 1,936,800 0 111,000 0 129,999 Bolivia 0 3,500 0 0 0 Burkina Faso 19,747,510 244,044 564,000 35,500 3,559,057 Burundi 5,760,000 134,500 1,639,267 0 594,600 Cambodia 5,730,480 11,000 200,000 30,000 9,551,557 Cameroon 26,245,443 125,052 10,000 46,550 48,465 Central African Republic 0 500 37,900 0 23,841 Chad 100,000 7,600 0 0 0 Comoros 1,303,200 1,008 78,400 0 35,001 Democratic Republic of Congo 65,606,368 308,230 1,189,200 0 3,124,218 Congo Rep 7,104,840 11,000 622,360 0 0 Cote d'Ivoire 100,000 15,664 212,000 0 5,224,561 Djibouti 0 500 296,667 0 93,327 Egypt Arab Rep 0 0 0 258,200 0 Eritrea 0 0 120,000 0 108,000 Ethiopia 31,052,091 1,180,607 2,000,000 650,000 8,478,983 Gambia 2,900 30,048 265,000 0 156,240 Ghana 13,995,000 403,236 1,394,600 0 1,993,464 Guinea 10,080,000 32,500 907,448 0 484,880 Guinea-Bissau 3,384,720 59,400 27,500 0 78,000 Haiti 60,014,400 9,300 421,400 0 228,571 Honduras 10,000,800 93,656 1,725,800 62,000 2,446,065 India 0 0 795,252 1,273,927 325,000 Indonesia 20,000 25,086 0 171,000 0 Iraq 0 0 0 0 0 Kenya 45,779,200 905,900 2,231,000 70,000 3,142,535 Korea Dem Rep 0 0 0 0 0 Kyrgyz Republic 1,527,264 0 80,000 0 0 Lao PDR 10,875,960 20,000 333,000 0 1,530,720 Lesotho 21,016,000 1,500 81,800 0 124,369 Liberia 9,009,780 44,600 846,800 0 459,270 Madagascar 1,500,000 72,722 9,349,250 35,996 595,605 Malawi 68,274,192 278,786 6,099,200 0 552,795 Mali 39,764,195 195,805 432,840 18,393 948,953 APPENDIX A AP PE ND IC ES 28 EXHIBIT A.5: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2015 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 0 86,264 41,200 0 140,640 Mongolia 5,752,800 0 90,000 0 242,382 Mozambique 41,712,000 95,000 3,025,500 0 0 Myanmar 42,282,008 108,156 7,231,700 900 1,134,860 Nepal 8,304,000 127,500 1,067,000 0 2,304,779 Nicaragua 0 2,000 65,050 3,000 188,640 Niger 0 12,700 820,800 10,425 2,495,670 Nigeria 97,478,368 379,591 8,132,250 75,000 2,725,901 Pakistan 290,853,000 210,484 0 3,024,116 0 Papua New Guinea 3,480 100,800 1,327,200 0 16,399 Philippines 0 731,244 0 82,336 4,135,001 Rwanda 18,626,900 28,752 727,667 5,768 334,166 Sao Tome and Principe 0 0 9,400 0 66,329 Senegal 18,858,530 65,384 760,000 0 1,471,680 Sierra Leone 7,926,120 68,500 726,800 0 1,214,340 Solomon Islands 0 0 15,000 0 0 Somalia 151,200 52,016 158,900 0 262,080 South Sudan 9,036,000 53,100 89,350 0 147,902 Sri Lanka 0 56,000 574,000 130,000 1,589,760 Sudan 3,000 30,568 474,200 0 3,851,868 Tajikistan 24,812,640 3,500 90,000 0 270,000 Tanzania 846,800 1,241,695 9,935,400 194,124 150,195 Timor-Leste 0 12,000 240,000 2,000 79,902 Togo 4,810,000 59,672 495,400 0 261,468 Uganda 35,316,096 258,060 8,235,050 48,300 258,123 Uzbekistan 0 0 701,600 2,408,900 1,989,949 Vietnam 0 0 0 1,005,000 0 West Bank and Gaza 0 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 5,256,000 25,536 14,300 75,000 8,386,917 Zambia 66,167,400 245,900 3,399,400 13,000 3,770,375 Zimbabwe 141,429,280 98,500 889,100 1,900 9,400,083 Other FP2020 Shipment Volumes 85,564,584 1,564,900 352,600 113,550 62,288,739 Total Volumes 1,382,019,149 10,210,602 96,986,050 9,941,385 178,041,824 APPENDIX A Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2018. AP PE ND IC ES 29 EXHIBIT A.6: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2016 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 1,010,880 14,200 19,000 20,000 211,440 Bangladesh 0 150,000 8,200,000 0 0 Benin 3,708,000 277,028 70,000 27,000 5,040 Bhutan 0 0 237,000 0 0 Bolivia 50,400 67,800 3,000 0 5,760 Burkina Faso 12,911,000 427,800 1,123,500 0 1,600,971 Burundi 14,555,999 1,600 0 0 70,240 Cambodia 5,719,248 58,960 1,000,000 30,000 10,539,359 Cameroon 18,205,048 82,488 482,975 0 500,000 Central African Republic 3,628,800 6,200 147,600 500 262,296 Chad 0 41,024 15,600 0 0 Comoros 1,442,448 1,972 113,000 0 77,040 Democratic Republic of Congo 12,403,997 688,089 0 10,000 1,026,756 Congo Rep 3,600,000 1,008 6,720 29,650 2,880 Cote d'Ivoire 16,569,000 97,256 3,023,395 10,000 997,500 Djibouti 0 0 663,000 0 44,280 Egypt Arab Rep 0 140,000 0 2,680,434 0 Eritrea 0 0 100,000 0 126,640 Ethiopia 46,914,000 1,022,105 7,570,056 751,144 6,625,921 Gambia 2,880,000 20,016 313,000 0 565,200 Ghana 32,898,960 141,432 3,889,100 15,410 2,751,660 Guinea 12,488,000 77,000 90,000 0 512,644 Guinea-Bissau 0 50,000 13,000 0 10,080 Haiti 51,351,000 5,300 0 1,500 30,240 Honduras 26,094,600 0 1,977,000 0 1,385,280 India 5,000 0 23,984 865,062 6,137,520 Indonesia 5,000 350,000 0 120,074 0 Iraq 0 1,000 0 0 0 Kenya 54,090,024 742,864 95,000 37,500 3,403,080 Korea Dem Rep 0 0 905,200 0 0 Kyrgyz Republic 2,440,080 0 0 0 0 Lao PDR 0 53,200 850,600 0 1,405,440 Lesotho 11,262,000 23,452 260,400 0 218,160 Liberia 12,461,280 44,600 0 0 251,040 Madagascar 4,500,000 303,932 1,440,600 0 849,600 Malawi 12,520,000 33,700 2,475,200 0 0 Mali 12,604,704 27,072 25,000 17,300 20,160 APPENDIX A AP PE ND IC ES 30 APPENDIX A AP PE ND IC ES EXHIBIT A.6: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2016 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 3,110,400 2,500 39,000 0 164,160 Mongolia 6,796,800 3,100 30,000 0 405,108 Mozambique 59,034,000 0 90,000 13,000 205,920 Myanmar 16,169,472 147,348 1,800 0 7,560,366 Nepal 32,161,800 98,400 25,400 31,950 228,066 Nicaragua 1,500,000 4,008 0 15,000 0 Niger 0 50,400 1,317,700 0 3,141,960 Nigeria 149,734,200 771,763 1,278,600 90,030 3,320,703 Pakistan 109,244,976 800 0 1,872,716 15,120 Papua New Guinea 1,994,400 103,000 22,600 0 11,520 Philippines 0 0 0 1,070,737 0 Rwanda 17,757,000 65,294 1,734,900 0 2,439,900 Sao Tome and Principe 0 0 0 0 63,360 Senegal 5,094,000 179,864 10,000 32,675 860,949 Sierra Leone 1,080,000 73,000 280,200 5,500 955,860 Solomon Islands 0 0 0 0 0 Somalia 0 0 1,950 0 19,000 South Sudan 9,681,120 30,000 150,000 0 172,080 Sri Lanka 0 50,500 650,000 100,000 6,049,600 Sudan 7,216,992 49,104 29,800 3,500 338,345 Tajikistan 17,392,200 0 93,000 25,000 415,440 Tanzania 428,800 986,112 4,741,200 486,000 5,621,360 Timor-Leste 0 10,500 0 0 0 Togo 14,036,128 46,656 315,800 0 27,360 Uganda 19,200,000 234,524 1,184,250 45,200 5,740,520 Uzbekistan 6,228,720 0 848,400 432,800 0 Vietnam 0 0 0 1,096,080 0 West Bank and Gaza 0 0 800 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 6,302,880 0 157,000 75,000 1,141,120 Zambia 32,762,600 142,000 443,000 0 0 Zimbabwe 106,975,000 140,656 661,800 1,800 19,521,550 Other FP2020 Shipment Volumes 20,389,000 1,016,700 392,800 198,850 21,702,220 Total Volumes 1,020,609,956 9,157,327 49,632,930 10,211,412 119,757,814 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2018. 31 EXHIBIT A.7: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2017 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 16,665,408 9,800 59,600 0 409,840 Bangladesh 1,195,200 400,000 6,258,000 0 0 Benin 14,507,399 34,900 30,600 0 0 Bhutan 0 0 0 0 0 Bolivia 2,001,600 94,600 50,400 0 30,000 Burkina Faso 15,050,016 95,300 481,200 0 3,741,150 Burundi 22,039,200 0 17,500 0 191,580 Cambodia 1,929,600 40,056 900,000 60,000 7,148,476 Cameroon 6,658,400 95,200 327,000 0 346,560 Central African Republic 268,999 0 0 0 95,040 Chad 0 0 0 0 0 Comoros 1,267,200 2,520 40,000 0 60,480 Congo Dem Rep 15,913,800 364,828 2,143,580 0 1,689,820 Congo Rep 2,160,000 76,076 32,000 0 720 Cote d'Ivoire 23,494,968 196,600 243,000 0 6,521,413 Djibouti 0 0 0 0 6,480 Egypt Arab Rep 0 40,032 0 375,045 0 Eritrea 8,640,000 12,500 100,000 0 112,560 Ethiopia 72,453,000 1,107,134 7,436,988 440,000 10,794,948 Gambia 5,371,200 16,488 110,000 1,500 269,040 Ghana 0 250,256 106,000 11,500 3,188,280 Guinea 9,518,136 100,000 0 0 30,240 Guinea-Bissau 8,412,624 27,300 2,500 0 2,160 Haiti 84,455,880 4,116 863,400 0 738,504 Honduras 34,884,000 1,440 21,000 0 1,641,840 India 0 0 1,047,488 1,060,550 2,262,311 Indonesia 0 0 0 0 0 Iraq 316,944 0 0 0 40,032 Kenya 373,000 408,781 437,376 126,000 7,921,836 Korea Dem Rep 0 0 0 0 0 Kyrgyz Republic 7,264,800 0 0 0 0 Lao PDR 3,474,840 65,808 76,800 0 719,760 Lesotho 13,713,000 31,200 165,000 0 176,400 Liberia 6,009,000 36,100 319,000 0 5,760 Madagascar 0 250,642 3,012,800 295,019 1,382,880 Malawi 24,783,000 167,408 1,000,000 36,500 236,700 Mali 20,115,816 209,728 293,000 0 217,920 APPENDIX A AP PE ND IC ES 32 APPENDIX A AP PE ND IC ES EXHIBIT A.7: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2017 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 0 10,404 88,600 0 295,920 Mongolia 8,488,800 800 0 37,000 350,160 Mozambique 110,406,000 60,016 1,373,600 23,600 4,351,920 Myanmar 35,536,744 18,936 6,108,125 200 14,780,928 Nepal 20,769,000 211,800 641,000 74,000 4,015,160 Nicaragua 2,911,680 504 0 0 50,000 Niger 979,200 54,100 499,000 7,920 437,040 Nigeria 44,137,048 665,160 3,316,700 0 1,229,445 Pakistan 20,000 900 0 50,090 123,840 Papua New Guinea 1,101,600 30,000 22,000 4,000 87,040 Philippines 0 0 0 0 0 Rwanda 20,606,200 84,062 8,200 13,200 68,400 Sao Tome and Principe 1,108,800 300 28,000 0 112,500 Senegal 7,005,000 67,864 160,000 0 221,700 Sierra Leone 19,728,000 230,400 332,650 16,000 1,180,840 Solomon Islands 0 0 0 0 0 Somalia 0 2,500 3,500 0 0 South Sudan 11,340,000 25,016 150,000 0 20,000 Sri Lanka 4,056,624 65,500 0 0 3,589,760 Sudan 0 36,936 0 6,000 2,143,560 Tajikistan 5,188,200 0 142,000 0 736,320 Tanzania 4,320,184 798,920 2,830,850 177,000 2,885,763 Timor-Leste 1,080,000 20,000 0 0 0 Togo 14,946,200 67,388 140,000 0 25,002 Uganda 78,884,400 297,652 3,895,400 251,000 389,200 Uzbekistan 13,217,540 0 0 0 718,989 Vietnam 21,816,000 12,636 1,196,500 1,239,531 0 West Bank and Gaza 1,944,000 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 7,104,960 64,288 445,000 0 0 Zambia 86,619,960 161,800 3,418,650 0 4,564,800 Zimbabwe 96,837,000 60,496 1,399,200 10,000 12,716,941 Other FP2020 Shipment Volumes 9,942,000 1,058,100 5,912,600 230,950 23,403,645 Total Volumes 1,053,032,172 8,245,291 57,685,807 4,546,605 128,481,603 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2018. 33 Prior to the development of market analyses, CHAI reviewed various data sources from partner organizations that provide family planning market data at the global level. CHAI assessed these databases based on available metrics, coverage of countries, frequency of updates, and ease of access to identify the most appropriate sources for sustainable analyses, with the ability to be updated as new data became available. The following provides an overview of the data sources CHAI relied upon for market analyses: FP2020 Global Markets Visibility Project FP2020 Global Markets Visibility Project: In early 2014, CHAI, in part- nership with RHSC and the FP2020 Market Dynamics Working Group, launched the Global Markets Visibility Project to help various donors, suppliers, and partners improve their understanding of the current market size and trends for key contraceptive markets. CHAI signed MOUs with six contraceptive manufacturers and received historical shipment data by product and country for each of the 69 FP2020 focus countries. CHAI has partnered with Concept Foundation to collect and aggregate shipment data from participating members of the RHSC Generic Manufacturers for Reproductive Health Caucus (GEMs). To date, the Global Markets Visibility Project has collected historical shipment data that covers institutional sales (USAID, UNFPA, SMOs, etc.) and MOH tender volumes from 14 manufacturers across five family planning product categories. The main analyses and data reflected in this report in the Supplier Shipment Analysis and associated Appendices are based on the supplier shipment data collected through this project. U.S. Agency for International Development (USAID) Overview of Contraceptive and Condom Shipments Report: USAID has provided commodities for family planning and reproductive health ac- tivities since the mid-1960s. The Overview of Contraceptive and Condom Shipments report is an annual publication that summarizes contra- ceptive and condom shipments sponsored by USAID, by value and unit. For the purposes of this year’s Family Planning Market Report’s Donor Spend Analysis, the FY2011 through FY2017 reports for FP2020 countries were accessed and used to analyze USAID’s spend on contraceptives, excluding male and female condoms, over the period. Values are in- clusive of commodity and freight costs and are reported based on the USAID fiscal year which ends on September 30. APPENDIX B — DATA SOURCES 35. RHI, available at https://www.unfpaprocurement.org/rhi-home The United Nations Population Fund (UNFPA) Procurement Services Branch (PSB) Procurement Data: UNFPA is the lead agency within the United Nations system for the procurement of reproductive health commodities and has been procuring reproduc- tive health supplies for the developing world for over 40 years. For the purposes of this year’s Family Planning Report’s Donor Spend Analysis, CHAI worked with UNFPA PSB to determine the value of the contracep- tive procurement conducted by UNFPA from 2011 to 2017 for FP2020 countries. Values are inclusive of commodity cost and exclude services such as freight, sampling, inspection, and testing and are reported based on the calendar year. Reproductive Health Interchange (RHI)35 Hosted by UNFPA, RHI collects data on past and upcoming contracep- tive volume shipments for over 140 countries from the central pro- curement offices of major contraceptive donors and procurers. This database is updated at variable times that depend on the frequency of data submissions from the data provider. The database aims to capture all of UNFPA’s and USAID’s contraceptive purchases, MSI’s and IPPF’s central procurements, and a few other procuring organizations’ purchases. For this report, the full RHI data was downloaded in Sep- tember 2018 and supplemented with data from USAID/ PSM systems to include the USAID-funded shipments not currently captured in RHI due to data integration issues. RHI is primarily used as a comparison for our data set for a high-level understanding of the supplier shipment data coverage. AP PE ND IC ES 34 The value of the FP2020 public sector market was constructed using the best available data sources: historical supplier-reported shipment data and RHI shipment data. Participating Suppliers’ Representation of the RHI Market Within the RHI shipment data, the suppliers participating in the Global Markets Visibility Project held 97 percent of the cumulative shipment volumes from 2011 to 2017 in every category with the exception of IUDs and emergency oral contraceptives, where suppliers held 51 percent and 58 percent of the volumes, respectively. (Exhibit C.1.) APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE AP PE ND IC ES EXHIBIT C.1: GLOBAL MARKETS VISIBILITY PROJECT PARTICIPATING SUPPLIER VOLUMES WITHIN RHI BY METHOD FOR THE FP2020 PUBLIC SECTOR MARKET METHOD PARTICIPATING SUPPLIER VOLUMES IN RHI 2011 – 2017 ALL SUPPLIER VOLUMES IN RHI 2011 – 2017 % OF TOTAL METHOD VOLUMES Condoms - Female 149 M 151 M 99% Implants 38 M 39 M 99% Injectables 398 M 410 M 97% IUDs 14 M 28 M 51% Orals - Combined & Progestin Only 702 M 714 M 98% Orals - Emergency 10 M 17 M 58% Total 1.31 B 1.36 B 97% EXHIBIT C.2: UNIT OF MEASUREMENT METHOD UNIT OF MEASURE Condoms - Female Piece Condoms - Male Piece Implants Set Injectables Vial IUDs Piece Orals - Combined Cycle Orals - Progestin Only Cycle Orals - Emergency Doses Sources: [1] RHI Shipment Data, September 2018 The historical supplier-reported shipment data captured a more comprehensive view of the FP2020 public sector market for female condoms, implants, injectables, IUDs, and orals relative to RHI, and thus served as the primary data source for these product markets. Because CHAI has not yet received male condom data from any suppliers, RHI data was relied upon for the male condom volumes. The data is quanti- fied by the units of measurement outlined in Exhibit C.2. 35 EXHIBIT C.3: GLOBAL MARKETS VISIBILITY PROJECT PARTICIPANTS AND PRODUCTS MANUFACTURER CONDOMS - FEMALE IMPLANTS INJECTABLES IUDS ORALS Bayer • • • Cipla • CR Zizhu • Cupid • Female Health Company • Helm AG • • Mylan • • • Merck (MSD) • • Pfizer • Pregna • PT Tunggal • • Shanghai Dahua • SMB • Techno Drugs • • The following section describes the data source and market size esti- mation in more detail. Historical Supplier-Reported Data To date, the Global Markets Visibility Project has collected historical supplier-reported shipment data from 14 manufacturers – Bayer, Cipla, CR Zizhu, Cupid, Female Health Company, Helm AG, Mylan, Merck (MSD), Pfizer, Pregna, PT Tunggal, Shanghai Dahua, SMB, and Techno Drugs. Collectively, the total volumes cover institutional sales (USAID, UNF- PA, SMOs, etc.) and MOH tenders across five family planning product categories.36 AP PE ND IC ES Suppliers have cumulatively shipped 150.6 million female condoms, 48.8 million implants, 594.3 million injectables, 61.0 million IUDs, 1.6 billion orals (combined & progestin only), and 42.7 million emergency oral contraceptives from 2011 to 2017. It is important to note that there were several shipments to procurer (USAID, UNFPA, SMOs) warehouses in non-FP2020 countries, such as Belgium, Denmark, France, Germany, Netherlands, Norway, Sweden, Switzerland, UK, and USA. Although these volumes were shipped to non-FP2020 countries, the end shipment destination of these volumes would likely be the 69 FP2020 countries. As a result, these non-FP2020 country volumes were included in the total shipments to 69 FP2020 countries after it was confirmed that the specific non-FP2020 country volumes were associated with institutional purchases. 36. Total shipment of oral contraceptives includes combined, progestin-only, and emergency oral contraceptives. Source: [Exhibit C.4]: [1] Historical Supplier-Reported Shipment Data APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE EXHIBIT C.4: SUPPLIER-REPORTED SHIPMENT VOLUMES TO FP2020 COUNTRIES BY METHOD, 2011–2017 METHOD 2011 2012 2013 2014 2015 2016 2017 CUMULATIVE 2011-2017 Condoms – Female 20.0 M 18.9 M 17.4 M 25.1 M 25.3 M 22.0 M 22.1 M 150.6 M Implants 3.1 M 5.8 M 6.1 M 6.2 M 10.2 M 9.2 M 8.2 M 48.8 M Injectables 73.3 M 109.1 M 93.7 M 113.9 M 97.0 M 49.6 M 57.7 M 594.3 M IUDs 10.3 M 9.1 M 8.1 M 8.8 M 9.9 M 10.2 M 4.5 M 61.0 M Orals - Combined & Progestin Only 311.0 M 319.5 M 283.4 M 267.5 M 171.6 M 113.7 M 122.0 M 1.6 B Orals - Emergency 3.0 M 10.9 M 4.9 M 4.9 M 6.5 M 6.1 M 6.5 M 42.7 M 36 CHAI analyzed and assessed the aggregated historical supplier-re- ported shipment data to confirm the coverage across various FP2020 product markets was greater relative to RHI shipment data for the 69 FP2020 countries. The aim of collecting historical volumes of all institutional purchases and MOH tenders directly from suppliers was to address data gaps observed in RHI shipment data which only captures a subset of procurers who choose to submit historical procurement data. Further, although some countries report national procurements, most national procurements are not reported in the RHI database. The total historical supplier-reported shipment volumes to 69 FP2020 countries and procurer warehouses are consistently greater than RHI volumes across four family planning methods: implants, injectables, IUDs, and orals.37 Thus, for these product markets, the supplier-reported shipment data captures a more comprehensive view of the family plan- ning market in the 69 FP2020 countries. For female condoms, the RHI volumes are actually greater than supplier shipment data in 2013 and 2014. However, the difference was relatively small in 2014, and aggregate 2011-2017 volumes for female condoms are higher in supplier shipment data compared to RHI. AP PE ND IC ES 37. Similar to the historical supplier-reported shipment totals, RHI volumes to Belgium, Den- mark, Germany, France, Netherlands, Norway, Sweden, Switzerland, UK, and the USA are included in the total. For the UK, shipments to IPPF or MSI warehouses are included in total volumes. For Belgium, Denmark, Germany, France, Netherlands, Norway, Sweden, Switzerland, UK, and the USA, shipments funded or procured by USAID and UNFPA are included in total volumes. We assume the end shipments destination of these volumes are likely to the 69 FP2020 countries and thus, include the volumes in the total FP2020 market estimate. Source: [1] Historical Supplier Shipment Data; [2] RHI Shipment Data, September 2018. APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE EXHIBIT C.5: SUPPLIER-REPORTED SHIPMENT VOLUMES AS A PERCENTAGE OF RHI REPORTED* VOLUMES BY METHOD, 2011–2017 METHOD 2011 2012 2013 2014 2015 2016 2017 AVERAGE 2011-2017 Condoms – Female 100% 105% 63% 95% 113% 122% 122% 103% Implants 174% 142% 100% 122% 123% 145% 118% 132% Injectables 127% 159% 137% 145% 184% 130% 126% 144% IUDs 235% 168% 134% 222% 383% 296% 191% 233% Orals - Combined & Progestin Only 242% 254% 206% 239% 193% 170% 226% 219% Orals - Emergency 102% 187% 432% 270% 357% 433% 352% 305% * Includes all reporting RHI suppliers to FP2020 countries and procurer warehouses 37 Male Condom Market Because CHAI has not yet received data from male condom suppliers, historical RHI shipment data for male condoms was used to capture a more comprehensive view of the family planning market for the 69 FP2020 countries. We used RHI shipment volume data from 2011 to 2017 and included all male condom shipment volumes to the 69 FP2020 countries as well as volumes associated with procurer warehouses in non-FP2020 focus countries.38 The male condom market reflected by the RHI data includes 23 manufacturers and 17 funding sources. 38. Total yearly volumes are based on the year that the product was shipped. Source: [Exhibit C.6] RHI Shipment Data, September 2018. Source: [Exhibit C.7] Historical Supplier-Reported Shipment Data; RHI Shipment Data, September 2018. EXHIBIT C.6: RHI MALE CONDOM SHIPMENT VOLUMES, 2011–2017 METHOD 2011 2012 2013 2014 2015 2016 2017 Condoms - Male 1.62 B 1.84 B 1.57 B 1.49 B 1.36 B 1.00B 1.03B EXHIBIT C.7: 69 FP2020 CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2011–2017 METHOD 2011 2012 2013 2014 2015 2016 2017 Condoms – Female 20.0 M 18.9 M 17.4 M 25.1 M 25.3 M 22.0 M 22.1 M Condoms – Male (RHI) 1623.1 M 1842.0 M 1570.7 M 1492.5 M 1356.8 M 998.6 M 1030.9 M Implants 3.1 M 5.8 M 6.1 M 6.2 M 10.2 M 9.2 M 8.2 M Injectables 73.3 M 109.1 M 93.7 M 113.9 M 97.0 M 49.6 M 57.7 M IUDs 10.3 M 9.1 M 8.1 M 8.8 M 9.9 M 10.2 M 4.5 M Orals – Combined & Progestin Only 311.0 M 319.5 M 283.4 M 267.5 M 171.6 M 113.7 M 122.0 M Orals – Emergency 3.0 M 10.9 M 4.9 M 4.9 M 6.5 M 6.1 M 6.5 M AP PE ND IC ES APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE The historical supplier-reported volumes for female condoms, implants, injectables, IUDs, and orals, together with RHI shipment volumes for male condoms, represent the estimated FP2020 public sector market from 2011 to 2017. 38 APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE Source: [1] USAID, “Couple-Years of Protection (CYP),” May 2017. EXHIBIT C.8: VOLUMES TO CYPs SHIPPED CONVERSION FACTORS, 2011–2017 METHOD UNITS PER CYP Condoms - Female 120.00 Condoms - Male 120.00 Implants - 3 Year 0.40 Implants - 4 Year 0.31 Implants - 5 Year 0.26 Injectables - 1 month 13 Injectables - 2 month 6 Injectables - 3 month 4 IUDs 0.22 Orals – Combined 15.00 Orals – Progestin Only 15.00 Orals – Emergency 20.00 Total FP2020 Public Sector Market In Terms of CYPs CHAI translated shipment volumes to CYPs by dividing shipment volumes by each method’s corresponding couple-years of protection (CYP) factor. CHAI divided all shipment volumes by the corresponding CYP factor published by USAID. CYP is the estimated protection provided by con- traceptive methods during a one-year period based upon the volume of all methods sold or distributed for free to clients during that period of time.39 Because various methods may have different CYPs associated with different sub-types of that method (e.g. there are different CYP factors for three-, four-, and five-year implants), the corresponding CYP of the method sub-type is used. The following exhibit shows the conversion factors used to translate volumes to users. 39. USAID, “Couple-Years of Protection (CYP)”, April 2014, available at http://www.usaid.gov/ what-we-do/global-health/family-planning/couple-years-protection-cyp. AP PE ND IC ES 39 APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE Value of the Total FP2020 Public Sector Market The total value of contraceptives was calculated by applying average unit prices to total shipment volumes. Average unit prices by method and year are based on the average price between USAID and UNFPA as reported in UNFPA’s Contraceptive Price Indicator. Although there are different prices for different products and markets, we estimate implied spend using UNFPA’s Contraceptive Price Indicator prices for simplici- ty.40 Finally, the Implant Access Program price of $8.50 was applied to Sources: [1] UNFPA Contraceptive Price Indicator, 2011–2017; [2] IAP Implant Prices. Notes: [1] For 2013-2017 implants, the Implant Access Program price is used; [2] The price range and unit prices in each year are based on an average of USAID and UNFPA prices via UNFPA's Contraceptive Price Indicators 40. UNFPA, “UNFPA Contraceptive Price Indicator –Year 2017”, available at https://www. unfpa.org/sites/default/files/resource-pdf/CYP_Report_Public.pdf, "UNFPA Contraceptive Price Indicator - Year 2016" available at http://www.unfpa.org/resources/contraceptive-price-indica- tor-2016,” "UNFPA Contraceptive Price Indicator - Year 2015" available at https://www.unfpa. org/sites/default/files/resource-pdf/UNFPA_Contraceptive_Price_Indicators.pdf, “UNFPA Contraceptive Price Indicator –Year 2014,” available at http://www.unfpa.org/re- sources/contraceptive-price-indicator-2014, “UNFPA Contraceptive Price Indicators – 2013,” available at http://www.unfpa.org/sites/default/files/resource-pdf/UNFPA%20Contraceptive%20 Price%20Indicators%20-%202013.pdf, “UNFPA Contraceptive Price Indicators – 2012,”avail- able at http://www.unfpa.org/sites/default/files/resource-pdf/UNFPA%20Contraceptive%20 Price%20Indicators%20-%202012.pdf, “UNFPA Contracep tive Price Indicators – 2011 implant volumes from 2013 to 2017. The average price only includes the cost of the product and does not account for additional costs associat- ed with procurement such as testing, insurance, and shipping costs. To maintain consistency across dollar-value comparisons, this average pricing was applied to all market trends across supplier-reported and RHI reported volumes. As a result, numbers may differ from the RHI reported value field. EXHIBIT C.9: AVERAGE UNIT PRICE PRICE RANGE 2011 2012 2013 2014 201541 201642 201743 Method Minimum Maximum Unit Price Unit Price Unit Price Unit Price Unit Price Unit Price Unit Price Condoms - Female $0.46 $0.56 $0.56 $0.55 $0.54 $0.53 $0.52 $0.49 $0.46 Condoms - Male $0.02 $0.03 $0.03 $0.03 $0.03 $0.03 $0.03 $0.03 $0.02 Implants $8.50 $18.65 $18.65 $17.98 $8.50 $8.50 $8.50 $8.50 $8.50 Injectables $0.79 $0.83 $0.82 $0.82 $0.83 $0.81 $0.81 $0.82 $0.79 IUDs $0.43 $0.48 $0.43 $0.43 $0.43 $0.48 $0.47 $0.46 $0.47 Orals - Combined $0.26 $0.31 $0.31 $0.30 $0.28 $0.30 $0.28 $0.26 $0.27 Orals - Progestin Only $0.31 $0.33 $0.32 $0.32 $0.31 $0.31 $0.32 $0.33 $0.32 Orals - Emergency $0.26 $0.49 $0.34 $0.49 $0.44 $0.30 $0.37 $0.35 $0.26 41. The 2015 unit pricing is an average of UNFPA 2015 prices and USAID 2014 prices as USAID 2015 prices were unavailable. 42. The 2016 unit pricing is UNFPA 2016 price only as USAID 2016 pricing is unavailable, with the exception of IUDs where the average of USAID 2014 price and UNFPA 2016 price was taken to avoid significant fluctuations. 43. The 2017 unit pricing is UNFPA 2017 price only as USAID 2017 pricing is unavailable, with the exception of IUDs where the average of USAID 2014 price and UNFPA 2017 price was taken to avoid significant fluctuations. AP PE ND IC ES 40 To protect customer confidentiality, suppliers were not asked to disclose customer information associated with shipment volumes. In previous reports, CHAI relied upon RHI to estimate the donor-funded volumes and in turn, CYPs and costs; however, for this report, CHAI has had the opportunity to work directly with USAID, GHSC-PSM, and UNFPA to improve visibility into the donor spend by the two major institutional procurers of family planning commodities. For more information on each of these data sources, refer to Appendix B. APPENDIX D – ESTIMATING TOTAL FP2020 DONOR-SPEND Going forward, CHAI will continue to work closely with the two major institutional procurers of family planning commodities to ensure the data provided is the most accurate and accessible for the purposes of this report. AP PE ND IC ES 41 APPENDIX E – ADDITIONAL MARKETS VISIBILITY CHAI historically conducted supplementary research and analysis using publicly available sources of data in three large markets: Bangladesh, India, and Indonesia44. In this report, the analysis is refreshed with the latest data for Bangladesh and India; government procurement tenders historically made available through the National Family Planning Coordinating Body (BKKBN) for Indonesia were not available for 2017 tenders. Due to the limitations of these data sources, CHAI cannot confirm that they represent comprehensive coverage of the public sector markets in these countries. Rather, the data is meant to be used as initial confir- mation of local and regional procurement in these markets that are not covered by the suppliers participating in this report. AP PE ND IC ES 44. Bangladesh, India, and Indonesia were countries that accounted for the largest proportion of the gap between FP2020-reported users on product-based methods and users implied by the shipment data based on country-specific comparisons 42 AP PE ND IC ES Bangladesh The Bangladesh Ministry of Health and Family Welfare (MOHFW) procured 3 million CYPs for the 2017 calendar year, as compared to 8 million CYPs for the 2016 calendar year. Procurement contracts for product-based contraceptives were awarded primarily to regional and local suppliers, including (but not limited to): HLL Lifecare Limited, MSD/Organon (India) Pvt Ltd.45, MSD B.V.46, M/S, Reneta Ltd., Popular Pharmaceuticals Ltd., and Techno Drugs from Bangladesh. Only the data from a subset of these manufacturers is included in the current calculation of the value derived from the supplier shipment data47. By applying the same prices (Exhibit C.9) used for 2017 supplier shipment volumes to the volumes from the Bangladesh MOHFW procurement data, we estimated the implied value from those contracts to be $8 mil- APPENDIX E – ADDITIONAL MARKETS VISIBILITY lion for 2017, as compared to the $8 million implied by the 2017 supplier shipment data48. In addition, a review of Bangladesh’s supply chain reports revealed that consumption of contraceptive commodities has been fairly consistent, between 12 to 14 million CYPs from 2011 to 2017, and that the lower 2017 procurement levels did correspond to a decrease in year-end stock levels and was not necessarily a result of lower consumption. CHAI used data from the Government of Bangladesh’s Ministry of Health and Family Welfare (MOHFW)49 for 2015, 2016, and 2017.50 EXHIBIT E.1: MOHFW SUPPLY CHAIN CONTRACEPTIVE SHIPMENT RECEIPT DETAILS PRODUCT NAME SUPPLIER NAME 2015 2016 2017 CONDOM ESSENTIAL DRUGS CO. LTD. 50,000,000 68,850,000 - CONDOM KHULNA ESSENTIAL LATEX PLANT((KELP) 100,000,000 35,000,000 - CONDOM UNFPA - - 1,195,200 ECP (2 TAB/PACK) M/S, RENETA LTD. 100,000 100,000 - IMPLANT (2 ROD) SOCIAL MARKETING COMPANY (SMC) - 17,000 35,000 IMPLANT (SINGLE ROD) JAMES INTERNATIONAL - 5 2,880 IMPLANT (SINGLE ROD) Merck Sharp & Dohme B.V(MSD B.V.). - 150,000 3,000 IMPLANT (SINGLE ROD) MSD-NV Organon, Organon(India) Private Ltd. 50,000 - 199,980 INJECTABLES (DMPA IM)51 Helm-AG 14,000,000 - - INJECTABLES (DMPA IM)51 TECHNO DRUGS Ltd 2,500,000 8,100,000 5,000,000 INJECTABLES (DMPA IM)51 UNFPA - - 299,997 INJECTABLES (DMPA IM)51 USAID - - 1,000,000 INJECTABLES (DMPA IM)51 Popular Pharmaceuticals Ltd. - - 1,000,000 IUD (CT-380A) SARBAN INTERNATIONAL LTD. 400,000 - - IUD (CT-380A) SOCIAL MARKETING COMPANY (SMC) 73,679 - - IUD (CT-380A) Marie Stopes Clinic - - 65,000 ORAL CONTRACEPTIVE PILL (SHUKHI) HLL Lifecare Limited 22,469,025 - - ORAL CONTRACEPTIVE PILL (SHUKHI) M/S, RENETA LTD. 20,730,975 54,750,000 - ORAL CONTRACEPTIVE PILL (SHUKHI) Maneesh Pharmaceuticals Limited 22,289,280 - - ORAL CONTRACEPTIVE PILL (SHUKHI) Popular Pharmaceuticals Ltd. 10,800,000 14,250,000 - ORAL CONTRACEPTIVE PILL (SHUKHI) TECHNO DRUGS Ltd 1,710,720 - - ORAL PILL APON M/S, RENETA LTD. 1,000,000 3,500,000 750,000 Source: Bangladesh MOHFW, Supply Chain Management Portal, 2018. 45. MSD/Organon (India) Pvt Ltd. is a Merck (MSD) company and therefore not a regional or local supplier. 46. MSD B.V. is a Merck (MSD) company and therefore not a regional or local supplier. 47. Manufacturers participating in this report include Merck (MSD) from the Netherlands, and Techno Drugs from Bangladesh 48. Despite the implied value being similar from the two data sources, the supplier shipment volumes indicate different method mix and volumes by method than the MOHFW procurement data; in other words, the supplier shipment volumes provide greater coverage in some methods and gaps in others when compared to the MOHFW procurement data. 49. Government of Bangladesh, Ministry of Health and Family Welfare, “MOHFW Supply Chain Management Portal – National Receive Details; Product Group: Contraceptive; Product Name: ALL; Warehouse; ALL” available at: https://scmpbd.org/index.php/wims-reports/national-re- ceive-details 50. The fiscal year for Bangladesh runs from July 1 to June 30, but for the purposes of this analysis, CHAI summed up the monthly data by calendar year for 2017. 51. The product name was changed from “Injectables (Depo-Provera)” to “Injectables (DMPA IM)” in this report to accurately reflect the generic name of the product. 43 APPENDIX E – ADDITIONAL MARKETS VISIBILITY India Based on India’s Ministry of Health and Family Welfare (MOHFW)52 An- nual Report for the 2016/2017 fiscal year53, which ends on March 31, CYPs from procured products-based methods54 totaled 35 million, compared to 41 million in the 2015/2016 fiscal year. These two additional years of data represent a decline from the 54 million CYPs in the 2010/2011 fiscal year and is primarily driven by a decline in IUDs, condoms55, and orals. However, the MOHFW report states that the consumption of IUDs has remained steady, and that focused efforts on spacing will likely increase uptake of IUDs in the future. Sterilizations remained steady at four million performed for both the 2015/2016 and 2016/2017 fiscal years. While the MOHFW annual report shipment volumes are based on the 2015/2016 and 2016/2017 fiscal years instead of the calendar year used in this report, by applying the same prices (Exhibit C.9) used for 2015, Source: India MOHFW Annual Report, 2015-2016, 2016-2017, 2017-2018. *Figures are Provisional 52. Government of India, Ministry of Health and Family Welfare, “Annual Report of Department of Health & Family Welfare for the year of 2016-17”, “Annual Report of Department of Health & Family Welfare for the year of 2015-16”, “Annual Report of Department of Health & Family Welfare for the year of 2014-15”, “Annual Report of Department of Health & Family Welfare for the year of 2013-14”available at: http://www.mohfw.nic.in/documents/publications 53. The fiscal year for India runs from April 1 to March 31, as such 2017/2018 figures were not included in this analysis as the reported data is not a full fiscal year. 54. Only modern contraceptive methods from India’s MOHFW reports including male condoms, IUDs, orals, and emergency oral contraception are included in this analysis. 55. Condoms are reported in millions whereas all other methods are reported as “lakh” – the Indian unit of 100,000 56. The latest reports from India referenced are from the 2015/2016 and 2016/2017 fiscal years and thus are compared to the corresponding supplier shipment data from 2015, 2016, and 2017. EXHIBIT E.2.1: QUANTITIES SUPPLIED TO STATES/UTS CONTRACEPTIVES 2013-14 2014-15 2015-16 2016-17 Condoms (In million pieces) 394 350.9 394.0 432.8 Oral Pills (In lakh cycles) 361.24 551.32 361.2 312.0 IUDs (In lakh pieces) 60.42 88.244 60.4 48.1 Tubal Rings (In lakh pairs) 19 27.145 19.0 6.4 ECP(in lakh packs) 75.8 75.8 75.8 60.8 Centchroman Contraceptive Pill (Lakh Strips) 7.1 Pregnancy Test Kits (in lakhs) 100.14 122.4 100.1 124.6 EXHIBIT E.2.2: PERFORMANCE OF SOCIAL MARKETING PROGRAMME IN THE SALE OF CONTRACEPTIVE CONTRACEPTIVES 2013-14 2014-15 2015-16 2016-17 Condoms (Million pieces) 698.33 683.93 482.2 399.0 Oral Pills (Social Marketing) (lakh cycles) 290.27 276.44 152.8 194.3 SAHELI (in Lakh tablets) 279.35 314.6 311.2 321.8 EXHIBIT E.2.3: EMERGENCY CONTRACEPTIVE PILLS [ECP] ITEM 2013-14 2014-15 2015-16 2016-17 ECP 75.80 75.80 86.1 - EXHIBIT E.2: ANNUAL REPORT OF DEPARTMENT OF HEALTH & FAMILY WELFARE FOR THE YEAR OF 2015-16 (INCLUDES FULL FISCAL YEARS 2013-14 TO 2014-15) 2016, and 2017 supplier shipment volumes, we estimate that implied value from the annual reports is approximately $57 million in 2015/2016 fiscal year and $45 million in the 2016/2017 fiscal year, as compared to the $1 million to $2 million implied by the 2015, 2016, and 2017 supplier shipment data56. While the MOHFW Annual Reports do not record who the awarded suppliers are, a report from USAID has identified local suppliers and the contraceptives they supply to the government and SMO programs as of 2006, including Indian Drug and Pharmaceutical Ltd. (IDPL), HLL Lifecare Limited, Phaarmasia, Pregna International, SMB Corporation, Cipla, Win-Medicare, and Famy Care, which is now Mylan. AP PE ND IC ES 44 APPENDIX E – ADDITIONAL MARKETS VISIBILITY EXHIBIT E.3 ANNUAL REPORT OF DEPARTMENT OF HEALTH & FAMILY WELFARE FOR THE YEAR OF 2013-14 (INCLUDES FULL FISCAL YEARS 2010-11 TO 2012-13) EXHIBIT E.3.1: QUANTITIES SUPPLIED TO STATES/UTS CONTRACEPTIVES 2010-11 2011-12 2012-13 2013-14 (UP TO SEPT. 2013) Condoms (In million pieces) 290.137 295.000 367.866 234.271 Oral Pills (In lakh cycles) 237.998 298.135 226.793 205.573 IUDs (In lakh pieces) 90.000 73.500 87.508 34.005 Tubal Rings (In lakh pairs) 34.534 30.359 31.22 18.274 ECP (in lakh packs) 21.540 18.300 75.919 14.098 Pregnancy Test Kits (in lakhs) 211.74 21174 222.186 0.00 EXHIBIT E.3.2: QUANTITIES SUPPLIED TO STATES/UTS CONTRACEPTIVES 2010-11 2011-12 2012-13 2013-14 (UP TO SEPT. 2013) Condoms (Million pieces) 581.44 677.91 618.18 315.19 Oral Pills (Social Marketing) (lakh cycles) 358.08 471.975 376.82 124.79 SAHELI Weekly Oral Pill (in lakh tablet) 234.31904 244.56 270.76 0.042* EXHIBIT E.4: LOCAL MANUFACTURERS & THEIR PRODUCTS IN INDIA* METHOD SUPPLIER NAME Condoms HLL Lifecare Limited Injectables HLL Lifecare Limited Famy Care (Mylan) IUDs Pregna International SMB Corporation Famy Care (Mylan) Orals Indian Drug and Pharmaceutical Ltd. (IDPL) HLL Lifecare Limited Phaarmasia Famy Care (Mylan) Win-Medicare Cipla *Figures are Provisional * USAID, “Assessment of India’s locally manufactured contraceptive product supply”, 2006, available at: http://pdf.usaid.gov/pdf_docs/Pnadf989.pdf *Figures are Provisional EXHIBIT E.3.3: EMERGENCY CONTRACEPTIVE PILLS [ECP] ITEM 2010-11 2011-12 2012-13 2013-14 (UP TO SEPT. 2013)* ECP 21.54 18.30 75.919 14.098 Sources: [Exhibit E.3] India MOHFW Annual Report, 2013-2014. [Exhibit E.4] [1] USAID Assessment, 2006; [2] Historical Supplier Shipment Data. AP PE ND IC ES 45 APPENDIX E – ADDITIONAL MARKETS VISIBILITY Indonesia As per the 2017 Family Planning Market Report, data from public tender documents published by the National Family Planning Coordinating Body (BKKBN)57 indicates an increase in CYPs procured from prod- uct-based methods58, from 17 million in 201559 to 23 million in 201660. By applying the same prices (Exhibit C.9) used for the 2015 and 2016 supplier shipment volumes, we estimate that the total implied value from these tender documents is $57 million in 2015 and $75 million in 2016, as compared to the less than $1 million and $3 million implied by the 2015 and 2016 supplier shipment data. Sources: [Exhibit E.5] BKKBN Tender Documents, 2015. [Exhibit E.6] BKKBN Tender Documents, 2016. 57. Family Planning and Reproductive Health Unit, National Family Planning Coordinating Body (BKKBN) 58. Procured methods from Indonesia’s MOHFW reports include implants, injectables and orals. 59. Tender Winner Announcement documents accessed June 2017 at http://lpse.bkkbn.go.id/ eproc/ 60. Tender Winner Announcement documents accessed June 2017 at https://e-katalog.lkpp. go.id/backend/katalog/list_produk/63 EXHIBIT E.5: MULTIPLE TENDER WINNER ANNOUNCEMENTS YEAR PRODUCT DISTRIBUTOR QUANTITY 2015 Combination Pills PT Indofarma Global Medika 11,776,656 2015 Combination Pills PT Perintis Bina Utama Farmasi 15,114,124 2015 Combination Pills PT Kimia Farma Trading & Distribution 4,042,768 2015 3-month Injectables PT Indofarma Global Medika 13,019,861 2015 3-month Injectables PT Trijaya Medika Farma 12,950,506 2015 3-month Injectables PT Trijaya Medika Farma 13,067,747 2015 3-month Injectables PT Trijaya Medika Farma 13,497,338 2015 2-rod implants w/ inserters PT Djaja Bima Agung 164,710 2015 2-rod implants w/ inserters PT Djaja Bima Agung 166,270 2015 2-rod implants w/ inserters PT Djaja Bima Agung 192,793 2015 2-rod implants w/ inserters PT Djaja Bima Agung 172,010 EXHIBIT E.6: MULTIPLE TENDER WINNER ANNOUNCEMENTS YEAR PRODUCT DISTRIBUTOR QUANTITY 2016 Combination Pills PT Harsen Laboratories 11,648,300 2016 Combination Pills PT Kimia Farma 17,626,000 2016 Combination Pills PT Pratapa Nirmala 8,793,200 2016 Combination Pills PT Sunthi Sepuri 8,829,100 2016 Combination Pills PT Triyasa Nagamas Farma 17,540,300 2016 3-month Injectables PT Catur Dakhwah Crane Farmasi 7,289,160 2016 3-month Injectables PT Harsen Laboratories 21,895,860 2016 3-month Injectables PT Triyasa Nagamas Farma 14,474,540 2016 3-month Injectables PT Tunggal Idaman Abadi 7,348,980 2016 2-rod implants w/ inserters PT Catur Dakhwah Crane Farmasi 633,680 2016 2-rod implants w/ inserters PT Harsen Laboratories 633,660 2016 2-rod implants w/ inserters PT Triyasa Nagamas Farma 633,660 61. The 2016 tender documents indicate the manufacturer; however, the 2015 documents refer only to distributors. 62. The Generic Manufacturers Caucus for Reproductive Health (GEMS Caucus) comprises generic pharmaceutical manufacturers throughout Asia, Africa, and Europe, united in their commitment to provide safe, quality-assured family planning products that enable women to make choices about their reproductive health; available at https://www.rhsupplies.org/activi- ties-resources/groups/generic-manufacturers-caucus/. AP PE ND IC ES The data also shows that the Indonesian procurement contracts were awarded primarily to regional and local suppliers, including: PT Catur Dakwah Crane Farmasi, PT Harsen Laboratories, PT Kimia Farma, PT Triyasa Nagamas Farma, PT Pratapa Nirmala, PT Sunthi Sepuri, and PT Tunggal61. Among them, PT Tunggal is the only supplier currently partici- pating in this report, as part of the GEMs Caucus62. 46 APPENDIX G – KEY TERMS AND DEFINITIONS CYP Couple Years of Protection (CYP) is the estimated protection provided by contraceptive methods during a one-year period e.g. 120 condoms provide a couple protection for one year. CYP mix CYP mix refers to the percentage distribution of CYPs shipped by method. Value Value refers to the supplier-reported shipment volume multiplied by the average prices of UNFPA and USAID for the specific years. Market Share Market share is the percentage of total value of shipment volumes in a market captured by a certain contraceptive method. Shipments or Shipment Volumes Shipment volumes refers to the amount of a particular contraceptive method that has been transported. Total FP2020 Public Sector Market The total FP2020 public sector market is based on volumes purchased by institutional buyers and MOH or government-affiliated procurers based on RHI data (male condoms) and historical supplier-reported shipment data (female condoms, implants, injectables, IUDs, and orals) for the 69 FP2020 focus countries, defined as countries with a 2010 gross national per capita annual income less than or equal to $2,500. Although South Africa made an FP2020 commitment, its GNI was greater than $2,500. AP PE ND IC ES 47 APPENDIX H – ACRONYMS CHAI CLINTON HEALTH ACCESS INITIATIVE CYP COUPLE-YEARS OF PROTECTION FP FAMILY PLANNING FP2020 FAMILY PLANNING 2020 GEMS GENERIC MANUFACTURERS FOR REPRODUCTIVE HEALTH IUD INTRA-UTERINE DEVICE LAM LACTATIONAL AMENORRHEA METHOD LARC LONG-ACTING REVERSIBLE CONTRACEPTIVES MOH MINISTRY OF HEALTH MOHFW MINISTRY OF HEALTH AND FAMILY WELFARE RHSC REPRODUCTIVE HEALTH SUPPLIES COALITION RHI REPRODUCTIVE HEALTH INTERCHANGE SMO SOCIAL MARKETING ORGANIZATION USAID UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT UNFPA UNITED NATIONS POPULATION FUND AP PE ND IC ES

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