Who Pays for Condoms? The Roles of the Various Sectors in Condom Supply and Promotion

Of the estimated 8 billion condoms needed in 2000, donors provided just 950 million — less than one-eighth of the number needed — valued at $46 million. While this figure takes into account only grant support, loans from the World Bank, for example, are also sometimes used to obtain condoms and other reproductive health supplies.

The past decade has seen little increase in the overall donor provision of condoms in response to the HIV/AIDS epidemic. Annual donor support for condoms averaged slightly over one billion condoms over the past decade (1990-2000), peaking in 1995 and 1996 at slightly more than 1.5 billion condoms. In financial terms, the $46 million contributed in 2000 was only slightly more than the $42 million contributed by donors in 1990, and is less than in 1990 when adjusted for inflation.

The absence of significant increases in donor support for condom supplies belies the entry of additional donors into the field. The U.S. Agency for International Development (USAID) and UN Population Fund (UNFPA) remain the two largest sources of condoms for developing countries.

Developing country governments that have the resources and political commitment are promoting condom use. For example, the governments of South Africa and Botswana, two of the wealthiest and hardest-hit countries in sub-Saharan Africa, provide the vast majority of condoms for distribution in their countries through the public sector and social marketing, and in 2000 they purchased 290 million and 12 million condoms, respectively. In comparison, all donors combined provided 400 million condoms to all of sub-Saharan Africa in that year.

The Indian government, like several other Asian nations, has long promoted condom use for family planning. More recently, there has been a push to increase condom availability in response to the growing HIV problem in southern India and elsewhere. In 2000, 450 millions condoms were sold through a variety of government social marketing programs that subsidize both condoms and their promotion.

The level of public sector support for condom promotion and distribution varies enormously from one country to another.

Because the commercial sector is profit-driven, it does not usually venture where it sees little potential for profit. The for-profit sector has its strongest presence, therefore, among developing countries in Asia and Latin America — in particular, in Brazil, the Philippines, Indonesia, Thailand, South Korea, and Malaysia. In Brazil, for example, 350 million male condoms were sold through the commercial sector in 2000, three times the number distributed by the government. In contrast, the commercial sector plays only a minimal role in condom provision in sub-Saharan Africa

There is potential for greater commercial sector involvement in condom provision, given the gap between the need for condoms, and the lagging support forthcoming from donors and developing country governments. Barriers to commercial private sector participation — ranging from tariffs and regulations to the lack of communication and coordination among sectors — can be addressed.

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