PSI Social Marketing on Contraceptives in Southern Africa 2017-2021

To address high unmet need for contraception and barriers to access in southern Africa, PSI launched the Southern Africa Social Enterprise (SA SE) Project in 2017, which built on previous support from Sida (contribution ID: 51040049) between 2012 - 2017 which had enabled PSI to launch condoms through a social enterprise. The new phase 2017 -2022 focused on enbaling PSI to launch a pharmaceutical division aimed at introducing Oral Contraceptives (OCs) and Emergency Contraceptive (ECs) pills, through social enterprise (SE) activities in countries across Southern Africa. PSI later expanded their product portfolio to include medical abortion (MA) products. Participating countries were selected based on identified gaps, and included South Africa, Namibia, Mozambique, Angola, Zambia, Zimbabwe, Botswana, eSwatini and Lesotho. This social enterprise (pharmaceutical division) achieved the following results between 2017 and 2022: - The primary indicator used to measure overall programme outcome was Couple Years of Protection (CYPs), which is a standard indicator for measuring impact of SRH-products and estimates the number of years of contraceptive protection provided to couples through sales and distribution of contraceptives using a standardized Impact Calculator. The programme achieved a total of 114,163 CYPs against a target of 212,635 (54%). Although data was not collected, these CYPs provide an indication of how the programme contributed to reducing unwanted pregnancies in the region. In addition, the sales of medical abortion products also contributed to averting unsafe abortions in the region, but no data was reported. At an output level, - Total of 1,399,576 emergency contraceptives (EC) sold, vs a life of project target of 1,194,711 which represents a 117% achievement - Total of 497,320 units of PSI's medical abortion (MA) product sold, achieving an average of 354% against targets. The MA product was only launched in the last few years of the programme. - Of the 29 product dossiers filed, 76% (22) were registered, 21% (6) are pending registration, and 3% (1) was rejected. A total of 11 products have been commercialized under this project. At the start of the project in 2017 PSI only had one oral contraceptive (OC) available and by the end of the project life, the method mix has increased to include 2 EC's, 6 OCs, 2 intrauterine devices (IUD) and Misoprostol for MA. In addition to these contraceptives the social enterprise developed a broad range of other non-contraceptive SRH-products. - PSI developed and launched "Viya", a digital tool across multiple social media platforms that brings together content, products and services to provide women with a safe, reliable platform to engage around sexual health and wellness. By the end of project, 3.7 million users were reached, with actual engagement with 200,000 people. In Angola, PSI launched the digital platform Entre Nos on Facebook and Instagram, with 284,923 followers on Facebook and 11,418 followers on Instagram by the end of the project. - In order to increase focus on vulnerable populations, PSI partnered with 100 Unjani Clinics, which are located in townships in South Africa and target vulnerable populations. In doing so, PSI increased the availability of contraceptives for especially low income populations. PSI also trained nurses in all 100 clinics. - A total of 59,809 service providers have also been trained on PSI products which includes training for sales reps, IUD insertion training for Unjani clinic nurses, and reaching providers via "Med Rep" detailing and via digital channels. - In an effort to address challenges in accessing OCs from pharmacies in Zimbabwe, the project worked with regulatory agencies in Zimbabwe to down-schedule Meuri (3rd generation OC) from being a provider prescribed medicine to a pharmacist dispensed medicine which doesnt require a prescription. Given ZaZiBoNa (a harmonized regulatory initiative in Zambia, Zimbabwe, Botswana and Namibia) regulatory processes this down scheduling also influences the access and availability of this OC in all ZaZiBoNa markets. By removing the need for a provider, the price to consumer also reduced (no cost of the provider consultation and easier access closer to them). - The partnership with the Zimbabwe National Family Planning Council (ZNFPC), a government agency, resulted in the increase in reach of vulnerable populations as PSI products are available in the public clinics. - PSI failed to register its own products in South Africa and as a result they formed a Viatris partnership with a South African pharmaceutical company (an unexpected result), which led to 4 OCs being commercialized in South Africa with an additional 3 products nearing final stage of discussion (Injectable and two new OCs). - PSI managed to reduce costs for supply chain and improve product availability and choice through the activation of a bonded warehouse in the region, enabling for order consolidation and for the business to meet the needs of smaller volume markets that dont meet the manufacturers minimum order quantities. This has previously been a barrier to expanded choice within product categories. - PSI conducted landscaping analyses concerning unsafe abortion in South Africa and developed country-level advocacy plans for South Africa, Botswana, Namibia, Zambia and Zimbabwe in order to raise awareness of unsafe abortion.

Through the intervention, PSI is working towards expanding access, particularly among young women, across Southern Africa for quality SRHR products through a regional social business approach with the aim of addressing health needs at scale and leveraging regional operational efficiencies to deliver long-term, financially sustainable health impact. The overall goal of the intervention is to "harness and strengthen Southern Africas regional health markets to improve SRHR of young women through a regional social enterprise approach". PSI's theory of change for the intervention identifies four outputs to achieve the overall outcome of to "grow and sustain voluntary use of SRHR Products among young women in Southern Africa": Output 1: Increased access to SRHR products Output 2: Increased quality of SRHR products Output 3: Creation of a sustainable enterprise that delivers impact beyond the life of the project and allows for progressive improvements in long-term financial self-reliance Output 4: Advocacy to create an enabling environment for SRHR in the region