Paying for Condoms and Contraceptives

Box 15: Supportive Country Governments: The Brazilian Example

Brazil is one of the few developing countries that is fully committed to ensuring the availability of condoms and contraceptives, and pays for these commodities entirely from national resources. The government’s support of condoms and contraceptives is reflective of its overall response to HIV and AIDS, which has garnered strong support from the highest level of government. Although HIV prevalence in Brazil is relatively low at 0.5 percent, because of its large population size, Brazil is home to more than one-third of people living with HIV in Latin America.³⁷⁴

Brazil’s National AIDS Program procures and promotes both male and female condoms. In 2008, UNAIDS projects that through its National AIDS Program, the Government of Brazil will spend a total of US $32.2 million on condoms. This will support the procurement of 1.2 billion male condoms, along with 7 million female condoms.³⁷⁵ Some of these condoms will be distributed freely at government-run pharmacies, as well as at national events such as Carnival.

While most condoms are imported, the share of condoms produced domestically in Brazil is growing. This year, in an effort to reduce costs and keep up with condom demand, the Xapuri condom factory was opened in north-western Brazil as the first and only national condom manufacturer. Construction of the US $10.6 million manufacturing site was spearheaded by the Acre state government and the factory is currently operated by a private company.[iii] In 2008, the factory is expected to produce 11.7 million pieces, and then greatly expand the following year to produce 100 million condoms annually.³⁷⁶

Still, there is enormous variation in levels of public sector support for condoms and contraceptives between countries. Some developing country governments have consistently failed to prioritize condom purchase in their budgets.³⁶³ Apart from the financial costs, social and political barriers and a lack of programmatic expertise often inhibit governments from promoting condoms and contraceptives.³⁶⁴

The Private Commercial Sector

Encouraging commercial products and services for people who can afford them is one strategy for improving services for those who cannot pay.³⁶⁵ With a strong private sector, public resources can be spent more effectively on lower-income clients. Where there may be substantial demand for certain family planning services and products, the private sector may be the most fit provider and may be the preferred provider among certain clients. Qualitative research conducted among adolescents in Jamaica and urban Cameroon suggests a key strength of the private sector is that people perceive it to offer high-quality products.³⁶⁶ The private commercial sector can ensure that clients who are not eligible for subsidized services in the public sector have affordable, quality alternatives.

The for-profit sector has its strongest presence among countries in Asia and Latin America—in particular, in Brazil, Indonesia, Malaysia, the Philippines, , South Korea and Thailand.³⁶⁷ Because there is less opportunity for profit, the commercial sector plays only a minimal role in condom provision in sub-Saharan Africa, but it is expanding in some countries. For example, in Tanzania public-private partnerships involve the growing commercial sector in serving the low-income market with affordable and quality condoms and contraceptives. T-Marc Company Ltd (Tanzania Marketing and Communications), an independent Tanzanian-led and controlled company is partnering with USAID and Shelys Pharmaceuticals and its sister company Beta Healthcare in marketing subsidized products: Dume brand male condoms, Lady Pepeta brand female condoms, and Flexi P brand oral contraceptives. In 2006, Shelys co-invested over $100,000 in in-kind support for marketing subsidized condoms and pills. The company intends to take ownership of USAID commodity brands as they graduate from USAID support, while also developing markets for its own brands.³⁶⁸

In many countries, non-profit organizations and social marketers collaborate with private wholesalers and retailers to expand condom access. In some cases, social marketing organizations use the distribution networks of private companies. For example, in the Dominican Republic, NGOs sell USAID supported condoms to Sterling Products International, a private pharmaceutical firm that then distributes the condoms nationally.³⁶⁹ The private commercial sector is also increasingly collaborating with NGOs to support programs and interventions that encourage behavior change. For example, SSL International (makers of Durex condoms) is supporting interventions in Brazil and India to promote gender equitable norms and HIV risk-reduction behaviors among young men.³⁷⁰

Because the private sector is diverse there is no “one size fits all” approach to expanding private sector provision of contraceptives and condoms, which will no doubt be a long-term venture.³⁷¹ However, given the gap between the need for condoms and contraceptives and considering the relatively stagnant funding trends from donors, there is potential for greater commercial sector involvement.³⁷² Governments are also key to encouraging private sector involvement by ensuring that tariffs, regulations and competition with public sector programs do not hinder involvement.³⁷³ Better coordination among donors, country governments and the private sector is needed to improve the supply and distribution of condoms and contraceptives.

Please see the Appendix for this section's end notes.