Global Market Visibility Project: Family Planning Market Report

Publication date: 2015

1 FAMILY PLANNING MARKET REPORT M A Y 2 0 1 5 A C K N O L W E D G E M E N T S : This report was produced as part of the FP2020 Global Markets Visibility Project that CHAI, in conjunction with the Reproductive Health Supplies Coalition (RHSC) and the FP2020 Market Dynamics Working Group (FP2020 MDWG), launched in early 2014. The shipment data provided by suppliers was pivotal to addressing information gaps and constructing a more comprehensive view of the reproductive health commodities market. We would like to thank participating suppliers (Bayer, CR Zizhu, Cupid, Famy Care, Helm-Fresenius, Merck/MSD, Pfizer, Pregna, PT Tunggal, Shanghai Dahua, and SMB) as well as our partners, the Concept Foundation and i+solutions, for their support in collecting and aggregating data from the Generic Manufacturers for Reproductive Health (the GEMS Caucus) and female condom manufacturers, respectively. We are also grateful to our colleagues in the FP2020 MDWG, Coordinated Supply Planning Group, UNFPA, USAID, and JSI | DELIVER for their invaluable feedback in the development of various market analyses. 2 The FP2020 market grew from US$277 million in 2011 to US$361 million in 2012 and then declined to US$280 million in 2013. The FP2020 market grew 30 percent year-over-year in 2012, largely driv- en by a shift in method mix in favor of injectables and implants, which have higher unit costs relative to other methods. The implant price reductions in 2013, combined with decreased purchase volumes of male condoms, injectables, IUDs, and orals, reduced the 2013 FP2020 market size to 2011 levels. (Exhibit 1) Short-acting methods (including condoms, injectables, and oral contraceptives) continue to dominate the FP2020 market despite a significant increase in implant purchase volumes. Short-acting methods represented 80 percent of the total FP2020 mar- ket value in 2013, but represented 62 percent of couple-years of protec- tion (CYPs) supplied.2 Implant purchase volumes have nearly doubled between 2011 and 2013 to 6 million units annually. The estimated spend on implants and IUDs, long-acting and reversible contraceptives (LARCs), was US$55 million in 2013, representing 20 percent of the total FP2020 market value and 38 percent of CYPs provided. (Exhibits 1–3) Seven countries represented half of the total FP2020 market value in 2013: Bangladesh, Uganda, Ethiopia, Kenya, Pakistan, Zimbabwe, and Nigeria. (Exhibit 7) Donors spent US$203 million, accounting for 73 percent of total spending on family planning products, in 2013. Donors reporting to the Reproductive Health Interchange (RHI) in- creased total funding for contraceptives in the FP2020 countries from US$171 million to US$224 million between 2011 and 2012, then decreased total funding to US$203 million in 2013. However, the CYPs supplied annually by donors increased every year from 2011 to 2013. (Exhibit 9) Although FP2020 has reported an increase in total women on modern methods from 265 million in 2012 to 274 million in 2013, this increase could not be confirmed using supplier-re- ported purchases by institutional buyers and government-af- filiated procurers.3 Visibility into the commercial sector of the FP2020 market and ministry of health (MOH) procurements supplied by other manufacturers is required to reconcile these differences. (Exhibit 11) AFTER GROWING FROM 2011 TO 2012, THE CONTRACEPTIVE MARKET IN THE 69 FP2020 COUNTRIES DECLINED FROM US$361 MILLION IN 2012 TO US$280 MILLION IN 20131 1. The FP2020 market is based on volumes purchased by institutional buyers and MOH or government-affiliated procurers from RHI (male and female condoms) and historical supplier-re- ported shipment data (female condoms, implants, injectables, IUDs, and orals) for FP2020’s 69 focus countries, defined as countries with a 2010 gross national per capita annual income (GNI) less than or equal to US$2,500. Although South Africa made an FP2020 commitment, its GNI was greater than US$2,500 per year. 2. Couple-years of protection is the estimated protection provided by a family planning method during a one-year period, based on the volumes of all contraceptives sold or distributed to clients during that period. This report relies upon USAID CYP conversion factors; 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. 3. Family Planning 2020, “FP2020 Partnership in Progress, 2013–2014,” December 2014, pp. 100–101, 127. MALE CONDOM SHIPMENTS 2011 2012 2013 1.62B 1.84B 1.64B EXHIBIT 1: TOTAL FP2020 MARKET SIZE (USD) EXHIBIT 2: TOTAL FP2020 MARKET IN TERMS OF VOLUMES (MALE CONDOMS SEPARATED) Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, December 2014; [3] UNFPA Contraceptive Price Indicator, 2011–2013; [4] PPMR Data, September 2014; [5] USAID, “Couple Years of Protection (CYP),” April 2014; [6] IAP Implant Price. $0M $100M $200M $300M $400M Condoms (Male) Condoms (Female) InjectablesOralsIUDSImplants 201320122011 $45M $11M $60M $99M $4M $58M $54M $11M $89M $100M $4M $103M $49M $15M $78M $83M $3M $52M Condoms (Male) Condoms (Female) InjectablesOralsIUDsImplants 201320122011 To ta l M ar ke t Si ze (M ill io ns U SD ) 0M 100M 200M 300M 400M 500M Condoms - Female Injectables Orals IUDS Implants 201320122011 21M 73M 314M 10M 3M 19M 109M 329M 9M 6M 28M 94M 286M 8M 6M Condoms (Female) InjectablesOralsIUDsImplants Vo lu m es S hi pp ed to F P2 02 0 Co un tr ie s (M ill io ns ) 3 Supplier-reported volumes for female condoms, implants, in- jectables, IUDs, and orals and RHI-reported shipment data for female condoms and male condoms are the primary sources used to estimate the FP2020 market size.4 These data sets include MOH or government-affiliated procurement and donor-funded purchases (USAID, UNFPA, SMOs, etc.) and do not include products sold through commercial channels. In addition, the data does not include suppliers that are not participating in the FP2020 Global Markets Visibility Project or included in RHI. CHAI is still seeking data from suppliers in countries such as India and Indonesia where laws favor local production over imports.⁵ Contraceptive suppliers who fall outside of the purview of donors and NGOs in the FP2020 MDWG are still being identified, and their data is not yet included. The identified FP2020 market size increased 30 percent from 2011 to 2012 and then declined 23 percent year-over-year in 2013. The FP2020 market size increased from US$277 million to US$361 million from 2011 and 2012. Increased spending on injectables and implants was the primary driver of growth in the FP2020 market between 2011 and 2012. Injectable shipment volumes increased from 73 million to 109 million from 2011 and 2012, translating into a nearly US$30 million increase in annual expenditures. Implant shipment volumes increased from 3.1 million to 5.8 million from 2011 and 2012, resulting in a greater than US$45 million increase in expenditures. The implant price reductions in 2013, combined with the de- cline in purchase volumes of male condoms, injectables, IUDs, and orals, reduced the FP2020 market size in 2013 to US$280 million. The 50 percent reduction in the price of implants in 2013 halved the size of the implant market. However, the volume of implants purchased continued to increase from 5.8 million to 6.1 million from 2012 to 2013. A decline in purchase volumes and spending on male condoms, inject- ables, IUDs, and orals further contributed to the reduction in market size between 2012 and 2013. 4. For the female condom market, historical supplier-reported shipment data from Cupid and i+solutions procurement volumes were supplemented with RHI shipment volumes for suppliers not participating in the FP2020 Global Markets Visibility Project. i+solutions confirmed its procurement volumes associated with the Universal Access for Female Condom (UAFC) Joint Programme were not reported in RHI. 5. Armand, Françoise, “Improving Hormonal Contraceptive Supply: The Potential Contribution of Manufacturers of Generic and Biosimiliar Drugs,” Private Sector Partnerships-One Project, Abt Associates Inc., January 2006, p. 11. Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, December 2014; [3] UNFPA Contraceptive Price Indicator, 2011–2013; [4] PPMR Data, September 2014; [5] USAID, “Couple Years of Protection (CYP),” April 2014; [6] IAP Implant Price. Between 2011 and 2013, there was a shift in the method mix towards implants and injectables. In comparison to 2011, an additional US$18 million was spent on inject- ables in 2013. Although the implant market size has declined, this was largely driven by the reductions in the price of implants in 2013, as the purchase volumes of implants have nearly doubled between 2011 and 2013. Consistent with volume and spending trends, the number of women utilizing product-based methods grew from 85 million to 101 million from 2011 to 2012 and declined to 90 million in 2013. EXHIBIT 3: TOTAL FP2020 MARKET IN TERMS OF USERS 0 M 10 M 20 M 30 M 40 M 50 M 60 M 70 M 80 M 90 M 100 M 201320122011 Condoms (Male) Condoms (Female) InjectablesOralsIUDsImplants W om en in F P2 02 0 Co un tr ie s U si ng Pr od uc t- Ba se d M od er n M et ho ds 12M 0.2M 24M 13M 30M 6M 14M 0.2M 35M 15M 26M 10M 12M 0.3M 30M 13M 23M 11M 201320122011 4 The FP2020 market for LARCs has declined from US$62 million in 2011 to US$55 million in 2013, largely driven by a decline in the implant purchase price per unit. As a result, the market share of LARCs has decreased from 22 percent to 20 percent over the same period. Although LARCs represented close to 40 percent of users supported, the commodity spend on LARCs at US$55 million in 2013 was less than a quarter of the total FP2020 market value. This is because the weighted average cost per CYP of LARCs is 81 per- cent lower than that of short-acting methods.⁶ Based on the aggregated shipment data, the method mix in user terms has remained relatively stable between short-act- ing methods and LARCs between 2011 and 2013. Short-acting methods continue to dominate market share in terms of users at 62 percent in 2013. Among the short-acting methods, inject- ables exhibited the greatest change with an increase in share of users, from 28 percent to 34 percent between 2011 and 2013. Among LARCs, there was a decrease in IUD share from 35 percent to 26 percent and in- crease in implant share from 7 percent to 12 percent from 2011 to 2013. SHORT-ACTING METHODS CONTINUE TO DOMINATE THE FP2020 MARKET DESPITE A SIGNIFICANT INCREASE IN IMPLANT PURCHASE VOLUMES 6. The weighted average cost per CYP for LARCs and short-acting methods is weighted by the users supported by each method for short-acting methods and LARCs. 7. Cost per CYP is calculated by multiplying units per CYP by unit price by method; CYP is calculated by method using the average USAID published CYP factors; Because there were several types of implants (3-, 4-, and 5-year) and injectables (1-, 2-, and 3-month), a weighted average CYP was calculated for implants and injectables using total volumes by product type; Unit price is based on the average USAID and UNFPA price as reported in UNFPA’s 2013 Con- traceptive Price Indicator; Cost of orals is the average of USAID and UNFPA prices via UNFPA’s 2013 Price Indicator for combined, progestin-only, and emergency oral contraceptives; The price of implants is based on the Implant Access Program (IAP) price; Average units per CYP and unit costs presented are rounded. EXHIBIT 4: COST PER COUPLE YEARS OF PROTECTION BY METHOD (USD)7 METHOD UNITS PER CYP UNIT COST COST PER CYP Condoms (Female) 120.0 $0.54 $65.04 Condoms (Male) 120.0 $0.03 $3.56 Implants 0.3 $8.50 $2.84 Injectables 4.1 $0.83 $3.41 IUDs 0.2 $0.43 $0.09 Orals 16.7 $0.35 $5.75 EXHIBIT 5: FP2020 CONTRACEPTIVE METHOD MIX (IN TERMS OF USERS) AND MARKET SHARE (IN TERMS OF DOLLARS)8 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, December 2014; [3] UNFPA Contraceptive Price Indicator, 2011–2013; [4] PPMR Data, September 2014; [5] USAID, “Couple Years of Protection (CYP),” April 2014; [6] IAP Implant Price. $0 $1 $2 $3 $4 $5 $6 $7 Condoms (Male) Injectables Orals IUDs Implants $3.41 $5.75 $3.56 $0.09 $2.84 Cost per CYP 0% 20% 40% 60% 80% 100% 201320122011 14% 0.2% 28% 16% 35% 7% 14% 0.2% 35% 15% 26% 10% 14% 0.3% 34% 14% 26% 12% Condoms (Male) Condoms (Female) InjectablesOralsIUDsImplants M et ho d M ix 2011 2012 2013 Condoms (Male) Condoms (Female) InjectablesOralsIUDsImplants 0% 20% 40% 60% 80% 100% 201320122011 16% 4% 22% 36% 2% 21% 15% 3% 25% 28% 1% 29% 17% 5% 28% 30% 1% 18% M ar ke t Sh ar e 2011 2012 2013 8. Market share is the percentage of total value of shipment volumes in a market captured by a certain contraceptive method; Method mix is the percentage distribution of contraceptive users by method. 5 Bangladesh, Uganda, Ethiopia, Kenya, Pakistan, Zimbabwe, and Nigeria represented 50 percent of the total FP2020 market from 2011 to 2013. From 2011 to 2013, total spending on family planning commodities across these seven countries averaged US$160 million annually. The top 20 countries in terms of users exhibit wide variation in method mix. In countries such as Egypt, Vietnam, India, Indonesia, Uzbekistan, and Tanzania, LARCs constituted the majority of the product-based method mix in 2013. In all of these countries except Tanzania, IUDs dominated purchase volumes. However, it is important to note that some of these countries may also procure nationally from suppliers that may not be participating in the FP2020 Global Markets Visibility Project. As a result, the analysis of users by method may not comprehensively reflect each country’s product-based modern method mix. SEVEN COUNTRIES REPRESENTED HALF OF THE FP2020 MARKET VALUE IN 2013 9. Market size is the total value of shipment volumes calculated by multiplying average prices by total shipment volume by method; The “Unknown FP2020 Region” represents the proportion of shipments to procurer warehouses where the final FP2020 destination is unknown. Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, December 2014; [3] UNFPA Contraceptive Price Indicator, 2011–2013; [4] PPMR Data, September 2014; [5] USAID, “Couple Years of Protection (CYP),” April 2014; [6] IAP Implant Price. EXHIBIT 6: TOTAL FP2020 MARKET SHARE BY REGION9 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 201320122011 14% 44% 4% 2% 38% 9% 56% 3% 2% 30% 9% 57% 4% 2% 29% Unknown FP2020 Region Sub-Saharan Africa Middle East & North Africa Latin America & Caribbean Asia & Pacific Pe rc en ta ge o f T ot al M ar ke t Si ze 2011 2012 2013 6 50% Other FP2020 Countries 12% 8% 7% 7% 6% 6% 4% Bangladesh Uganda Ethiopia Kenya Pakistan Zimbabwe Nigeria $0 M $40 M $80 M $120 M $160 M $200 M $240 M $280 M $320 M $360 M $400 M 201320122011 Other FP2020 Countries Top 7 Countries To ta l M ar ke t S iz e (M ill io ns U SD ) $145 M $132 M $194 M $167 M $140 M $140 M 2011 2012 2013 EXHIBIT 7: TOP MARKETS AND OTHER FP2020 MARKETS EXHIBIT 7: TOP 7 COUNTRIES IN TERMS OF MARKET SIZE EXHIBIT 8: TOP 20 COUNTRIES IN TERMS OF USERS, 2013 To p 20 C ou nt ri es Male & Female Condoms InjectablesOralsIUDsImplants 0 100000020000003000000400000050000006000000700000080000000 M 1 M 2 M 3 M 4 M 5 M 6 M 7 M 8 M Bangladesh Egypt Arab Rep Uganda Pakistan Ethiopia Kenya Vietnam Zimbawe Yemen Rep India Uzbekistan Madagascar Indonesia Nigeria Mozambique Congo Dem Rep Malawi Zambia Tanzania Philippenes 7 IN 2013, DONOR-FUNDED PROCUREMENTS SUPPORTED 65 MILLION WOMEN USING PRODUCT-BASED METHODS. USAID AND UNFPA, THE TWO MAJOR INSTITUTIONAL PROCURERS OF FAMILY PLANNING COMMODITIES IN LMICS, HAVE SHIFTED THEIR METHOD MIX IN FAVOR OF LARCS. Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, December 2014; [3] UNFPA Contraceptive Price Indicator, 2011–2013; [4] PPMR Data, September 2014; [5] USAID, “Couple Years of Protection (CYP),” April 2014; [6] IAP Implant Price. In 2013, donor-funded procurements supported 65 million women using product-based modern methods, representing 73 percent of total users implied by the supplier-reported shipment data. Based on donor-funded shipments reported into RHI, donors increased annual funding for commodities in the FP2020 countries from US$171 million to US$224 million from 2011 to 2012 and then decreased funding to US$203 million in 2013. The decline in commodity funding between 2012 and 2013 corresponded with a reduction in implant prices and male condom purchase volumes. Donors have significantly increased total procurement of im- plants and female condoms. Between 2011 and 2013, annual implant shipments to FP2020 69 coun- tries have increased over 200 percent from 1.8 million to 6.0 million, resulting in an estimated 10.8 million women using donor-funded implants in 2013; annual female condom shipments have increased almost 50 percent from 17 million to 26 million from 2011 to 2013, re- sulting in over 200,000 women using female condoms. However, in 2013, 74 percent of donor commodity spend was on short-acting methods. Male condoms, injectables, and orals each represented approximately a quarter of the 2013 donor commodity spend. While USAID has remained fairly stable in total users support- ed, UNFPA has more than doubled its commodity support in terms of users between 2011 and 2013. Relative to other procurers and donors, UNFPA has more than doubled its spending on commodities between 2011 and 2013. This increase in spending corresponds with an increase in commodity shipments and users supported by UNFPA across almost all methods. The purchasing patterns of USAID and UNFPA reveal a shift in method mix in favor of LARCs. For USAID, the implied method mix of family planning procurements shows an increase in LARC share from 24 percent of users in 2011 to 31 percent in 2013, driven by increased funding for IUDs. For UNFPA, LARCs increased from 40 percent of the method mix in 2011 to 49 percent in 2013, driven by an increase in implant purchase volumes. The increase in the share of IUDs provided through USAID coincided with a decrease in the percentage of users receiving IUDs through UNFPA from 2011 to 2013. 0 M 20 M 40 M 60 M 80 M 100 M 201320122011 M ill io ns o f W om en (F P2 02 0 co un tr ie s) U si ng P ro du ct -B as ed M od er n M et ho ds 28 M 35 M 15 M 7 M 25 M 40 M 25 M 10 M 26 M 24 M 34 M 5 M Other Global Markets Visibility Volumes Other Donor-funded Donor-funded UNFPA-procured USAID-funded 2011 2012 2013 Other Global Markets Visibility Volumes Other Donor-funded Donor-funded UNFPA-procured USAID-funded $0 M $100 M $200 M $300 M $400 M 201320122011 Co m m od it y Sp en di ng (M ill io ns U SD ) $106 M $106 M $41 M $24 M $93 M $138 M $92 M $38 M $78 M $77 M $110 M $14 M 2011 2012 2013 EXHIBIT 9: KNOWN-DONOR-SUPPORTED USERS & COMMODITY COSTS 8 25% 0.3% 39% 11% 17% 7% 22% 0.3% 45% 10% 16% 7% 22% 0.2% 37% 10% 24% 7% 14% 0.3% 37% 8% 35% 5% 11% 0.2% 29% 7% 35% 18% 12% 0.5% 32% 7% 24% 25% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 201320122011201320122011 Condoms (Male) Condoms (Female) InjectablesOralsIUDsImplants USAID UNFPA 2011 2012 2013 2011 2012 2013 EXHIBIT 10: USER METHOD MIX IMPLIED BY USAID & UNFPA PROCUREMENT 9 THE FIRST LOOK AT SUPPLIER-PROVIDED SHIPMENT DATA SUGGESTS A SIGNIFICANT GAP BETWEEN FP2020 TARGETS AND PRODUCT SUPPLIED TO THE FP2020 COUNTRIES. Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, December 2014; [3] PPMR Data, September 2014; [5] USAID, “Couple Years of Protection (CYP),” April 2014; [6] FP2020 Progress Report, December 2014. 10. Family Planning 2020, “FP2020 Partnership in Progress, 2013–2014,” November 2014, pp. 93, 100–101, 127; FP2020 updated 2012 estimates of total women on reproductive age on mod- ern methods in the 69 FP2020 priority countries from 258 million to 265 million. FP2020 has reported an increase in total women on modern methods from 265 million in 2012 to 274 million in 2013.10 If we assume that ap- proximately 110 million of these women were using sterilization in both 2012 and 2013, then 155 million women in 2012 and 164 million women in 2013 were using product-based methods.11 However, the supplier-re- ported shipment data accounts for only half of total FP2020 estimated product-based users in 2012 and 2013. Additionally, the supplier-report- ed shipment data showed a drop in the total number of users based on purchases by institutional buyers and MOH/government-affiliated procurers over the same period. The discrepancy between total FP2020-reported users on product-based modern methods—which is derived from household survey data—and the estimates based on shipment data presents a challenge in measuring progress towards meeting the FP2020 goals. 11. Family Planning 2020, “Technical Note: Data Sources and Methodology for Developing the 2012 Baseline, 2020 Objective, Impacts and Costings,” June 2012, p. 10. 12. Sterilization does not have associated product costs but does have procedure costs. For 2012 and 2013, the sum of the individual stacked bars may differ slightly from total users due to rounding. EXHIBIT 11: MILLIONS OF WOMEN USING MODERN METHODS AND FP2020 GOALS12 54M 50M 25M 25M 110M 88M 29M 34M 26M 110M 176M 110M 190M 110M 204M 110M 221M 110M 238M 110M 255M 110M 275M 110M 265 M 274 M 286 M 300 M 314 M 331 M 348 M 365 M 385 M M ill io ns o f W om en (F P2 02 0 co un tr ie s) u si ng M od er n M et ho ds 0 M 50 M 100 M 150 M 200 M 250 M 300 M 350 M 400 M 450 M 202020192018201720162015201420132012 MOH-, NGO-, and Other-funded Donor-funded UNFPA-procured USAID-fundedSterilization FP2020 GoalsDifference Between FP2020 Users & Users Implied by Supplier-Reported Shipments Product Users: Unidentified Funding & Supply Source CHAI is currently investigating the possible gaps in supplier-reported shipment data. Under-reporting of total shipments to FP2020 countries could stem from: • Commercial sector sales from all suppliers participating in the FP2020 Global Markets Visibility Project, as the current supplier-re- ported data covers primarily public/NGO sector volumes • National government procurements from domestic or regional manufacturers that do not supply to the international donor-fund- ed markets Support from NGOs, donors, and suppliers to improve FP2020 market visibility would enable the family planning community to better quantify progress and identify strategies to meet the goal of providing an additional 120 million women access to family planning products and services by 2020. 10 APPENDIX A 13. Other FP2020 shipment volumes include shipments to procurer (USAID, UNFPA, SMOs) warehouses in non-FP2020 countries, such as Denmark, Netherlands, Switzerland, UK, and US. Although these volumes were shipped to non-FP2020 countries, the end shipment destination of these volumes would likely be the FP2020 69. As a result, these non-FP2020 69 volumes were FP2020 69 MARKET VOLUMES BY METHOD AND COUNTRY 2011–201313 EXHIBIT A.1: FP2020 69 CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2011 COUNTRY CONDOMS - FEMALE CONDOMS - MALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 2,000 19,572,826 - 1,395,200 67,000 807,674 Bangladesh - 112,426,800 422,109 18,984,000 475,000 138,631,121 Benin 200,000 13,049,064 48,600 10,300 21,000 - Bhutan - 2,880,000 - 475,200 1,600 88,002 Bolivia 16,000 1,449,360 2,350 - 35,000 210,000 Burkina Faso 3,000 - 2,000 - - 1,597,501 Burundi 400,000 14,053,200 44,600 - 39,000 33,335 Cambodia - 1,764,000 19,000 - 20,000 - Cameroon 1,602,000 - 11,500 - 31,000 50,200 Central African Republic 13,000 5,997,600 500 200 - 91,403 Chad 50,000 1,497,600 15,000 52,000 1,000 - Comoros - 1,008,000 1,024 26,800 100 - Congo Dem Rep 2,200,000 70,999,800 8,500 350,000 26,000 1,295,595 Congo Rep 91,000 20,546,352 10 1,412,400 500 391,905 Cote d'Ivoire 291,000 34,676,400 - 630,800 10,000 2,613,145 Djibouti 20,000 570,240 - - 1,500 - Egypt Arab Rep - 50,400 17,500 4,780,000 2,135,000 3,000,000 Eritrea 100,000 7,704,000 5,100 - 5,500 61,672 Ethiopia - 146,223,384 382,704 5,471,200 420,000 7,752,440 Gambia 1,000 1,584,000 100 10,000 500 433,337 Ghana - 4,197,000 57,674 3,044,000 - - Guinea 100,000 7,682,400 1,000 546,240 11,000 233,335 Guinea-Bissau 5,000 1,440,000 5,000 - - 5,001 Haiti - 54,534,096 - 976,800 - 200,001 Honduras - 19,202,400 - 148,000 22,453 943,300 India - - - 193,201 1,959,570 8,611,743 Indonesia 210,000 - - - 316,721 50,001 Iraq - - - - 75,000 2,625,000 Kenya 2,300,000 46,566,720 505,209 1,370,032 - 15,136,914 Korea Dem Rep - 1,267,200 - - 36,150 139,500 Kyrgyz Republic - 5,169,600 - - 160,000 - Lao PDR - 8,474,208 6,200 650,000 - 922,112 Lesotho 157,000 4,167,936 2,000 65,000 - 63,000 Liberia 100,000 22,048,800 3,000 423,200 - - Madagascar 144,000 23,710,800 124,318 1,913,600 4,500 280,000 included in the total shipments to FP2020 69 countries after it was confirmed that the specific non-FP2020 69 volumes were associated with institutional purchases. 11 EXHIBIT A.1: FP2020 69 CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2011 COUNTRY CONDOMS - FEMALE CONDOMS - MALE IMPLANTS INJECTABLES IUDS ORALS Malawi - 10,326,001 46,452 540,000 - 50,000 Mali - - 53,600 1,292,625 41,501 - Mauritania 20,000 3,600,000 3,728 6,000 5,500 533,336 Mongolia 25,000 9,992,880 1,000 - - 321,000 Mozambique 1,004,000 95,394,000 5,010 1,241,400 41,000 5,393,262 Myanmar 340,000 56,184,712 4,000 - - 6,659,699 Nepal - 33,627,000 - 327,600 10,000 250,000 Nicaragua - 13,356,000 - 332,100 50,000 842,001 Niger - - 4,612 814,000 2,800 400,000 Nigeria 1,232,000 78,269,652 32,900 3,157,500 209,000 1,055,335 Pakistan - 249,421,800 25,300 5,862,000 200,000 400,299 Papua New Guinea 100,000 1,200,000 2,000 - - 1,663,200 Philippines - 640,800 - - - 6,639,745 Rwanda 51,000 30,211,488 - 1,768,400 18,600 - Sao Tome and Principe 6,000 2,181,600 - 852,075 200 47,129 Senegal 442,000 11,400,000 10,350 - 3,000 220,000 Sierra Leone - 4,240,800 91,700 - 35,500 1,166,269 Solomon Islands 31,000 - - - - 24,000 Somalia - - - - - - South Sudan - - - - - - Sri Lanka - 777,600 10,000 - 80,000 2,125,000 Sudan - 14,752,344 3,500 - 2,000 1,167,875 Tajikistan 15,000 10,095,072 5,440 - 150,000 - Tanzania 825,000 29,766,456 240,104 6,176,400 25,000 1,410,170 Timor-Leste - 57,600 1,100 - 3,500 145,002 Togo 7,000 14,392,368 16,500 - 6,400 12,663 Uganda 1,607,000 82,119,600 86,688 2,089,800 83,785 303,040 Uzbekistan 35,000 5,414,112 - - 1,500,000 600,000 Vietnam - 15,000,000 9,000 1,180,000 1,772,000 - West Bank and Gaza - 4,521,600 - - - - Western Sahara - - - - - - Yemen Rep - 829,440 6,625 2,001,875 30,000 3,971,120 Zambia 612,000 56,607,168 - 1,544,200 - 748,000 Zimbabwe 6,185,000 123,876,000 61,900 782,500 2,600 14,836,223 Other FP2020 Shipments 6,000 6,336,864 692,800 385,700 140,100 76,285,355 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, December 2014. APPENDIX A 12 EXHIBIT A.2: FP2020 69 CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2012 COUNTRY CONDOMS - FEMALE CONDOMS - MALE 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 40,000 21,606,400 16,500 - 19,000 - Bhutan 2,000 3,456,000 - 70,000 - 97,899 Bolivia 35,000 - 25,300 - 6,000 3,000 Burkina Faso 2,000 16,741,200 117,100 1,369,900 16,500 2,348,935 Burundi 160,000 5,652,000 120,000 996,000 175,000 608,160 Cambodia 3,000 748,656 29,676 307,600 58,650 1,097,838 Cameroon 410,000 3,162,000 12,300 - 20,000 17,840 Central African Republic 332,000 3,002,400 13,600 198,400 1,000 1,031,664 Chad - - 25,800 30,000 3,000 - Comoros 12,000 - 500 15,000 - 17,199 Congo Dem Rep 4,230,000 146,577,600 46,800 1,344,000 39,000 4,210,965 Congo Rep 156,000 6,998,400 300 800,000 - - Cote d'Ivoire 400,000 37,080,000 16,456 700,000 - 2,455,000 Djibouti 5,000 499,680 - - 500 96,000 Egypt Arab Rep - 2,185,920 45,000 5,000,000 338,000 4,746,366 Eritrea - - 100 - - 21,600 Ethiopia 10,000 173,877,714 1,471,188 16,429,200 257,200 8,545,593 Gambia - - 5,000 1,000 - 24,000 Ghana - 7,605,000 196,460 2,172,000 - 120,000 Guinea 201,000 4,328,640 7,000 713,000 2,600 1,650,800 Guinea-Bissau - 720,000 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 - 691,900 19,400 1,810,800 India - - - 134,494 2,973,600 5,750,000 Indonesia 250,000 - - - 588,850 - Iraq - - - - - 3,252,000 Kenya - 150,768,000 176,556 9,631,025 25,000 4,503,281 Korea Dem Rep - 2,592,000 - 51,000 30,000 351,999 Kyrgyz Republic 399,000 26,236,800 - 5,600 255,000 482,880 Lao PDR 10,000 2,865,600 1,600 605,000 13,000 2,676,480 Lesotho 204,000 1,699,200 - 110,000 - - Liberia - 6,186,945 18,000 - - 4,860 Madagascar 515,000 3,002,400 174,336 2,896,200 - 2,861,680 Malawi 2,910,000 19,656,960 182,744 4,922,400 6,000 125,791 Mali 24,000 6,433,920 55,000 168,800 18,000 2,314,375 Mauritania - - - 13,400 - - Mongolia 10,000 6,048,000 5,120 120,000 - 652,797 Mozambique 1,500,000 96,978,960 30,000 2,490,000 - 6,419,170 Myanmar 365,000 9,440,112 - 1,501,600 18,000 6,705,458 Nepal 15,000 66,400,720 88,000 237,600 104,600 - Nicaragua - 4,229,280 - 450,400 11,896 822,055 Niger - 14,400 3,108 200,600 10,000 740,850 APPENDIX A 13 EXHIBIT A.2: FP2020 69 CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2012 COUNTRY CONDOMS - FEMALE CONDOMS - MALE IMPLANTS INJECTABLES IUDS ORALS Nigeria 677,000 199,169,440 328,212 14,321,300 872,634 2,235,777 Pakistan 10,000 252,501,000 70,768 857,600 90,700 226,701 Papua New Guinea 300,000 - 26,500 800,000 600 6,335 Philippines 100,000 2,001,600 1,536 200,000 447,514 14,565,234 Rwanda - 15,674,568 20,060 776,400 - 105,000 Sao Tome and Principe 11,000 1,677,600 6,100 15,000 5,000 125,400 Senegal - 13,965,000 77,056 1,478,400 14,000 1,002 Sierra Leone 278,000 1,119,000 - 250,000 15,990 739,073 Solomon Islands - - - - - - Somalia - - 2,000 - - 20,000 South Sudan - - 5,004 - - - Sri Lanka 2,000 - 74,800 250,000 1,800 2,060,000 Sudan - 5,635,968 25,040 - 9,000 3,968,200 Tajikistan 10,000 1,785,600 - 41,500 140,000 432,480 Tanzania 1,408,000 51,724,408 351,500 4,155,900 47,000 2,105,540 Timor-Leste - 2,592,000 5,450 - 2,000 128,571 Togo 10,000 42,885,408 26,000 322,400 - 27,000 Uganda - 87,214,536 396,829 6,249,200 76,896 99,400 Uzbekistan - 3,600,000 - 445,000 800,000 1,121,280 Vietnam 49,000 52,546,800 23,976 900,000 800,000 138,999 West Bank and Gaza - - - - - - Western Sahara - - - - - - Yemen Rep - 3,801,888 24,000 180,000 95,000 3,443,504 Zambia 2,217,000 38,674,440 38,300 2,010,800 - 1,655,200 Zimbabwe 1,696,000 94,452,000 113,600 634,200 6,050 14,254,948 Other FP2020 Shipments 146,000 14,839,200 721,200 10,000 77,400 68,012,790 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, December 2014. APPENDIX A 14 EXHIBIT A.3: FP2020 69 CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2013 COUNTRY CONDOMS - FEMALE CONDOMS - MALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 5,000 23,181,600 - 1,550,000 - 17,001 Bangladesh 5,000 10,102,800 - 14,200,000 - 76,298,840 Benin 64,000 6,580,800 44,200 32,400 32,000 180,000 Bhutan - 295,200 - - 2,000 126,420 Bolivia 125,000 3,335,760 34,500 500,000 70,000 429,840 Burkina Faso - 1,411,200 257,196 215,650 28,000 565,200 Burundi - 20,833 - 1,000,000 - 574,080 Cambodia - 2,160,000 51,399 - 2,000 4,300,008 Cameroon 1,600,000 - 30,300 12,800 57,659 1,494,720 Central African Republic 582,000 10,036,800 6,000 183,000 1,500 1,003,797 Chad 150,000 1,267,200 44,100 628,400 13,000 2,701,920 Comoros - 1,252,800 1,600 93,300 500 48,720 Congo Dem Rep 2,349,000 79,405,344 187,168 1,219,300 118,000 2,384,472 Congo Rep 150,000 - 800 273,500 500 2,457,988 Cote d'Ivoire 100,000 18,316,800 14,000 240,000 2,500 4,584,370 Djibouti 5,000 2,268,000 - 7,600 500 8,640 Egypt Arab Rep - 100,800 10,801 1,000,164 2,340,100 - Eritrea - - 600 - - 50,400 Ethiopia 50,000 75,766,296 981,740 6,159,396 160,000 15,082,178 Gambia 10,000 1,000,800 5,000 110,000 - 253,160 Ghana - 34,302,000 144,348 1,025,500 10,000 451,280 Guinea 20,000 9,050,400 13,000 - 4,000 - Guinea-Bissau 17,000 1,749,600 21,400 20,600 5,500 42,840 Haiti - 51,940,800 1,700 1,646,400 2,000 223,920 Honduras 3,000 11,505,600 5,056 670,000 - 1,879,920 India - - - 18,260 650,800 17,671,399 Indonesia - - 113,500 - 727,409 - Iraq - - - - - 3,000,000 Kenya 776,000 345,600 635,043 12,635,755 1,250 6,269,302 Korea Dem Rep - 2,462,400 - - 15,000 96,000 Kyrgyz Republic - 5,299,200 - 15,000 - 570,300 Lao PDR - 655,200 - 279,200 5,000 178,962 Lesotho 200,000 13,392,000 100 120,000 15,000 238,800 Liberia 71,000 17,400,000 15,200 244,800 - 400,320 Madagascar 583,000 4,398,768 239,980 5,733,542 - 2,326,960 Malawi 975,000 74,491,080 193,048 1,742,327 15,610 1,590,523 Mali 11,000 20,041,008 87,700 1,197,198 - - Mauritania 15,000 12,528,000 5,120 156,700 - 726,480 Mongolia 5,000 4,608,152 17,744 80,000 35,000 435,482 Mozambique 1,300,000 29,528,579 127,000 3,072,000 16,000 8,425,200 Myanmar 305,000 5,119,032 - 821,000 23,000 10,112,399 Nepal 13,000 6,362,288 10,000 655,200 30,000 - Nicaragua - 4,003,200 300 339,000 7,500 1,094,813 Niger 64,000 3,384,000 90,016 503,400 - 3,183,760 APPENDIX A 15 EXHIBIT A.3: FP2020 69 CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2013 COUNTRY CONDOMS - FEMALE CONDOMS - MALE IMPLANTS INJECTABLES IUDS ORALS Nigeria 5,116,000 88,466,740 344,663 2,142,300 - 1,803,072 Pakistan - 315,867,000 45,492 9,151,200 200,400 - Papua New Guinea - 19,324,800 38,790 - 4,000 1,313,583 Philippines 10,000 - 85,056 1,485,000 - 9,331,385 Rwanda 72,000 14,082,000 27,000 928,000 - 1,477,200 Sao Tome and Principe 8,000 - 500 - - 6,000 Senegal 93,000 9,943,200 - 1,159,000 26,000 - Sierra Leone 16,000 11,119,800 36,600 733,000 18,000 1,652,870 Solomon Islands 72,000 - - - 500 - Somalia - - 1,000 - - 148,700 South Sudan - - 10,940 - 500 775,200 Sri Lanka - - 93,000 233,500 110,000 2,000,000 Sudan 60,000 10,890,600 30,572 - - 2,456,292 Tajikistan - 7,081,200 - - 105,000 - Tanzania 1,178,000 28,944,000 309,621 - 55,000 2,009,270 Timor-Leste - 57,600 2,100 - - 225,863 Togo 113,000 11,294,400 68,000 606,500 - 108,960 Uganda 5,400,000 183,991,800 471,635 12,243,775 143,000 - Uzbekistan - 9,518,400 - 300,000 800,000 1,367,760 Vietnam 500,000 31,968,000 56,136 870,000 1,700,000 71,665 West Bank and Gaza 2,000 3,998,304 - - - - Western Sahara - - - - - - Yemen Rep - 6,082,704 56,192 1,126,284 471,459 17,423,472 Zambia 500,000 85,809,000 75,000 1,656,900 - 2,669,480 Zimbabwe 4,429,000 106,257,000 244,180 2,460,400 3,500 24,101,441 Other FP2020 Shipments 1,036,000 148,903,200 678,000 251,400 79,630 45,132,570 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, December 2014. APPENDIX A 16 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: Procurement Planning and Monitoring Report (PPMR): 14 Produced monthly by the USAID | DELIVER Project, this online database provides information on consumption and current/desired stock levels of contraceptive products on a country-by-country basis for 33 coun- tries. Data is provided by ministries of health or USAID partners (Abt Associates, USAID |DELIVER Project), SMOs (MSI, PSI), and UNFPA. APPENDIX B — DATA SOURCES 14. RHSC, “Procurement Planning and Monitoring Report,” available at http://ppmr.rhsupplies. org/content?id=1. 15. AccessRH, “What is RHInterhcnage?” UNFPA, available at http://www.myaccessrh.org/ rhi-home. Reproductive Health Interchange (RHI): 15 Hosted by UNFPA, RHI collects data on past and upcoming contracep- tive shipments for over 140 countries from the central procurement offices of major contraceptive donors and procurers. This database is updated at variable times that depend on the frequency of data sub- missions from the data provider. RHI reflects all of UNFPA’s and USAID’s contraceptive purchases, MSI’s and IPPF’s central procurements, and a few other procuring organizations’ purchases. FP2020 Global Markets Visibility Project: In early 2014, CHAI, in partnership with RHSC and the FP2020 Market Dy- namics Working Group, launched the Global Markets Visibility Project to help various donors, suppliers, and partners improve their understand- ing 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 FP2020 69 priority 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). Additionally, CHAI recently signed an MOU with i+solutions to collect historical shipment data from female condom manufacturers. To date, the Global Markets Visibility Project has collected historical shipment data that covers institutional sales (USAID, UNFPA, MSI, etc.) and MOH tender volumes from 11 manufacturers across five family planning product categories. 17 The FP2020 market size was constructed using the best available data sources: historical supplier-reported shipment data and RHI shipment data. The historical supplier-reported shipment data captured a more comprehensive view of the FP2020 market for implants, injectables, IUDs, and orals relative to RHI and thus, served as the primary data source for these product markets. Because the RHI shipment data had greater coverage of the male condom market relative to the historical supplier-reported data, RHI data was relied upon for the male condom volumes. The female condom market was constructed based on suppli- er- (Cupid) and procurer-reported (i+solutions) shipment data and sup- plemented with RHI shipment volumes for suppliers not participating in the FP2020 Global Markets Visibility Project. The data is quantified by units of measure outlined in Exhibit A.4. The following section describes the data source and market size estimation in more detail. Historical Supplier-Reported Data In early 2014, CHAI, in conjunction with RHSC and the FP2020 Market Dy- namics Working Group, launched the Global Markets Visibility Project to help various donors, suppliers, and partners improve their understand- ing 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 FP2020 69 priority countries. CHAI also partnered with Concept Foundation to collect and aggregate shipment data from participating members of the RHSC Generic Manufacturers for Reproductive Health Caucus (GEMs). Additionally, CHAI and i+solutions established a partnership in late 2014 to collect shipment data from female condom manufacturers. To date, the Global Markets Visibility Project has collected historical supplier-reported shipment data from 11 manufacturers – Bayer, CR Zizhu, Cupid, Famy Care, Helm-Fresenius, Merck/MSD, Pfizer, Pregna, PT Tunggal, Shanghai Dahua, and SMB. Collectively, the total volumes cover institutional sales (USAID, UNFPA, MSI, etc.) and MOH tenders across five family planning product categories.16 APPENDIX C — ESTIMATING THE TOTAL FP2020 MARKET SIZE 16. Total shipment of oral contraceptives includes combined, progestin-only, and emergency oral contraceptives. EXHIBIT A.4: UNIT OF MEASUREMENT METHOD UNITS PER CYP Condoms - Female Piece Condoms - Male Piece Implants Set Injectables Vial IUDs Piece Orals - Combined Cycle Orals - Progestin Only Cycle Orals - Emergency Doses EXHIBIT A.5: FP2020 GLOBAL MARKETS VISIBILITY PROJECT PARTICIPANTS AND PRODUCTS MANUFACTURER CONDOMS - FEMALE IMPLANTS INJECTABLES IUDS ORALS Bayer • • • CR Zizhu • Cupid • Famy Care • • • Helm-Fresenius • Merck/MSD • • Pfizer • Pregna • PT Tunggal • • Shanghai Dahua • SMB • 18 Aggregating across implants, injectables, IUDs, and orals in the FP2020 69 countries and methods, suppliers have shipped an average of 415 million units of family planning commodities annually from 2011 to 2013.17 Because Cupid is currently the only supplier reporting historical shipments of female condoms, total female condom shipments have been excluded in the below table to ensure confidentiality of individual supplier shipment data. It is also important to note that there were several shipments to procurer (USAID, UNFPA, SMOs) warehouses in non-FP2020 countries, such as Denmark, Netherlands, Switzerland, UK, and US. Although these volumes were shipped to non-FP2020 countries, the end shipment destination of these volumes would likely be the FP2020 69. As a result, these non-FP2020 69 volumes were included in the total shipments to FP2020 69 countries after it was confirmed that the specific non-FP2020 69 volumes were associated with institutional purchases. 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 FP2020 69 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 into the RHI database. When compared to RHI, the total historical supplier-reported shipment volumes to FP2020 69 countries and procurer warehouses is consistent- ly greater than RHI volumes across four family planning methods—im- plants, injectables, IUDs, and orals.18 Thus, for these product markets, the supplier-reported shipment data captures a more comprehensive view of the family planning market in the FP2020 69. APPENDIX C — ESTIMATING THE TOTAL FP2020 MARKET SIZE 18. Similar to the historical supplier-reported shipment totals, RHI volumes to Denmark, Neth- erlands, Switzerland, UK, and the US are included in the total. For the UK, shipments to IPPF or MSI warehouses are included in total volumes. For Denmark, Switzerland, UK, and the US, 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 FP2020 69 countries and thus, include the volumes in the total FP2020 market estimate. 17. Negative volumes and volumes with no associated shipment destination have been excluded. Source: [1] Historical Supplier-Reported Shipment Data. EXHIBIT A.6: SUPPLIER-REPORTED SHIPMENTS TO FP2020 COUNTRIES BY METHOD, 2011–2013 METHOD 2011 2012 2013 Implants 3.1 M 5.8 M 6.1 M Injectables 73.3 M 109.1 M 93.7 M IUDs 10.3 M 9.1 M 8.1 M Orals 313.5 M 329.2 M 285.6 M Total 400.2 M 453.1 M 393.5 M 19 APPENDIX C — ESTIMATING THE TOTAL FP2020 MARKET SIZE EXHIBIT A.7: RHI VS SUPPLIER-REPORTED SHIPMENTS TO FP2020 COUNTRIES BY METHOD, 2011–2013 IMPLANTS IUDS INJECTABLES ORALS Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, December 2014. 0 M 1 M 2 M 3 M 4 M 5 M 6 M 7 M 201320122011 1.8 M 3.1 M 4.1 M 5.8 M 6.1 M 6.1 M Historical Supplier-Reported Shipments RHI Shipments Im pl an t Se ts (M ill io ns ) 2011 2012 2013 Historical Supplier-Reported Shipments RHI Shipments 0 M 2 M 4 M 6 M 8 M 10 M 12 M 201320122011 4 M 10 M 5 M 9 M 6 M 8 M IU D P ie ce s (M ill io ns ) 2011 2012 2013 Historical Supplier-Reported Shipments RHI Shipments 0 M 20 M 40 M 60 M 80 M 100 M 120 M 201320122011 58 M 73 M 68 M 109 M 69 M 94 M Vi al s (M ill io ns ) 2011 2012 2013 Historical Supplier-Reported Shipments RHI Shipments 0 M 50 M 100 M 150 M 200 M 250 M 300 M 350 M 201320122011 132 M 314 M 132 M 329 M 137 M 286 M Cy cl es (M ill io ns ) 2011 2012 2013 20 Female and Male Condom Market Because CHAI has not yet received data from male condom suppliers, historical RHI shipment data for male condoms is used to capture a more comprehensive view of the family planning market for the FP2020 69 countries. We use RHI shipment data from 2011 to 2013 and include all male condom shipments to FP2020 69 countries as well as volumes associated with procurer warehouses in non-FP2020 69 countries.19 The male condom market reflected by the RHI data includes 18 manufactur- ers and funding sources.19 We constructed the female condom market using both shipment data collected as part of the FP2020 Global Markets Visibility Project and shipment data from RHI. From the FP2020 Global Markets Visibility Project, CHAI has received shipment data from Cupid and shipment data associated with Universal Access for Female Condom (UAFC) Joint Programme procurements from i+solutions. The female condom pro- curement volumes associated with the UAFC Joint Programme have not been reported into RHI. Because CHAI has not yet received data from other major female condom manufacturers, historical RHI shipment data for female condoms is supplemented for other manufacturers. The historical supplier-reported volumes for female condoms, implants, injectables, IUDs, and orals, together with RHI shipment volumes for female and male condoms, represent the estimated FP2020 market from 2011 to 2013. APPENDIX C — ESTIMATING THE TOTAL FP2020 MARKET SIZE 19. Total yearly volumes are based on the year that the product was shipped. Source: [Exhibit A.8] RHI Shipment Data, December 2014. Source: [Exhibit A.9] Historical Supplier-Reported Shipment Data; RHI Shipment Data, December 2014. Source: [Exhibit A.10] Historical Supplier-Reported Shipment Data; RHI Shipment Data, December 2014. EXHIBIT A.8: RHI MALE CONDOM SHIPMENTS, 2011–2013 METHOD 2011 2012 2013 Condoms - Male 1,619.1 M 1,841.4 M 1,642.7 M EXHIBIT A.9: FEMALE CONDOM SHIPMENTS, 2011–2013 SOURCE 2011 2012 2013 FP2020 Global Markets Visibil- ity Project 3.0 M 1.1 M 0.8 M RHI Shipment Data 17.5 M 18.0 M 27.3 M Total 20.5 M 19.1 M 28.2 M EXHIBIT A.10: FP2020 69 CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2011–2013 METHOD 2011 2012 2013 Condoms – Female (RHI & Supplier- Reported) 20.5 M 19.1 M 28.2 M Condoms – Male (RHI) 1,619.1 M 1,841.4 M 1,642.7 M Implants 3.1 M 5.8 M 6.1 M Injectables 73.3 M 109.1 M 93.7 M IUDs 10.3 M 9.1 M 8.1 M Orals 313.5 M 329.2 M 285.6 M Total 2,039.9 M 2,313.6 M 2,064.3 M 21 Total FP2020 Market Size The total value of contraceptives is 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 simplic- ity. Finally, the Implant Access Program price of US$8.50 is applied to implant volumes in 2013. 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. APPENDIX C — ESTIMATING THE TOTAL FP2020 MARKET SIZE 21. UNFPA, “UNFPA Contraceptive Price Indicator –Year 2013,” available at http://africa.unfpa. org/webdav/site/global/shared/procurement/06_for_customers/UNFPA%20Contraceptive%20 Price%20Indicator%20-%20Year%202013.pdf; UNFPA, “UNFPA Contraceptive Price Indicators – 2011 and 2012,” available at http://africa.unfpa.org/webdav/site/global/shared/procure- ment/06_for_customers/Contraceptive%20Price%20Indicators%202012%20and%202011.pdf. Sources: [Exhibit A.11] [1] PPMR Data, December 2014; [2] RHI Shipment Data, December 2014; [3] USAID, “Couple Years of Protection (CYP),” April 2014. [Exhibit A.12] Notes: [1] For implants, the Implant Access Program price is used; [2] The range and average unit price in each corresponding is based on average USAID and UNFPA prices via UNFPA's Contraceptive Price Indicators; [3] The average price of all oral contraceptives is calculated by taking the average of combined, progestin-only, and emergency oral contraceptives. Sources: [1] UNFPA Contraceptive Price Indicator, 2011–2013; [2] IAP Implant Price. EXHIBIT A.11: VOLUMES TO USERS CONVERSION FACTORS METHOD CONSUMPTION TO SHIPMENT UNITS PER COUPLE YEARS OF PROTECTION Condoms - Female 0.9 120.0 Condoms - Male 1.1 120.0 Implants 1.7 0.3 Injectables 0.8 4.1 IUDs 1.6 0.2 Orals - Combined 1.7 15.0 Orals - Progestin Only 1.2 15.0 Orals - Emergency 0.3 20.0 EXHIBIT A.12: AVERAGE UNIT PRICE (USD) PRICE RANGE 2011 2012 2013 Method Minimum Maximum Unit Price Unit Price Unit Price Condoms - Female $0.51 $0.57 $0.56 $0.55 $0.54 Condoms - Male $0.02 $0.03 $0.03 $0.03 $0.03 Implants $8.50 $20.86 $18.65 $17.98 $8.50 Injectables $0.64 $1.34 $0.82 $0.82 $0.83 IUDs $0.32 $0.54 $0.43 $0.43 $0.43 Orals - Combined $0.27 $0.70 $0.31 $0.30 $0.28 Orals - Progestin Only $0.30 $0.42 $0.32 $0.32 $0.31 Orals - Emergency $0.25 $0.70 $0.34 $0.49 $0.44 Total FP2020 Market In Terms of Users CHAI translated shipments to users by estimating the volumes con- sumed and converting to users based on a CYP factor. First, shipments are converted to consumption using a method-specific consump- tion-to-shipment conversion based on the ratio of 2013 consumption (via PPMR) to shipments (via RHI). Using consumption and shipment data for countries reporting into both the PPMR and RHI databases, a ratio between total 2013 consumption and shipments is calculated by method. Next, we estimate users by dividing consumption by the corresponding CYP factor published by USAID. CYP is the estimated the protection provided by contraceptive 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.20 Because implants and injectables have different CYPs associated with different sub-types (e.g. there are different CYP factors for 3-, 4-, and 5-year implants), a weighted average is calculated based on volumes. The following exhibit shows the con- version factors used to translate volumes to users. 20. 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. 22 To protect customer confidentiality, suppliers were not asked to dis- close customer information associated with shipments. Instead, CHAI relied upon RHI to estimate the known donor-funded volumes and in turn, users and costs. RHI data contains shipment data reported by central procurement offices of major contraceptive orders and other organizations that procure contraceptives. This includes organizations such as IPPF, MSI, PSI, USAID, and UNFPA. From 2011 to 2013, the follow- ing funding sources are associated with shipments to FP2020 69 coun- tries and shipments to procurer warehouses that are reported into RHI: APPENDIX D — ESTIMATING TOTAL KNOWN FP2020 DONOR-FUNDED VOLUME Source: [1] RHI Shipment Data, December 2014 EXHIBIT A.13: FP2020 FUNDING SOURCES REPORTING TO RHI, 2011–2013 FUNDING SOURCES AFDB KFW UNFPA BMGF MOH UNPEACE CDC MSI USAID DFID NETHERLANDS USDOD DKT OTHER WORLDBANK GLOBALFUND OTHERGOV ICA PSI IPPF UNDP For the purposes of this analysis, national procurements identified as “OTHERGOV” and “MOH” as well as unknown funding sources identified as “OTHER” have been excluded. These may include volumes associated with UNFPA third party procurements or SMOs procurements using un- identified funding sources. It is important to note that RHI only includes data for procurement agencies that are data providers. There may be other donor-funded procurements that are not reported into RHI.

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