Family Planning Market Report

Publication date: 2019

FAMILY PLANNING MARKET REPORT D E C E M B E R 2 0 1 9 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 comprehensive view of the reproductive health contraceptive product market. We would like to thank current participating suppliers: Bayer, CR Zizhu, Cipla, Cupid, Female Health Company, Helm AG*, Incepta Pharmaceuticals, Merck (MSD), Mylan, Pfizer, Pregna, PT Tunggal, Shanghai Dahua, SMB, and Techno Drugs, as well as our partner, Concept Foundation, for their support in collecting and aggregating 2014-2017** 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 U.S. Department of International Development (USAID), the Global Health Supply-Chain – Procurement and Supply-Management (GHSC-PSM), and FP2020, for their invaluable feedback 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 18 for more information on HELM AG and other participating suppliers. ** CHAI collected data directly from suppliers in the GEMs Caucus for the 2018 shipment data. 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, 2014–2018 APPENDIX B – DATA SOURCES APPENDIX C – ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE APPENDIX D – ESTIMATING TOTAL FP2020 DONOR-SPEND VOLUMES APPENDIX E – ADDITIONAL MARKETS VISIBILITY APPENDIX F – KEY TERMS AND DEFINITIONS APPENDIX G – ACRONYMS 3 14 16 17 18 20 30 31 37 38 44 45 3 FROM 2017 TO 2018, THE FP2020 PUBLIC SECTOR MARKET4 INCREASED IN VOLUME, VALUE, AND CYPS SHIPPED.5 NOTABLY, CYPS SHIPPED OF IUDS INCREASED SIGNIFICANTLY IN 2018 FROM A HISTORIC LOW IN 20176 AND RETURNED TO HISTORICAL LEVELS SEEN OVER THE 20147 TO 2016 PERIOD. WHILE THE OVERALL MARKET VALUE INCREASED FROM 2017 TO 2018, IT REPRESENTS AN OVERALL DECREASE FROM 2014. CONVERSELY, TOTAL CYPS SHIPPED REMAINED RELATIVELY FLAT OVER THE FIVE-YEAR PERIOD, DRIVEN BY A DECREASE IN ORAL CONTRACEPTIVES (COMBINED & PROGESTIN ONLY) AND INJECTABLES8, AND OFFSET BY AN INCREASE IN IMPLANTS. The scope of the 2019 Family Planning Market Report comprises 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 countries.1 The report is based on the most recent and up-to-date information and methodology covering all product-based modern methods based on historical supplier-reported shipment data collected from 15 suppliers2 for female condoms, implants, injectables, IUDs, orals (combined and progestin only), and emergency oral contraceptives, and reflects the latest five-year trend. Findings for male condoms are based on data from the Reproductive Health Interchange (RHI).3 This section analyzes trends in shipment volumes, value in USD, and CYPs shipped in the total FP2020 public sector market from 2014 to 2018.9 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 2014 to 2018 of the Reproductive Health Interchange (RHI), with the exception of IUDs and emergency contraceptives, which represent ~50-60 percent; see Appendix C.1 for further de- tails. Additionally, the cumulative total from 2014 to 2018 historical supplier-reported shipment volumes to 69 FP2020 countries and procurer warehouses is greater than RHI in every method; see Appendix C.5 for further details. 3. Supplier shipment data collection does not include male condoms. For more details see Appendix C. 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. 5. Couple Years of Protection (CYP) is the estimated protection provided by contraceptive methods during a one-year period e.g. 13 units of a 1-month injectable provide protection for one year. CYPs shipped in this report were calculated by applying a method-specific CYP conversion factor to each method’s volumes shipped to FP2020 countries. Volumes shipped are from supplier shipment data. See Appendix C for further details. 6. It should be noted that single-year trends may be attributed in part to the nature of shipment data and factors such as shipment timing and other procurement factors further Overall, the value of the public sector market in the 69 FP2020 focus countries decreased from $293 million10 in 2014 to $226 million in 2018, driven primarily by changes in shipment volumes.11 The most significant change was observed between 2015 and 2016, where the market value decreased by 29 percent.12 Since 2016, the value decreased further to $185 million in 2017 before increasing to $226 million in 2018. (Exhibits 1, 2) CYPs shipped remained relatively level from 2014 to 2018, with the exception of the significant 22 percent annual decrease seen from 2015 to 2017 largely driven by IUDs and partly by injectables. 2017 marked a historical low point for the FP2020 public sector market in terms of CYPs shipped, driven in large part by a decrease in IUDs shipped. In 2018, CYPs shipped of IUDs returned to 2014 to 2016 historical levels. (Exhibit 3) SU PP LI ER S HI PM EN T AN AL YS IS explored on page 17. As also discussed in RHSC’s 2016 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 preferences by donors or the government itself for particular methods or products may also influence what type, and what volume, of supplies to procure.” 7. This report focuses on providing the most recent five-year trend and up-to-date data and methodology. It provides expanded coverage than prior reports with a greater number of participating suppliers. 8. 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. 9. The reporting year referenced in this report is January 1 to December 31. 10. The currency reported is in US dollars, unless otherwise noted. 11. Prices used to calculate the value of the market for each method by year are listed in Appendix C. 12. The decrease in market value from 2015 to 2016 was driven by declines in shipment volumes of injectables and orals (combined and progestin only). Notable Market Trends 4 13. CYP mix refers to the percentage distribution of CYPs shipped by method. 14. Long-acting and reversible contraceptive methods include IUDs and implants. Short-act- ing methods include male and female condoms, injectables, orals (combined & progestin only), and emergency oral contraceptives. 15. Where percentage changes are discussed, the Compound Annual Growth Rate (CAGR) is used unless otherwise noted. 16. In 2015, the top 10 markets made up 48 percent of the total value of the FP2020 public sector market. Long-acting reversible contraceptives (LARCs) continued to make up a larger proportion of the CYP mix13 compared to short-acting meth- ods in 2018.14 LARCs’ percentage of the CYP mix has increased since 2014 – LARCs made up 53 percent of the CYP mix in 2014 and this has increased to an average of 66 percent of the CYP mix from 2016 to 2018. (Exhibit 4) CYPs shipped of LARCs increased by 5 percent annually15 from 2014 to 2018, driven mainly by an increase in CYPs shipped of implants and, to a lesser extent, by an increase in CYPs shipped of IUDs. (Exhibit 3) Each year from 2014 to 2018, the 10 largest markets for that year have accounted for over 50 percent of the total value of the FP2020 public sector market, with the exception of 2015.16 While the list of Top 10 mar- kets has fluctuated from year to year, five core countries, Bangladesh, Ethiopia, Nigeria, Uganda, and Zimbabwe, have consistently appeared in the top 10 markets over the 2014 to 2018 period.17 (Exhibits 5, 6, 7) Notable Product Trends Although IUD shipments increased significantly in 2018 from the meth- od’s 2017 low, volumes shipped of IUDs in 2018 were in line with the method’s 2014 to 2016 historical average.18 (Exhibit 2) IUDs made up 41 percent of all CYPs shipped in the public sector in 2018, a significant change from 2017 when they accounted for 24 percent, and more in line with the 2014 to 2016 historical average of 40 percent. IUDs have the lowest cost per CYP of the methods covered in this report. (Exhibit 4,8) As a result, an increase in IUD volumes has a larger impact on the FP2020 public sector market in terms of CYPs shipped, but a relatively lesser impact on the market in terms of value. (Exhibits 9, 10) The market value of injectables increased by $19 million19 from $47 million in 2017 to $65 million in 2018; however, the market value of injectables has not returned to its 2014 high of $94 million. (Exhibit 1) Implants also saw an increase in market value of $18 million, increasing from $70 million in 2017 to $88 million in 2018. The 2018 market value for implants is the highest since 2014. (Exhibit 1) Together, implants and injectables constituted the bulk of 2018’s overall increase in market value, which was partially offset by a decrease in the market value of female condoms. (Exhibit 1)SU PP LI ER S HI PM EN T AN AL YS IS 17. Zambia was part of the top 10 countries that accounted for over 50 percent of the value of the 2017 FP2020 public sector market; however, Zambia is not part of 2018’s list of top 10 countries by value. 18. Average CYPs shipped of IUDs from 2014 to 2016 was 46 million CYPs shipped. 19. Calculated numbers may differ slightly than what is represented in the exhibits due to rounding of totals. 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 20182017201620152014 To ta l M ar ke t S ize (M ill io ns U SD ) $53M $87M $78M $3M $31M $2M $41M $11M $25M $3M $50M $2M $79M $12M $37M $3M $86M $1M $94M $13M $42M $70M $1M $32M $2M $47M $10M $23M $88M $3M $31M $2M $65M $6M $30M Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female $293M $269M $190M $185M $226M METHOD YOY* 2017-2018 CAGR** 2014-2018 Implants 26% 14% IUDs 170% 0% Orals - Combined & Progestin Only -3% -22% Orals - Emergency 6% 5% Injectables 40% -9% Condoms - Female -38% -16% Condoms - Male 27% -8% Total 22% -6% * Year over year (YOY) ** Compound Annual Growth Rate (CAGR) Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, January 2019; [3] UNFPA Contraceptive Price Indicator, 2014–2018; [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* 2017-2018 CAGR** 2014-2018 Implants 26% 14% IUDs 172% 2% Orals - Combined & Progestin Only 7% -17% Orals - Emergency -2% 7% Injectables 38% -8% Condoms - Female -40% -15% Total 14% (13%) 0 M 100 M 200 M 300 M 400 M 500 M 20182017201620152014 Sh ip m en t V ol um es (M ill io ns ) Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female 6M 10M 10M 10M 9M 10M 8M 4M 269M 168M 7M 97M 25M 114M 6M 50M 22M 22M 59M 6M 118M 5M 114M 25M 430M 211M 218M 10M 11M 13M 81M 6M 127M 249M 317M *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) 2014 2015 2016 2017 2018 YOY 2017-2018* CAGR** 2014-2018 1.49B 1.35B 0.99B 1.03B 1.34B 31% -3% Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, January 2019 Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding * Year over year (YOY) ** Compound Annual Growth Rate (CAGR) 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 20182017201620152014 CY Ps S hi pp ed (M ill io ns ) Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female 20M 31M 29M 26M 18M 8M 0.3M 15M 0.2M 9M 47M 12M 8M 0.2M 8M 46M 11M 0.3M 0.3M 24M 0.2M 11M 46M 18M 28M 0.2M 0.2M 12M 123M 31M 50M 20M 8M 0.3M 0.1M 11M 122M 104M 125M 76M EXHIBIT 3: CYPs SHIPPED TO THE FP2020 PUBLIC SECTOR MARKET METHOD YOY* 2017-2018 CAGR** 2014-2018 Implants 22% 12% IUDs 172% 2% Orals - Combined & Progestin Only 7% -17% Orals - Emergency -2% 7% Injectables 37% -8% Condoms - Female -40% -15% Condoms - Male 31% -3% Total 61% -1% Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, January 2019; [3] USAID, "Couple-Years of Protection (CYP)" Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding * Year over year (YOY) ** Compound Annual Growth Rate (CAGR) 8 SU PP LI ER S HI PM EN T AN AL YS IS EXHIBIT 4: CYP MIX (IN TERMS OF CYPS SHIPPED) 0% 20% 40% 60% 80% 100% 20182017201620152014 CY P M ix Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female 16% 37% 14% 0.2% 22% 0.2% 10% 25% 37% 9% 0.3% 19% 0.2% 9% 27% 45% 7% 0.3% 12% 0.2% 8% 125M 123M 104M 34% 24% 10% 0.4% 19% 0.2% 11% 26% 41% 7% 0.3% 16% 0.1% 9% 76M 122MCYPs shipped Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, January 2019; [3] USAID, "Couple-Years of Protection (CYP)" 9 SU PP LI ER S HI PM EN T AN AL YS IS EXHIBIT 5: VALUE OF 10 LARGEST FP2020 PUBLIC SECTOR COUNTRIES COMPARED TO VALUE OF ALL OTHER COUNTRIES COMBINED Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, January 2019; [3] UNFPA Contraceptive Price Indicator, 2014–2018; [4] IAP Implant Price. Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding EXHIBIT 6: TOP 10 COUNTRIES IN TERMS OF VALUE, 2018 $0M $50M $100M $150M $200M $250M $300M 20182017201620152014 Top 10 Countries Other FP2020 Countries $293M $269M $190M $185M $226M $93M $93M $127M $99M $140M $153M $124M $146M $89M $102M M ar ke t S ize (M ill io ns U SD ) *Top countries in this graph are defined by 2018 data and different in each year. Top 10 countries are in alphabetical order: Bangladesh, Ethiopia, Kenya, Malawi, Mozambique, Myanmar, Nigeria, Tanzania, Uganda, and Zimbabwe. * 11% 44% 6% 7% 9% 5% 5% 4% 3% 3%3% Bangladesh Ethiopia Uganda Nigeria Zimbabwe Malawi Tanzania Kenya Mozambique Myanmar Other FP2020 Countries 10 SU PP LI ER S HI PM EN T AN AL YS IS EXHIBIT 7: MARKET SHARE OF FP2020 PUBLIC SECTOR BY REGION (USD) 0% 20% 40% 60% 80% 100% 20182017201620152014 Country Not Specified Latin America & Caribbean Asia & Pacific Sub-Saharan AfricaMiddle East & North Africa $293M $269M $190M $185M $226M 33% 2% 1% 53% 12% 23% 2% 1% 60% 14% 18% 2% 2% 68% 9% 19% 3% 1% 65% 12% 20% 3% 2% 66% 10% Market Value *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. * Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, January 2019; [3] UNFPA Contraceptive Price Indicator, 2014–2018; [4] IAP Implant Price. 11 SU PP LI ER S HI PM EN T AN AL YS IS Cost Per CYP By Method in 2018 (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 $0.07 $2.24 $2.64 $3.16 $3.40 $3.56 $4.40 $5.52 $6.90 $11.05 $56.88 Sources: [1] UNFPA Contraceptive Price Indicator, 2014–2018; [2] USAID, “Couple-Years of Protection (CYP)”; [3] IAP Implant Price METHOD UNITS PER CYP UNIT COST COST PER CYP 2014 2015 2016 2017 2018 2014 2015 2016 2017 2018 Condoms - Female 120.00 $0.51 $0.49 $0.49 $0.46 $0.47 $60.72 $58.80 $59.28 $55.32 $56.88 Condoms - Male 120.00 $0.03 $0.03 $0.03 $0.02 $0.02 $3.37 $3.24 $3.03 $2.71 $2.64 Injectables - 1 month 13.00 $0.85 $0.85 $0.85 $0.85 $0.85 $11.05 $11.05 $11.05 $11.05 $11.05 Injectables - 2 month 6.00 $1.30 $1.15 $1.15 $1.15 $1.15 $7.80 $6.90 $6.90 $6.90 $6.90 Injectables - 3 month 4.00 $0.79 $0.78 $0.80 $0.77 $0.79 $3.17 $3.13 $3.20 $3.09 $3.16 Orals - Combined 15.00 $0.32 $0.29 $0.26 $0.27 $0.24 $4.80 $4.35 $3.95 $4.01 $3.56 Orals - Progestin Only 15.00 $0.31 $0.34 $0.33 $0.32 $0.29 $4.70 $5.10 $4.92 $4.76 $4.40 Orals - Emergency 20.00 $0.30 $0.37 $0.35 $0.26 $0.28 $5.92 $7.40 $7.02 $5.14 $5.52 Implants - 3 Year 0.40 $8.50 $8.50 $8.50 $8.50 $8.50 $3.40 $3.40 $3.40 $3.40 $3.40 Implants - 5 Year 0.26 $8.50 $8.50 $8.50 $8.50 $8.50 $2.24 $2.24 $2.24 $2.24 $2.24 IUDs 0.22 $0.32 $0.30 $0.30 $0.31 $0.30 $0.07 $0.07 $0.06 $0.07 $0.07 EXHIBIT 8: COST PER CYP BY METHOD (USD) 12 0% 20% 40% 60% 80% 100% 20182017201620152014 M ar ke t S ha re Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female $293M $269M $190M $185M $226M 18% 1% 29% 0% 32% 4% 14% 32% 1% 18% 1% 29% 5% 14% 41% 2% 16% 1% 21% 6% 13% 38% 1% 17% 1% 25% 6% 13% 39% 1% 14% 1% 29% 3% 13% Market Value SU PP LI ER S HI PM EN T AN AL YS IS Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, January 2019; [3] UNFPA Contraceptive Price Indicator, 2014–2018; [4] IAP Implant Price EXHIBIT 9: MARKET SHARE (IN TERMS OF MARKET VALUE) 13 EXHIBIT 10: 2017 AND 2018 CYP MIX (IN TERMS OF CYPS SHIPPED) AND MARKET SHARE (IN TERMS OF MARKET VALUE) SU PP LI ER S HI PM EN T AN AL YS IS 0% 20% 40% 60% 80% 100% 2018 Market Share2018 CYP Mix 2017 Market Share2017 CYP Mix Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female 76M $185M 122M $226M 34% 38% 1% 17% 1% 25% 6% 13% 24% 10% 19% 0.4% 0.2% 11% 26% 41% 7% 16% 0.3% 0.1% 9% 39% 1% 14% 29% 1% 3% 13% CYPs shipped / Market value Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, January 2019; [3] UNFPA Contraceptive Price Indicator, 2014–2018; [4] USAID, “Couple-Years of Protection (CYP)”; [5] IAP Implant Price Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding 14 BOTH USAID AND UNFPA INCREASED THE VALUE OF THEIR SPENDING20 ON FAMILY PLANNING PRODUCTS BETWEEN 2017 AND 2018. USAID’S SPEND TO FP2020 COUNTRIES INCREASED SIGNIFICANTLY IN 2018, BUT IT HAS NOT YET RETURNED TO PRE-2016 LEVELS. UNFPA’S SPENDING IN 2018 REPRESENTS A FIVE-YEAR HIGH. DO NO R SP EN D AN AL YS IS This section focuses on data from the “Overview of Contraceptive and Condom Shipment” reports by USAID and data from the Procurement Services Branch of UNFPA to understand historical spend by the two major institutional procurers in the public sector markets of the 69 FP2020 focus countries. Note that fiscal year (FY) is used for USAID figures while calendar year is used throughout the report unless otherwise specified. The annual value of all contraceptives shipped by USAID, excluding male and female condoms,21 to the 69 FP2020 focus countries increased from FY201422 to FY2015. From FY2016 to FY2018, the average value was notably lower, at $43 million (range of $34 million to $50 million), reach- ing a five-year low of $34 million in 2017.23 From FY2017 to FY2018, the annual value increased by 46 percent from $34 million in FY2017 to $50 million in FY2018, driven by increased shipments of implants, inject- ables, and IUDs, but the overall value has not returned to pre-FY2016 levels. As cited in USAID's "Overview of Contraceptive and Condom Shipments" FY2018 report,24 the FY2017 to FY2018 increase in value was potentially due to a resumption of more regular ordering patterns after a FY2017 dip in implants, injectables, and IUDs.25 (Exhibit 11) For UNFPA, the value of contraceptives procured increased by 8 percent annually from 2014 to 2018. From 2014 to 2015, procurement values remained relatively flat. A decrease of 27 percent was observed in 2016, followed by an increase of 25 percent in 2017. In 2018, the value of UNFPA’s procurement was the highest it has been in the last five years, at $149 million. (Exhibit 12) The increase in UNFPA’s procurement in 2018 was driven by an increase in funds allocated by the UNFPA Supplies Programme for procurement of contraceptive products, rapid fund mo- bilization initiatives from UNFPA country offices to support procurement of contraceptive products, and third party procurement.26 20. USAID values are based on shipment data for FP2020 countries and inclusive of product and freight costs. Values are taken from the USAID annual “Overview of Contraceptive and Condom Shipments” reports from FY2014 to FY2018. UNFPA procurement values reflect all contraceptive procurement conducted by UNFPA for FP2020 countries including fresh produc- tion (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. 21. The FY2018 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 2014 to 2018 to compare a consistent data set across years. 22. USAID's Fiscal Year (FY) runs from Oct. 1 to Sept. 30. 23. USAID attributed the decreases in FY2016 and FY2017 to the transition from the USAID | DELIVER project to the GHSC-PSM project. 24. USAID, Overview of Contraceptive and Condom Shipments available at https://www.usaid. gov/sites/default/files/documents/1864/CC_FY18.pdf 25. The USAID 2018 Overview of Contraceptive and Condom Shipments report suggests that FY2018 may be showing a resumption of more regular ordering patterns from a FY2017 dip that may have been caused by countries bringing stock levels up in anticipation of a procurement agent shift prior to FY2017. USAID awarded the current contract for procuring and delivering medicines and commodities and providing supply-chain technical assistance to countries in FY2015: 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 26. Third party procurement refers to procurement carried out by UNFPA using funds allocat- ed by third party partners. 15 DO NO R SP EN D AN AL YS IS EXHIBIT 11: USAID WORLDWIDE CONTRACEPTIVE (EXCL. MALE AND FEMALE CONDOMS) SHIPMENT VALUES TO FP2020 COUNTRIES (IN USD) EXHIBIT 12: UNFPA PROCUREMENT VALUE - CONTRACEPTIVES TO FP2020 COUNTRIES (IN USD) $0M $10M $20M $30M $40M $50M $60M $70M $80M 20182017201620152014 Sh ip m en t V al ue s to F P2 02 0 (M ill io ns U SD ) USAID $58M $73M $46M $34M $50M $0M $30M $60M $90M $120M $150M 20182017201620152014 UNFPA $110M $108M $79M $99M $149M 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 2014 – 2018; [2] UNFPA PSB Procurement Values 2014 -2018 2017-2018 YOY: +46% 2014-2018 CAGR: -4% 2017-2018 YOY: +51% 2014-2018 CAGR: +8% 16 FU TU RE O UT LO OK ALTHOUGH THERE WAS AN INCREASE IN DONOR SPENDING IN 2018, THERE IS STILL UNCERTAINTY ABOUT THE AVAILABILITY OF FUTURE DONOR SPEND FOR FAMILY PLANNING PRODUCTS. Both UNFPA and USAID increased their spending on modern contra- ceptives in 2018 relative to 2017. The U.K. government also announced a new £600 million funding commitment over 2020 to 2025 for family planning supplies.27 However, there remains uncertainty over lon- ger-term donor funding. Based on conversations with stakeholders in the reproductive health community, the 2019 RHSC Global Contraceptive Commodity Gap Analysis suggested reduced or stagnant donor funding 27. https://www.gov.uk/government/news/healthcare-for-everyone-must-prioritise-womens-sex- ual-and-reproductive-health-and-rights-says-uk-at-un-general-assembly 28. 2019 Commodity Gap Analysis, RHSC. Available at https://www.rhsupplies.org/activi- ties-resources/commodity-gap-analysis/ 29. Family planning and reproductive health (FP/RH) funding totals $665 million in the Senate-approved FY20 State & Foreign Operations appropriations bill, compared to the FY19 enacted level of $608 million, the House FY20 level of $806 million, and the FY20 Request was $259 million. Henry J. Kaiser Family Foundation, October 2019. Available at: https://www.kff.org/ news-summary/senate-appropriations-committee-releases-draft-fy-2020-state-and-foreign-oper- ations-sfops-appropriations-bill/ 30. The 2019 RHSC Global Contraceptive Commodity Gap Analysis forecasts a funding gap of $178 million in 2020 if the amount spent annually on contraceptive supplies remains at the current level, while the number of women who need supplies continues to grow. in the next decade.28 There is also uncertainty related to the U.S. gov- ernment’s position on family planning and related funding intentions.29 The 2019 RHSC Commodity Gap Analysis also suggests that if annual spend on contraceptive supplies remains unchanged while women continue to demand family planning contraceptive products in growing numbers, a significant funding gap will emerge in 2020.30 17 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 THIS REPORT. While stakeholders were pleased to see the market increase from its 2017 low, some expressed concern that the value of the FP2020 public sector market had not yet returned to pre-2016 levels. The significant increase in donor spending between 2017 and 2018 was viewed with relief, as a number of stakeholders had previously expressed concern regarding the continued decrease in donor spending in recent years. Certain stakeholders offered perspectives on a prominent trend observed in 2018 – the increase in CYPs shipped, driven by increased shipments of IUDs in 2018. Some suggested that the increase in IUDs shipped in 2018 was a reversal from the significant drop in IUD shipments seen in 2017. Specifically, Egypt saw the largest drop in IUD volumes in 2017 following the devaluation of the Egyptian Pound against the US dollar. It also accounted for the greatest increase in IUD shipments in 2018. Year-to-year observations may also be attributed, at least in part, to the nature of the supplier shipment data, which may not always reflect programmatic changes. For instance, total annual volumes provided by suppliers are recorded when they are shipped which differs in timing from when those orders are placed. Thus, orders placed in one year may ship in subsequent years depending on production cycles and manufacturing lead times; one-year fluctuations are not necessarily a result of programmatic shifts. Finally, as stated in the 2016 RHSC Commodity Gap Analysis,31 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 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. 2016 Commodity Gap Analysis, RHSC. Available at https://www.rhsupplies.org/uploads/ tx_rhscpublications/Commodity_Gap_Analysis-2018.pdf32. 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 About the Global Markets Visibility Project The Global Markets Visibility Project is a landmark initiative that has been providing the reproductive health community with detailed assessments of the public sector family planning market across the 69 FP2020 focus countries since 2015. The initiative provides insightful and strategic outputs for donors, MOHs, implementing organizations, and suppliers to develop and implement more effective strategies to enable women in the world’s 69 poorest countries to use family planning prod- ucts 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 15 suppliers participating in the project. Donors, suppliers, and partners remain fully committed to this project, expressing strong interest in continuing to strengthen the family planning community’s market knowledge. About the Participating Suppliers Bayer Bayer is a Germany-based life science company with core competen- cies in health care and agriculture. Its contraceptive product portfolio includes contraceptive implants, LNG-IUS, 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 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. 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 and FP 2019 reports do not contain shipment volumes for IUDs or Injectables from HELM AG. Sanavita Pharmaceuticals 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. Incepta Pharmaceuticals Incepta Pharmaceuticals Ltd. is a pharmaceutical company based in Dhaka, Bangladesh, that manufactures and markets generic drugs. In- cepta has a portfolio of more than 500 generic products, in 1,100+ pre- sentations, across various therapeutic areas. Incepta currently exports its products to 67 countries around the world. Its contraceptive product portfolio includes oral (combined and progestin only) and injectable contraceptives. 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 focus 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 may not represent the entirety of institutional purchases for the FP2020 public sector. This report includes data from the majority, but not all suppliers associated with these markets. 19 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 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 sterilization.32 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, implants, and injectables. For injectables, Techno Drugs has also served as a supplier to Helm AG previously. 32. The procurement of products used for sterilization such as tubal rings are not covered in this report as the scope is limited to product-based modern methods of contraception. 20 APPENDIX A 33. Female condoms are aggregated with male condoms by country in order to protect data confidentiality. 69 FP2020 COUNTRIES MARKET VOLUMES BY METHOD33 AND COUNTRY, 2014–2018 EXHIBIT A.1: 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 1,099,081 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 39,000 1,757,096 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 2,860 1,141,200 Lesotho 44,934,736 600 1,000 0 26,640 Liberia 9,574,000 0 457,000 0 352,080 APPENDIX A AP PE ND IC ES 21 APPENDIX A EXHIBIT A.1: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2014 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS 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 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 82,000 8,500 74,880 South Sudan 5,205,600 15,000 0 0 24,999 Sri Lanka 0 63,000 406,800 210,000 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 Timor0Leste 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 2,430,100 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 3,431,740 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 6,245,627 113,915,602 10,025,968 274,345,101 AP PE ND IC ES Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, January 2019. 22 EXHIBIT A.2: 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 66,500 463,602 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 3,555,723 Burundi 5,760,000 134,500 1,639,267 0 520,528 Cambodia 5,730,480 11,000 200,000 30,000 9,484,891 Cameroon 26,245,443 125,052 10,000 46,550 29,079 Central African Republic 0 500 37,900 0 22,881 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 32,222 3,758,922 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 79,995 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 0 141,840 Ghana 13,995,000 403,236 1,394,600 0 1,993,464 Guinea 10,080,000 32,500 907,448 0 431,280 Guinea-Bissau 3,384,720 59,400 27,500 0 59,040 Haiti 60,014,400 9,300 421,400 0 201,759 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 3,125,201 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 0 120,009 Liberia 9,009,780 44,600 846,800 0 396,018 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 18,393 908,569 APPENDIX A AP PE ND IC ES 23 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, January 2019. APPENDIX A EXHIBIT A.2: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2015 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 0 86,264 41,200 0 84,384 Mongolia 1,360,800 0 90,000 0 242,382 Mozambique 41,712,000 95,000 3,025,500 0 0 Myanmar 42,251,912 108,156 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 2,226,162 Nigeria 97,478,368 379,591 8,132,250 75,000 2,474,121 Pakistan 290,853,000 210,484 0 3,024,116 0 Papua New Guinea 3,480 100,800 1,327,200 0 12,999 Philippines 0 731,244 0 82,336 4,135,001 Rwanda 18,626,900 28,752 727,667 5,768 265,296 Sao Tome and Principe 0 0 9,400 0 65,997 Senegal 18,858,530 65,384 760,000 0 1,393,920 Sierra Leone 7,926,120 68,500 726,800 0 1,058,340 Solomon Islands 0 0 15,000 0 0 Somalia 151,200 52,016 197,900 0 207,360 South Sudan 9,036,000 53,100 89,350 0 139,702 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 9,935,400 194,124 143,397 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 48,300 218,859 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 7,706,239 Zambia 66,167,400 245,900 3,399,400 13,000 3,707,865 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 60,732,503 Total Volumes 1,377,597,053 10,210,602 97,025,050 9,973,607 174,905,366 AP PE ND IC ES 24 EXHIBIT A.3: 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 Congo Dem Rep 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 25 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, January 2019. APPENDIX A EXHIBIT A.3: 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 1,540,800 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 32,654,280 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 108,752,496 800 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 1,015,353,956 9,157,327 49,632,930 10,211,412 119,757,814 AP PE ND IC ES 26 EXHIBIT A.4: 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 0 365,200 Bangladesh 1,195,200 400,000 7,258,000 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 0 169,980 Cambodia 1,929,600 40,056 900,000 60,000 7,082,236 Cameroon 6,658,400 95,200 327,000 0 298,080 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 Democratic Republic of Congo 15,913,800 364,828 2,143,580 0 1,380,220 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 1,500 235,440 Ghana 0 250,256 106,000 11,500 3,183,960 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 0 647,304 Honduras 34,884,000 1,440 21,000 0 1,641,840 India 0 0 1,047,488 522,885 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 0 701,040 Lesotho 14,001,000 31,200 165,000 0 176,400 Liberia 6,009,000 36,100 319,000 0 5,760 Madagascar 0 256,618 3,012,800 295,019 1,288,800 Malawi 27,759,000 167,408 1,000,000 36,500 236,700 Mali 20,115,816 209,728 293,000 0 210,240 APPENDIX A AP PE ND IC ES 27 EXHIBIT A.4: 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 1,144,800 800 0 37,000 350,160 Mozambique 110,748,000 60,016 1,373,600 23,600 3,278,160 Myanmar 35,536,744 18,936 6,108,125 200 14,780,928 Nepal 20,841,000 211,800 641,000 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 82,720 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 98,100 Senegal 7,005,000 67,864 160,000 0 139,140 Sierra Leone 19,728,000 230,400 332,650 16,000 1,087,240 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 2,123,400 Tajikistan 5,188,200 0 142,000 0 613,440 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 3,895,400 251,000 249,520 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 87,915,960 161,800 3,418,650 0 3,528,960 Zimbabwe 96,837,000 60,496 1,399,200 10,000 12,716,941 Other FP2020 Shipment Volumes 9,942,000 1,058,100 5,912,600 228,950 23,003,805 Total Volumes 1,050,662,172 8,251,267 58,685,807 4,006,940 124,754,403 APPENDIX A Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, January 2019. AP PE ND IC ES 28 EXHIBIT A.5: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2018 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 0 16,500 307,750 0 224,480 Bangladesh 10,771,200 793,064 15,194,000 480,000 20,049,680 Benin 12,966,000 38,100 38,000 0 2,250 Bhutan 0 0 0 0 0 Bolivia 0 73,300 200,000 0 230,022 Burkina Faso 12,008,400 342,940 246,400 0 3,398,400 Burundi 0 4,000 126,400 0 415,332 Cambodia 3,427,200 46,392 700,000 0 11,986,296 Cameroon 9,633,600 112,952 338,000 3,500 100,000 Central African Republic 12,960,000 4,800 108,200 0 39,648 Chad 1,008,000 38,846 187,000 0 5,000 Comoros 1,180,800 0 0 0 3,000 Democratic Republic of Congo 54,908,976 331,170 1,343,100 0 370,560 Congo Rep 0 63,000 0 86,000 12,120 Cote d'Ivoire 27,040,800 139,088 474,800 18,800 3,867,676 Djibouti 684,000 3,200 70,400 0 0 Egypt Arab Rep 0 160,046 0 3,774,650 0 Eritrea 0 2,200 100,000 0 10,025 Ethiopia 25,153,440 1,205,446 7,753,455 600,000 7,896,030 Gambia 0 1,400 160,500 0 660,816 Ghana 33,221,400 282,314 2,423,500 30,500 2,827,200 Guinea 0 0 100,000 0 51,360 Guinea-Bissau 10,310,400 0 6,600 0 42,120 Haiti 113,420,040 34,016 1,827,000 2,000 100,212 Honduras 34,012,800 1,000 107,000 1,100 74,880 India 0 0 102,000 3,221,980 366,065 Indonesia 0 0 0 852,430 0 Iraq 1,000,800 0 0 0 0 Kenya 2,000,000 379,232 470,124 84,225 12,791,937 Korea Dem Rep 0 0 0 0 0 Kyrgyz Republic 0 0 0 0 0 Lao PDR 2,090,400 0 242,000 0 660,600 Lesotho 8,192,600 7,644 15,000 0 116,682 Liberia 28,800 37,500 705,200 0 32,400 Madagascar 5,001,000 325,344 4,866,200 0 204,800 Malawi 202,545,600 173,874 4,947,825 0 1,250,484 Mali 10,207,200 56,576 1,578,800 0 1,063,635 APPENDIX A AP PE ND IC ES 29 EXHIBIT A.5: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2018 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 0 5,700 86,800 0 711,360 Mongolia 900,000 6,200 0 0 420,000 Mozambique 92,244,400 231,648 3,291,800 10,000 643,680 Myanmar 49,103,616 103,540 2,889,125 5,000 11,190,719 Nepal 16,943,496 176,000 2,170,400 20,000 3,299,530 Nicaragua 11,164,320 2,854 0 12,000 0 Niger 849,600 170,940 914,200 0 658,002 Nigeria 48,724,800 1,023,764 4,731,600 150,800 1,996,764 Pakistan 612,000 10,000 100,000 320,285 0 Papua New Guinea 5,680,800 60,000 5,000 0 424,967 Philippines 2,397,600 0 0 50,450 0 Rwanda 30,399,200 256,072 862,200 0 55,680 Sao Tome and Principe 1,315,008 500 26,000 0 67,080 Senegal 11,052,000 186,336 0 7,000 0 Sierra Leone 1,987,200 153,533 972,800 0 435,480 Solomon Islands 0 0 0 0 0 Somalia 100,800 15,240 100,000 0 0 South Sudan 2,476,000 54,000 340,000 0 610,080 Sri Lanka 0 500 0 0 2,119,680 Sudan 720,000 51,264 0 0 0 Tajikistan 0 0 138,000 0 595,224 Tanzania 2,868,000 810,780 2,067,300 10,000 1,273,980 Timor-Leste 725,760 3,900 0 0 0 Togo 14,767,832 75,264 118,400 0 164,154 Uganda 178,114,000 811,576 5,469,525 103,500 4,369,950 Uzbekistan 0 0 0 0 0 Vietnam 21,816,000 0 0 925,250 0 West Bank and Gaza 0 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 1,483,200 37,440 1,093,600 29,700 30,000 Zambia 85,347,400 115,096 1,855,950 0 6,965,040 Zimbabwe 159,922,460 87,500 1,010,975 0 18,265,635 Other FP2020 Shipment Volumes 22,343,648 1,263,200 7,977,325 87,000 10,256,278 Total Volumes 1,357,832,596 10,386,791 80,960,254 10,886,170 133,406,993 APPENDIX A Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, January 2019. AP PE ND IC ES 30 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 becomes available. The following provides an overview of the data sources CHAI relied upon for market analyses: FP2020 Global Markets Visibility Project In early 2014, CHAI, in partnership with RHSC and the FP2020 Market Dynamics Working Group, launched the Global Markets Visibility Project to help various donors, suppliers, and partners improve their under- standing of the current market size and trends for key contraceptive markets. CHAI collects historical shipment data by product and country from suppliers for each of the 69 FP2020 focus countries. For the 2015, 2016, 2017, and 2018 reports, CHAI partnered with Concept Foundation to collect and aggregate shipment data from participating members of the RHSC Generic Manufacturers for Reproductive Health Caucus (GEMs). For the 2019 report, CHAI collected shipment data directly from GEMs suppliers. We have expanded our coverage and are privileged to now include data from one new supplier. In addition, all suppliers who previously provided data agreed to participate in this year’s report. To date, the Global Markets Visibility Project has collected historical ship- ment data that covers institutional sales (USAID, UNFPA, SMOs, etc.) and MOH tender volumes from 15 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 contraceptive products for family planning and reproductive health activities since the mid-1960s. The Overview of Con- traceptive and Condom Shipments report is an annual publication that summarizes contraceptive 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 FY2014 through FY2018 re- ports for FP2020 countries were accessed and used to analyze USAID’s spend on contraceptives, excluding male and female condoms, over the period. Values are inclusive of commodity and freight costs and are reported based on the USAID fiscal year which ends on September 30. APPENDIX B — DATA SOURCES 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 products and has been procuring reproductive 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 contraceptive procurement conducted by UNFPA from 2014 to 2018 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)34 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 UNFPA’s and USAID’s contraceptive purchases, MSI’s and IPPF’s cen- tral procurements, and a few other procuring organizations’ purchases. For this report, the full RHI data was downloaded in January 2019. RHI is used as a comparison for our data set for a high-level understanding of the supplier shipment data coverage as well as for male condom data. AP PE ND IC ES 34. RHI, available at https://www.unfpaprocurement.org/rhi-home 31 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 2014 to 2018 in every category with the exception of IUDs and emergency contraceptives, where suppliers held 48 percent and 63 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 2014 – 2018 ALL SUPPLIER VOLUMES IN RHI 2014 – 2018 % OF TOTAL METHOD VOLUMES Condoms - Female 101 M 104 M 97% Implants 37 M 38 M 99% Injectables 277 M 278 M 100% IUDs 8 M 16 M 48% Orals - Combined & Progestin Only 382 M 385 M 99% Orals - Emergency 5 M 8 M 63% Total 810 M 828 M 98% 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, January 2019 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 does not collect male condom data from any suppliers, RHI data was relied upon for the male condom volumes. The data is quantified by the units of measurement outlined in Exhibit C.2. 32 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 • • Incepta Pharmaceuticals • 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 15 manufacturers – Bayer, Cipla, CR Zizhu, Cupid, Female Health Company, Helm AG, Incepta Pharmaceu- ticals, Mylan, Merck (MSD), Pfizer, Pregna, PT Tunggal, Shanghai Dahua, SMB, and Techno Drugs. Collectively, the total volumes cover institution- al sales (USAID, UNFPA, MSI, etc.) and MOH tenders across five family planning product categories.35 AP PE ND IC ES Suppliers have cumulatively shipped 108 million female con- doms, 44 million implants, 400 million injectables, 45 million IUDs, 797 million orals (combined & progestin only), and 30 million emergency contraceptives from 2014 to 2018. 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. 35. Total shipment of oral contraceptives includes combined, progestin-only, and emergency oral contraceptives. Source: [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, 2014–2018 METHOD 2014 2015 2016 2017 2018 CUMULATIVE TOTAL 2014-2018 Condoms – Female 25 M 25 M 22 M 22 M 13 M 108 M Implants 6 M 10 M 9 M 8 M 10 M 44 M Injectables 114 M 97 M 50 M 59 M 81 M 400 M IUDs 10 M 10 M 10 M 4 M 11 M 45 M Orals - Combined & Progestin Only 269 M 168 M 114 M 118 M 127 M 797 M Orals - Emergency 5 M 7 M 6 M 6 M 6 M 30 M 33 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 cumulative total from 2014 to 2018 historical supplier-reported shipment volumes to 69 FP2020 countries and procurer warehouses is greater than RHI in every method. AP PE ND IC ES Sources: [1] Historical Supplier Shipment Data; [2] RHI Shipment Data, January 2019. APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE * Includes all reporting RHI suppliers to FP2020 countries and procurer warehouses EXHIBIT C.5: SUPPLIER-REPORTED SHIPMENT VOLUMES AS A PERCENTAGE OF RHI REPORTED* VOLUMES BY METHOD, 2014–2018 METHOD 2014 2015 2016 2017 2018 CUMULATIVE TOTAL 2014-2018 Condoms – Female 95% 113% 122% 122% 69% 103% Implants 122% 125% 145% 119% 95% 118% Injectables 145% 184% 130% 130% 128% 144% IUDs 253% 392% 299% 169% 305% 284% Orals - Combined & Progestin Only 250% 193% 178% 239% 165% 207% Orals - Emergency 322% 389% 647% 361% 358% 394% 34 Male Condom Market 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 2014 to 2018 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.36 The male condom market reflected by the RHI data includes at least 17 manufacturers and 5 funding sources. Source: [Exhibit C.6] RHI Shipment Data, January 2019. Source: [Exhibit C.7] Historical Supplier-Reported Shipment Data; RHI Shipment Data, January 2019. EXHIBIT C.6: RHI MALE CONDOM SHIPMENT VOLUMES, 2014–2018 METHOD 2014 2015 2016 2017 2018 Condoms - Male 1.49 B 1.35 B 0.99 B 1.03 B 1.34 B EXHIBIT C.7: 69 FP2020 CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2014–2018 METHOD 2014 2015 2016 2017 2018 Condoms – Female 25 M 25 M 22 M 22 M 13 M Condoms – Male (RHI) 1,493 M 1,352 M 993 M 1,029 M 1,344 M Implants 6 M 10 M 9 M 8 M 10 M Injectables 114 M 97 M 50 M 59 M 81 M IUDs 10 M 10 M 10 M 4 M 11 M Orals – Combined & Progestin Only* 269 M 168 M 114 M 118 M 127 M Orals – Emergency 5 M 7 M 6 M 6 M 6 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 2014 to 2018. 36. Total yearly volumes are based on the year that the product was shipped. * Some shipment units in the “Orals – Combined & Progestin Only” category provide 28 days of protection, while others provide 35 days of protection. Wherev- er oral contraceptive volumes are shown, tables and charts have been updated to reflect that one shipment unit refers to the smallest unit shipped (i.e., A unit of pills containing 35 pills is counted as one unit, and a unit of pills containing 28 pills is also counted as one unit). 35 APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE Sources: [1] USAID, “Couple-Years of Protection (CYP),” January 2019. EXHIBIT C.8: VOLUMES TO CYPs SHIPPED CONVERSION FACTORS, 2014–2018 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* 12.00 or 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 based upon the volume of all methods sold or dis- tributed for free to clients during that period of time.37 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 trans- late volumes to CYPs. 37. 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 * For the conversion of shipment volumes to CYPs shipped, an oral contraceptive unit that provides 28 days of protection is converted to CYPs using a units per CYP conver- sion factor of 15, while an oral contraceptive unit that provides 35 days of protection is converted to CYPs using a units per CYP conversion factor of 12. 36 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. 2014 to 2018 average unit prices by method are based on UNFPA prices as reported in UNFPA’s Contra- ceptive Price Indicator.38 Although there are different prices for different products and markets, we estimate implied spend using UNFPA’s Contraceptive Price Indicator prices for simplicity.39 Finally, the Implant Access Program price of $8.50 was applied to implant volumes from 2014 to 2018. The average price only includes the cost of the product and does not account for additional costs associated with procurement such as testing, insurance, and shipping costs. Sources: [1] UNFPA Contraceptive Price Indicator, 2014 to 2018; [2] IAP Implant Prices. Notes: [1] For 2014-2018 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 38. Historical reports used the average price of USAID and UNFPA prices in some years; however after 2014, USAID stopped publishing prices in UNFPA’s Contraceptive Price Indicator, thus only UNFPA prices are used to calculate total market value for 2014 to 2018 for consistency. 39. UNFPA, “UNFPA Contraceptive Price Indicator –Year 2018”, available at https://www. unfpa.org/resources/contraceptive-price-indicator-year-2018, UNFPA, “UNFPA Contraceptive 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 2014 2015 2016 2017 2018 Method Minimum Maximum Unit Price Unit Price Unit Price Unit Price Unit Price Condoms - Female $0.46 $0.51 $0.51 $0.49 $0.49 $0.46 $0.47 Condoms - Male $0.02 $0.03 $0.03 $0.03 $0.03 $0.02 $0.02 Implants $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 Injectables $0.79 $0.83 $0.83 $0.81 $0.82 $0.79 $0.81 IUDs $0.30 $0.32 $0.32 $0.30 $0.30 $0.31 $0.30 Orals - Combined $0.24 $0.32 $0.32 $0.29 $0.26 $0.27 $0.24 Orals - Progestin Only $0.29 $0.34 $0.31 $0.34 $0.33 $0.32 $0.29 Orals - Emergency $0.26 $0.37 $0.30 $0.37 $0.35 $0.26 $0.28 Price Indicator –Year 2017”, available at https://www.unfpa.org/sites/default/files/resource-pdf/ UNFPA_CYP_2017_correctedversion.pdf, “UNFPA Contraceptive Price Indicator –Year 2016”, available at http://www.unfpa.org/resources/contraceptive-price-indicator-2016, "UNFPA Con- traceptive Price Indicator - Year 2015" available at https://www.unfpa.org/sites/default/files/re- source-pdf/UNFPA_Contraceptive_Price_Indicators.pdf, “UNFPA Contraceptive Price Indicator –Year 2014”, available at http://www.unfpa.org/resources/contraceptive-price-indicator-2014 AP PE ND IC ES 37 To protect customer confidentiality, suppliers were not asked to dis- close customer information associated with shipment volumes. CHAI uses information from USAID, GHSC-PSM, and UNFPA to understand do- nor spend by the two major institutional procurers of family planning products. For more information on each of these data sources, refer to Appendix B. APPENDIX D – ESTIMATING TOTAL FP2020 DONOR-SPEND VOLUMES Going forward, CHAI will continue to work closely with the two major institutional procurers of family planning products to ensure the data provided is the most accurate and accessible for the purposes of this report. AP PE ND IC ES 38 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 Indonesia.40 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 Co- ordinating Body (BKKBN) for Indonesia were not available for 2017 and 2018 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 40. 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. 39 AP PE ND IC ES Bangladesh The Bangladesh Ministry of Health and Family Welfare (MOHFW) procured 17 million CYPs for the 2018 calendar year, as compared to 3 million CYPs for the 2017 calendar year, 8 million CYPs for the 2016 calendar year, and 13 million CYPs for the 2015 calendar year. Procure- ment contracts for product-based contraceptives from 2015 to 2018 were awarded primarily to regional and local suppliers, including (but not limited to): HLL Lifecare Limited, MSD/Organon (India) Pvt Ltd.,41 MSD B.V.42, M/S, Reneta Ltd., Popular Pharmaceuticals Ltd.,43 and Techno Drugs from Bangladesh. Only the data from a subset of these manufac- turers is included in the current calculation of the value derived from the supplier shipment data.44 By applying the same prices used for APPENDIX E – ADDITIONAL MARKETS VISIBILITY 2018 supplier shipment volumes to the volumes from the Bangladesh MOHFW procurement data, we estimated the implied value from those contracts to be $46 million for 2018, as compared to the $24 million implied by the 2018 supplier shipment data.45 A review of Bangladesh’s supply chain reports revealed that consump- tion of contraceptive products was between 12 and 14 million CYPs each year from 2014 to 2017 and was 11 million CYPs in 2018. CHAI used data from the Government of Bangladesh’s Ministry of Health and Family Welfare (MOHFW)46 for 2015, 2016, 2017, and 2018.47 41. MSD/Organon (India) Pvt Ltd. is a Merck/MSD company and therefore not a regional or local supplier. 42. MSD B.V. is a Merck/MSD company and therefore not a regional or local supplier. 43. In 2017, Incepta Pharmaceuticals supplied the Ministry of Health and Family Welfare (MOHFW) with injectables via Popular Pharmaceuticals Ltd. Source: Incepta Pharmaceuticals. 44. Manufacturers participating in this report include Merck (MSD) from the Netherlands, Incepta Pharmaceuticals from Bangladesh, and Techno Drugs from Bangladesh 45. 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. 46. 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 47. 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 2015, 2016, 2017, and 2018. 40 EXHIBIT E.1: MOHFW SUPPLY CHAIN CONTRACEPTIVE SHIPMENT RECEIPT DETAILS PRODUCT NAME SUPPLIER NAME 2015 2016 2017 2018T CONDOM ESSENTIAL DRUGS CO. LTD. 50,000,000 68,850,000 56,854,800 CONDOM Direct Relief 1,584,000 CONDOM KHULNA ESSENTIAL LATEX PLANT((KELP) 100,000,000 35,000,000 62,158,800 CONDOM UNFPA 1,195,200 10,080,000 ECP (2 TAB/PACK) M/S, RENETA LTD. 100,000 100,000 100,000 IMPLANT (2 ROD) SOCIAL MARKETING COMPANY (SMC) 17,000 35,000 IMPLANT (2 ROD) TECHNO DRUGS Ltd 385,000 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 IMPLANT (SINGLE ROD) UNFPA 200,000 INJECTABLES (DMPA IM) Helm-AG 14,000,000 INJECTABLES (DMPA IM)15 TECHNO DRUGS Ltd 2,500,000 8,100,000 5,000,000 18,250,000 INJECTABLES (DMPA IM)15 UNFPA 299,997 INJECTABLES (DMPA IM)15 USAID 1,000,000 914,800 INJECTABLES (DMPA IM)15 Popular Pharmaceuticals Ltd. 1,000,000 1,000,000 IUD (CT-380A) SARBAN INTERNATIONAL LTD. 400,000 IUD (CT-380A) SMB Corporation Of India 450,000 IUD (CT-380A) SOCIAL MARKETING COMPANY (SMC) 73,679 IUD (CT-380A) Marie Stopes Clinic 65,000 56,000 IUD (CT-380A) IPAS Bangladesh 9,500 IUD (CT-380A) UNFPA 200,000 ORAL CONTRACEPTIVE PILL (SHUKHI) HLL Lifecare Limited 22,469,025 ORAL CONTRACEPTIVE PILL (SHUKHI) M/S, RENETA LTD. 20,730,975 54,750,000 54,800,125 ORAL CONTRACEPTIVE PILL (SHUKHI) Maneesh Pharmaceuticals Limited 22,289,280 ORAL CONTRACEPTIVE PILL (SHUKHI) Popular Pharmaceuticals Ltd. 10,800,000 14,250,000 16,700,000 ORAL CONTRACEPTIVE PILL (SHUKHI) TECHNO DRUGS Ltd 1,710,720 16,700,000 ORAL PILL APON M/S, RENETA LTD. 1,000,000 3,500,000 750,000 4,000,000 AP PE ND IC ES APPENDIX E – ADDITIONAL MARKETS VISIBILITY Source: Bangladesh MOHFW, Supply Chain Management Portal, 2019. 41 India Based on India’s Ministry of Health and Family Welfare (MOHFW)48 Annual Reports for the 2018/2019 fiscal year and 2017/2018 fiscal year,49 which ends on March 31, CYPs from procured products-based methods50 totaled 37 million and 25 million respectively. While 2018/2019 CYPs represent an increase from the historic five-year low in 2017/2018, it is a decrease from the average 2013/2014 to 2015/2016 levels of 47 million CYPs. The 2018/2019 fiscal year CYPs increase from 2017/2018 fiscal year is mainly driven by an increase in IUD CYPs of 19 million from the previ- ous year, bringing IUD CYPs closer to levels seen in the 2015/2016 fiscal year; this increase in IUD CYPs was offset by a decrease of 5 million in male condoms51 CYPs. Notably, the MOHFW added injectables to its contraceptive basket in the 2017/2018 fiscal year; injectables are now available across the country. Sterilizations decreased slightly, at 3.4 million for the 2018/2019 fiscal year compared to 3.9 million performed for the 2016/2017 fiscal year. 48. Government of India, Ministry of Health and Family Welfare, "Annual Report of Department of Health & Family Welfare for the year of 2018-19", “Annual Report of Department of Health & Family Welfare for the year of 2017-18” ,“Annual Report of Department of Health & Family Wel- fare 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 49. The fiscal year for India runs from April 1 to March 31. 50. Only modern contraceptive methods from India’s MOHFW reports including male condoms, injectables, IUDs, orals, and emergency contraception are included in this analysis. 51. Condoms are reported in millions whereas all other methods are reported as “lakh” – the Indian unit of 100,000. 52. The latest reports from India referenced are from the 2016/2017 and 2017/2018 fiscal years and thus are compared to the corresponding supplier shipment data from 2016, 2017, and 2018. While the MOHFW annual report shipment volumes are based on the 2017/2018 and 2018/2019 fiscal years instead of the calendar year used in this report, by applying the same prices (Exhibit C.9) used for 2017 and 2018 supplier shipment volumes, we estimate that implied value from the annual reports is approximately $44 million in 2016/2017 fiscal year, $45 million in the 2017/2018 fiscal year, and $26 million in the 2018/2019 fiscal year, as compared to the $1 million to $2 million implied by the 2017 and 2018 supplier shipment data.52 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 APPENDIX E – ADDITIONAL MARKETS VISIBILITY 42 AP PE ND IC ES APPENDIX E – ADDITIONAL MARKETS VISIBILITY EXHIBIT E.2: ANNUAL REPORTS OF DEPARTMENT OF HEALTH & FAMLIY WELFARE (INCLUDES FULL FISCAL YEARS 2013-14 TO 2018-19) EXHIBIT E.2.1: QUANTITIES SUPPLIED TO STATES/UTS CONTRACEPTIVES 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 Condoms (In million pieces) 394 350.9 394.0 432.8 526.8 Oral Pills (In lakh cycles) 361.24 551.32 361.2 312.0 275.3 394.4 IUDs (In lakh pieces) 60.42 88.244 60.4 48.1 22.6 64.3 Tubal Rings (In lakh pairs) 19 27.145 19.0 6.4 14.6 12.4 ECP (in lakh packs) 75.8 75.8 86.1 60.8 50.4 128.0 Centchroman Contraceptive Pill (Lakh Strips) 7.1 24.0 170.3 Injectable Contraceptive (Lakh Doses) 27.0 Pregnancy Test Kits (in lakhs) 100.14 122.4 100.1 124.6 180.4 187.0 EXHIBIT E.2.2 PERFORMANCE OF SOCIAL MARKETING PROGRAMME IN THE SALE OF CONTRACEPTIVE CONTRACEPTIVES 2013-14 2014-15 2015-16 2016-17 2017-18 2018-19 Condoms (Million pieces) 698.33 683.93 482.2 399.0 483.2 435.2 Oral Pills (Social Marketing) (lakh cycles) 290.27 276.44 152.8 194.3 205.3 79.3 SAHELI (in Lakh tablets) 279.35 314.6 311.2 321.8 322.8 0.0 EXHIBIT E.3: 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 Sources: [Exhibit E.2] India MOHFW Annual Report, 2015-2016, 2016-2017, 2017-2018, 2018-2019. [Exhibit E.3] [1] USAID Assessment, 2006; [2] Historical Supplier Shipment Data 43 APPENDIX E – ADDITIONAL MARKETS VISIBILITY Indonesia Data from public tender documents published by the National Family Planning Coordinating Body (BKKBN)53 indicates an increase in CYPs procured from product-based methods54, from 17 million in 201555 to 23 million in 2016.56 By applying the same prices 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.4] BKKBN Tender Documents, 2015. [Exhibit E.5] BKKBN Tender Documents, 2016. 53. Family Planning and Reproductive Health Unit, National Family Planning Coordinating Body (BKKBN) 54. Procured methods from Indonesia’s MOHFW reports include implants, injectables and orals. 55. Tender Winner Announcement documents accessed June 2017 at http://lpse.bkkbn.go.id/ eproc/ 56. Tender Winner Announcement documents accessed June 2017 at https://e-katalog.lkpp. EXHIBIT E.4: 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.5: 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 go.id/backend/katalog/list_produk/63 57. The 2016 tender documents indicate the manufacturer; however, the 2015 documents refer only to distributors. 58. 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 Tunggal.57 Among them, PT Tunggal is the only supplier currently partici- pating in this report, as part of the GEMs Caucus.58 44 APPENDIX F – 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 45 APPENDIX G – 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 LARC LONG-ACTING REVERSIBLE CONTRACEPTIVES MOH MINISTRY OF HEALTH MOHFW MINISTRY OF HEALTH AND FAMILY WELFARE RHI REPRODUCTIVE HEALTH INTERCHANGE RHSC REPRODUCTIVE HEALTH SUPPLIES COALITION SMO SOCIAL MARKETING ORGANIZATION UNFPA UNITED NATIONS POPULATION FUND USAID UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT AP PE ND IC ES

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