Social marketing of reproductive health supplies in sub-Saharan Africa

As with previous years, the reported programme results by DKT for 2022 are not specifically attributable to Sida's financial support, rather DKT reports on total operations in the target countries where Sida contributes financially to a varying degree (from 9% of total cost in DR Congo, to 40% in Francophone West and Central Africa). Total costs comprise Sida, other donors and DKT's internal resources from e.g. sales revenue. Impact-level results Using the "MSI Impact 2 calculator" and the "PSI impact calculator", DKT estimated that in the target countries its programming averted: 530,238 unintended pregnancies (72% target) 1,096,621 unsafe abortions (86% target) 6,301 maternal deaths (86% target) 355,948 maternal disability-adjusted life years (85% target) 10,650 HIV infections (104% target)* and 210,683 HIV-related disability-adjusted life years (52% target)*. *In 2022 estimations were made based on a model developed by DKT as the PSI impact calculator was discontinued by PSI. Outcome-level results The agreed outcome indicator for the programme is couple years of protection (CYPs), which is a generally accepted measure that estimates the protection from pregnancy provided by contraceptive methods during a one-year period. In 2022, DKT reported that it generated over 2.39 million CYPs against a target of 3.18 million (75% achievement). Output-level results In addition to impact and outcome results, DKT achieved the following output-level results: Output 1: Increased knowledge of SRH products among primary beneficiaries - In 2022, 81% of clients who were surveyed across the target countries could name at least two methods of contraception and 92% knew where to access contraceptives. - There were 739 649 visitors to DKT's Women First Digital websites from target countries and 154 649 interactions on online chat and hot-lines (target was 12 500). - DKT used a wide variety of methods to increase awareness of sexual and reproductive health among clients, which included community outreach, brand building, mass media advertising, and call center support. For example, in 2022, FWACAs call center reached over 37,000 contacts from across the region, of which 9% were adolescents and 46% were ages 20-24. Of the clients who received SRH counseling, 98% were women. In Liberia, DKTs Lydia Contact Center reached over 5,100 clients via mobile phone and received over 1,570 inbound calls from clients around the country. Output 2: Increased demand for SRH products and SRHR services among primary beneficiaries - DKT reported on product sales as evidence of an increase in demand for products and services. In 2022, DKT sold more than 34.4 million condoms (64% of target), 45,780 female condoms (no target), 1.1 million cycles of oral contraception (37% of target), 1 million units of emergency contraception (48% of target), 179,450 injectables (12% of target), 82,230 implants (69% of target), 137,400 intrauterine devices (IUDs) (145% of target), 3.5 million misoprostol tablets (90% of target), 250,060 mifepristone-misoprostol medical abortion combipacks (100% of target), and 15,640 manual vacuum aspiration (MVA) kits (69% of target). Total sales of contraceptives and safe abortion products were 75% of the total target. - DKT made particular progress in the sales of safe abortion products in 2022, enabling the provision of critical services in the Sub-Saharan region. DKT won a government tender to provide 14,490 combipacks in Burkina Faso, where the latest data shows that nine out of every ten abortions are unsafe. Based on data from the Guttmacher Institute, it is estimated that DKT contributed to an estimated 47% of all annual abortions in 2022 in Mozambique. Liberia also saw significant growth in sales of medical abortion and targets for misoprostol and medical abortion (MA) combipack sales were surpassed by 664% and 437%, respectively. DKT also grew sales of MVA kits, which increased 142% in FWACA and 359% in Mali thanks to the Duo Lydia training model, which pairs a midwife trainer with a medical detailer, combining their training and sales skills. Output 3: Better quality SRH services - DKT trained over 15,490 service providers in 2022 with a particular focus on safe abortion and long-acting reversible contraceptives (LARCs), to provide quality, judgment-free SRH care. DKT tested providers on their ability to name three contraceptive methods, their duration of effectiveness, and their side effects as provider knowledge is a fundamental aspect of quality care. On average 81% of providers who participated in post-training surveys across the region answered the questions correctly. 96% of respondents to a survey confirmed that DKTs training was the only external training they received on SRH. - To ensure providers and clients have consistent access to SRH products, DKT takes precautions against centralized stock outs. In 2022 DKT reported only five stockouts across the region. This represents a 50% decrease from 2021. DKT prevented delays in SRH product delivery by strengthening procurement times, conducting frequent supply meetings, and leveraging regional procurement strategies. - As part of DKTs M&E strategy, DKT deployed mystery shoppers across the region to evaluate the quality of SRH care. DKTs research indicated low levels of judgment and stigma during SRH counseling and product/service provision. In Liberia, mystery shoppers visited 400 facilities - 102 clinics and 298 pharmacies and medicine stores. The shoppers reported feeling comfortable with 91.6% of service providers at the clinics and product providers at pharmacies. In Mozambique, 81.2% of mystery shoppers reported that they did not experience any judgment at the point of sale/service. This is a significant increase from all prior years, which started with a 2019 baseline of 74.8%. - Mystery shoppers helped evaluate the prevalence of discrimination at point-of-service, which may appear in different ways for different demographic groups. In FWACA, the results showed that only one out of 134 mystery clients were asked if they were married - a common form of stigmatization by pharmacists. Moreover, a composite score on youth friendliness was generated from combining nine distinct mystery shopper survey questions, for which Mali received especially high marks (93%). Output 4: Increased choice of contraceptive methods - DKT offered at least three DKT products in over 4,500 outlets across the region in 2022 (82% achievement). DKT reported that due to its affordable pricing, pharmacies often wanted to stock more than one product at point of sale as it attracted more clients. - DKT uses "availability surveys" to monitor that products are accessible to consumers, and the results of availability surveys for 2022 showed that all countries except Cameroon improved in terms of availability of various contraceptives. Output 5: making social marketing more equitable - In 2022, 38% of DKT outlets were located in areas serving clients below the poverty line. - 81% of clients surveyed believed that DKT's adverts portray men and women in a positive light. Unintended results As a result of dialogue between Sida and DKT, DKT also increased collaboration between DKT country offices during the year and implemented knowledge sharing through monthly internal reporting. In addition, DKT in Anglophone West Africa helped DKT Mozambique shift from paper receipts to a digital sales app while DKT DRC partnered with DKT Mozambique around stock management and anti-corruption measures. DKT's digital platforms, Women First Digital, also developed more regional content for West Africa and these learnings were shared by DKT in an article in "Sexual and Reproductive Health Matters" entitled "Supporting young women in Francophone West and Central Africa with their reproductive health decisions: what can we learn from the Lydia Conseil Call Centre?". DKT was able to enjoy economies of scale and used pooled procurement through the regional approach in order to improve product availability.