Family Planning Market Report 2017

Publication date: 2017

FAMILY PLANNING MARKET REPORT O C T O B E R 2 0 1 7 A C K N O W L E D G E M E N T S : This report was produced as part of the landmark FP2020 Global Markets Visibility Project that CHAI launched in early 2014 in conjunction with the Reproductive Health Supplies Coalition (RHSC). 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 current participating suppliers (Bayer, CR Zizhu, Cipla, Cupid, Mylan, Helm AG, Female Health Company, Merck/MSD, Pfizer, Pregna, PT Tunggal, Shanghai Dahua, SMB and Techno Drugs) as well as our partner, the Concept Foundation, for their support in collecting and aggregating data from the Generic Manufacturers for Reproductive Health (the GEMS Caucus). We are grateful to our colleagues from FP2020, Coordinated Supply Planning Group, UNFPA, USAID, GHSC-PSM, DFID and MSH for their invaluable feedback in the develop- ment and refinement of various market analyses. We would also like to thank DFID for the funding to conduct this work. EXECUTIVE SUMMARY SUPPLIER SHIPMENT ANALYSIS DONOR FUNDING ANALYSIS ADDITIONAL ANALYSIS ON HIGH VOLUME COUNTRIES EXPLORING POTENTIAL CONTRIBUTING FACTORS TO THE 2015 TO 2016 MARKET DECLINE FUTURE OUTLOOK GLOBAL MARKETS VISIBILITY PROJECT ACKNOWLEDGEMENTS APPENDIX A – 69 FP2020 COUNTRIES MARKET VOLUMES BY METHOD AND COUNTRY, 2011–2016 APPENDIX B – DATA SOURCES APPENDIX C – ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE APPENDIX D – ESTIMATING TOTAL FP2020 DONOR-FUNDED VOLUMES APPENDIX E – ADDITIONAL ANALYSIS ON HIGH VOLUME COUNTRIES APPENDIX F – EXPLORING POTENTIAL CONTRIBUTING FACTORS TO THE 2015 TO 2016 MARKET DECLINE APPENDIX G – KEY TERMS AND DEFINITIONS APPENDIX H – ACRONYMS 3 4 10 13 14 15 16 18 30 31 37 38 42 43 44 The 2017 Family Planning Market Report covers the total FP2020 public sector market– defined as volumes purchased by institutional buyers (USAID, UNFPA, SMOs, etc.) and Ministries of Health (MOHs) or government-affiliated procurers for the 69 FP2020 focus countries (defined as countries with a 2010 gross national income per capita less than or equal to US$2,500). The report covers all product-based modern methods using historical supplier-reported shipment data collected from 14 suppliers1 for female condoms, implants, injectables, IUDs, orals (combined and progestin only), and emergency contraceptives, and data from the Reproductive Health Interchange (for male condoms). THE FP2020 PUBLIC SECTOR MARKET VALUE DECLINED SHARPLY FROM 2015 TO 2016, WHILST THE CYP2 MIX3 CONTINUED TO SHIFT TOWARDS LONG-ACTING REVERSIBLE CONTRACEPTIVES, OFFSETTING SOME OF THE DECLINE IN TOTAL CYPS SHIPPED. From 2015 to 2016, there was a 28 percent decline4, US$274 million to US$196 million, in the value5 of the public sector market in the 69 FP2020 focus countries. This substantial decrease in market value was primarily driven by a sharp decline in the shipments of injectables and orals (combined and progestin only), 49 percent and 34 percent decline respectively, to the 69 FP2020 countries. Consequently, the total couple years of protection (CYPs) shipped, an estimate of the duration of con- traceptive protection provided through products shipped, fell from 123 million in 2015 to 104 million in 2016. This significant decrease of the to- tal FP2020 public sector market value, as implied by supplier shipment data, aligns to the sizeable decline also observed in the donor-funded shipments tracked by the Reproductive Health Interchange (RHI).6 Though the value of the FP2020 public sector market remained rela- tively stable since 20117, the sharp decrease from 2015 to 2016 offset the gains of prior years and caused a net annual decline in value of seven percent from 2011 to 2016. Despite this significant decline, the total CYPs shipped only decreased by one percent over the same period. This was mainly driven by the shift in CYP mix towards implants8, which account- ed for 9 percent of all CYPs shipped in 2011 compared to 27 percent in 2016. 1. Participating suppliers represent >95% of volumes within each method of the Reproductive Health Interchange except for IUDs and male condoms. 2. Couple Years of Protection (CYP) is the estimated protection provided by contraceptive methods during a one-year period e.g. 120 condoms provide a couple protection for one year. See Appendix C for further details. 3. CYP mix refers to the percentage distribution of CYPs shipped by method. 4. Where percentage changes are discussed, the Compound Annual Growth Rate (CAGR) is used unless otherwise noted. 5. Market value and spend refers to the supplier-reported shipment volume multiplied by the average prices of UNFPA and USAID for the specific years. 6. Reproductive Health Interchange, available at https://www.unfpaprocurement.org/rhi-home. See Appendix B for more details. 7. Except for a 2012 increase driven by higher implant shipment levels prior to the 50 percent reduction prices in 2013 as part of the Implant Access Program (IAP). 8. Since the price reductions, the implant unit cost remains higher relative to other methods, but lower on a cost per couple-years of protection (CYP) basis. See Exhibit 4 for further details. 9. Examples of other procurers include MOHs and SMOs. 10. RHSC Global Contraceptive Commodity Gap Analysis, available at https://www.rhsupplies. org/uploads/tx_rhscpublications/Global_Contraceptive_Commodity_Gap_Analysis_2016.pdf EX EC U TI VE S U M M AR Y 3 There are a number of possible reasons for the declined market value from 2015 to 2016. Though further investigation beyond the scope of this report would be required to affirm these reasons, they could include: • The decline in donor spending may have led to a decline in total public sector procurement as other procurers9 may not have fully covered the shortfall. • Some shipments may have shifted to local and regional non do- nor-supported suppliers that are not captured in this report. • Procurement patterns fluctuate and 2016 might be an outlier year in which procurers intentionally procured less and instead con- sumed more of their inventories. Moving forward, the availability of funding for contraceptive commodi- ties could significantly impact the family planning commodity market. A number of recent analyses, including RHSC’s 2016 Global Contraceptive Commodity Gap Analysis, have identified significant funding gaps based on current and existing family planning spending levels.10 In addition, there is continued uncertainty with regard to the future of the U.S. gov- ernment’s financial commitment to family planning. Should the funding challenges remain unaddressed, there could be a decline in the family planning commodity market and subsequently in the number of users on modern methods of contraception. 4 FROM 2015 TO 2016, THERE WAS A SUBSTANTIAL DECREASE IN THE MARKET VALUE OF THE FP2020 PUBLIC SECTOR MARKET, PRIMARILY DRIVEN BY A DECLINE IN THE SHIPMENTS OF INJECTABLES AND ORALS (COMBINED AND PROGESTIN ONLY). PRIOR TO 2016, THE VALUE OF THE FP2020 PUBLIC SECTOR MARKET REMAINED RELATIVELY STABLE. THE SHIFT IN CYP MIX TOWARDS IMPLANTS FROM 2011 TO 2016 HELPED OFFSET SOME OF THE DECLINE IN CYPS SHIPPED OVER THE SAME PERIOD. This section analyzes shipment, market value, and CYPs shipped trends in the total FP2020 public sector market from 2011 to 2016, with a focus on significant new findings from 2015 to 2016. Analyses are based on the supplier shipment data of the 14 participating suppliers (one additional supplier from the previous report) for all product-based methods except for male condoms, which are de- rived from the Reproductive Health Interchange (RHI) database. 11. Long-acting and reversible contraceptive methods include IUDs and implants. 12. From 2011 to 2016, the implant market value saw an annual increase of only 6 percent com- pared to the annual increase of 24 percent in shipment quantities because of the implant price reductions in 2013 allowing more implants to be purchased with the same amount of funding. 13. Short-acting methods include male and female condoms, injectables, orals (combined & progestin only) and emergency contraceptives. 14. The prices for orals (combined and progestin only) have remained relatively stable from 2011 to 2016, indicating the decrease is driven by volume. 15. The prices for injectables have remained relatively stable from 2015 to 2016 indicating the decrease is being driven by volume. 16. Pakistan, Malawi and Madagascar were part of the top 11 countries which accounted for A 28 percent decline in market value from 2015 to 2016 led to an overall annual decline of 7 percent from 2011 to 2016. The total FP2020 public sector market value declined from US$277 million in 2011 to US$196 million in 2016; from 2011 to 2015 the market value remained relatively stable, with the exception of an increase in 2012 driven by increased implant shipments prior to the 2013 reduced price. From 2011 to 2016, the market value of long-acting reversible contra- ceptives (LARCs)11 increased by 6 percent annually, propelled by an annual increase of 24 percent in implant shipments during this period12. Conversely, the market value of all short-acting methods13 decreased by 12 percent annually over this period, including a 21 percent annual de- crease among orals (combined and progestin only) products, offsetting the overall market value.14 The largest decline in the overall market value in a single year was re- corded from 2015 to 2016, with a decrease of US$78 million, from US$274 million to US$196 million. This was due to a decline in shipments across all methods (with the exception of IUDs), and most notably a sharp decline among injectables15. (Exhibits 1 & 2). The total number of CYPs shipped decreased from 110 million in 2011 to 104 million in 2016, at an annual rate of 1 percent for the period. This decrease in CYPs is lower than the 7 percent annual decline of the market value for the period due to the continued shift towards long-acting implants. From 2011 to 2016, the annual decrease of 12 percent derived from short-acting method CYPs shipped – particularly orals (combined and progestin only) – is the main cause for the overall decline in the number of CYPs shipped from product-based modern methods of contraception. Specifically, from 2015 to 2016, the decline related to in- jectables and orals (combined and progestin only) is most notable, with 48 percent and 34 percent decreases in CYPs shipped respectively. By contrast, CYPs shipped from long-acting implants and IUDs increased by 6 percent annually from 2011 to 2016, and remained relatively stable from 2015 to 2016, decreasing by 1 percent. Although contraceptive implant shipments declined slightly by 10 percent from 2015 to 2016, LARCs continued to increase as a proportion of the market value and dominated in the CYP mix. After a period of continued growth from three million units in 2011 to 10 million units in 2015, annual implant shipments decreased by 10 per- cent to 9 million units in 2016. Short-acting methods, which saw steady shipment declines year over year, experienced the largest decline ob- served at 30 percent from 2015 to 2016. As a result, the 2016 proportion of market share and CYP mix represented by LARCs increased relative to 2015, with LARCs making up 42 percent of the total FP2020 public sector market value and 73 percent of the CYP mix in 2016. (Exhibits 1-3, 5) In 2016, 10 countries represented just over half of the total FP2020 public sector market value. The market for contraceptives is fairly concentrated with 10 high vol- ume countries (Ethiopia, Tanzania, Zimbabwe, Nigeria, Kenya, Bangla- desh, the Democratic Republic of Congo, Ghana, Uganda, and Burkina Faso) accounting for US$101 million, or 52 percent of the total FP2020 public sector market value in 201616. This trend, which includes five core countries17, has remained relatively stable over the past four years. (Exhibits 6, 7, 8) SU PP LI ER S H IP M EN T AN AL YS IS over 50 percent of the 2015 FP2020 public sector market value in 2015, but they are no longer on this list. CHAI has identified through consultations with stakeholders that donor funding for Pakistan has shifted away from commodity procurement. Further research is needed to determine if other sectors in Pakistan are covering the shortfall resulting from the decline in donor-funded shipments, as in the case of Bangladesh, India, and Indonesia, which is further described on page 13. 17. (in alphabetical order) Bangladesh, Ethiopia, Nigeria, Uganda and Zimbabwe have consis- tently appeared in the top 10 markets from 2013 to 2016. 5 $0M $50M $100M $150M $200M $250M $300M $350M $400M $58M 2011 2012 2013 2014 2015 2016 $103M $4M $95M $5M $89M $10M $54M $52M $53M $87M $5M $49M $2M $79M $13M $40M $4M $79M $1M $93M $13M $44M $3M $81M $2M $78M $9M $47M $4M $98M $1M $60M $11M $45M To ta l M ar ke t Si ze (M ill io ns U SD ) Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female $277M $362M $273M $288M $274M $78M $5M $31M $2M $41M $11M $29M $196M SU PP LI ER S H IP M EN T AN AL YS IS EXHIBIT 1: TOTAL FP2020 MARKET SIZE (USD) EXHIBIT 2: TOTAL FP2020 MARKET VOLUMES (MALE CONDOMS EXCLUDED)* Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding 3M 10M 6M 9M 6M 8M 6M 9M 10M 10M 9M 10M 311M 319M 283M 5M 94M 17M 267M 5M 114M 25M 173M 6M 98M 25M 22M 50M 6M 114M 3M 11M 109M 19M 73M 20M 2011 2012 2013 2014 2015 2016V ol um es S hi pp ed to F P2 02 0 Co un tr ie s (M ill io ns ) 0M 100M 200M 300M 400M 500M Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female 421M 414M 426M 322M 210M 473M MALE CONDOM SHIPMENT VOLUMES (BILLIONS) 2011 2012 2013 2014 2015 2016 1.62 1.84 1.57 1.49 1.36 0.97 *Male condoms are shown separately because the source of the shipment data is from RHI whereas all other methods are supplier-reported. See Appendix C for further details. 6 METHOD UNITS PER CYP UNIT COST COST PER CYP 2011 2012 2013 2014 2015 2016 2011 2012 2013 2014 2015 2016 Condoms - Female 120.00 $0.56 $0.55 $0.54 $0.53 $0.52 $0.49 $67.02 $66.42 $65.04 $63.36 $62.40 $59.28 Condoms - Male 120.00 $0.03 $0.03 $0.03 $0.03 $0.03 $0.03 $3.34 $3.52 $3.56 $3.57 $3.51 $3.64 Injectables - 1 month 13.00 $0.82 $0.82 $0.83 $0.81 $0.81 $0.82 $10.61 $10.64 $10.82 $10.58 $10.47 $10.70 Injectables - 2 month 6.00 $0.82 $0.82 $0.83 $0.81 $0.81 $0.82 $4.90 $4.91 $5.00 $4.88 $4.83 $4.94 Injectables - 3 month 4.00 $0.82 $0.82 $0.83 $0.81 $0.81 $0.82 $3.27 $3.27 $3.33 $3.26 $3.22 $3.29 Orals – Combined 15.00 $0.31 $0.30 $0.28 $0.30 $0.28 $0.26 $4.70 $4.44 $4.26 $4.43 $4.20 $3.95 Orals – Progestin Only 15.00 $0.32 $0.32 $0.31 $0.31 $0.32 $0.33 $4.84 $4.85 $4.64 $4.60 $4.80 $4.92 Orals – Emergency 20.00 $0.34 $0.49 $0.44 $0.30 $0.37 $0.35 $6.74 $9.74 $8.84 $5.92 $7.40 $7.02 Implants - 3 Year 0.40 $18.65 $17.98 $8.50 $8.50 $8.50 $8.50 $7.46 $7.19 $3.40 $3.40 $3.40 $3.40 Implants - 4 Year 0.31 $18.65 $17.98 $8.50 $8.50 $8.50 $8.50 $5.83 $5.62 $2.66 $2.66 $2.66 $2.66 Implants - 5 Year 0.26 $18.65 $17.98 $8.50 $8.50 $8.50 $8.50 $4.91 $4.73 $2.24 $2.24 $2.24 $2.24 IUDs 0.22 $0.43 $0.43 $0.43 $0.48 $0.47 $0.46 $0.09 $0.09 $0.09 $0.10 $0.10 $0.10 EXHIBIT 4: COST PER CYP BY METHOD (USD) EXHIBIT 3: TOTAL FP2020 CYPS SHIPPED SU PP LI ER S H IP M EN T AN AL YS IS 0M 20M 40M 60M 80M 100M 120M N um be r of C YP s sh ip pe d to FP 20 20 c ou nt ri es (M ill io ns ) 2011 2012 2013 2014 2015 10M 17M 18M 20M 31M 46M 12M 0.3M 23M 0.2M 11M 41M 28M 18M 0.2M 12M 37M 19M 0.2M 0.2M 22M 0.1M 13M 42M 21M 27M 1M 0.2M 15M 47M 21M 0.2M 18M 0.2M 14M Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female 110M 110M 2016 29M 47M 12M 8M 0.3M 0.2M 8M 104M 119M123M 123M Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding 7 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, May 2017; [3] UNFPA Contraceptive Price Indicator, 2011–2016; [4] USAID, “Couple-Years of Protection (CYP),” May 2017; [6] IAP Implant Price. EXHIBIT 5: FP2020 CONTRACEPTIVE SHIPMENT MIX (IN TERMS OF VOLUMES), CYP MIX (IN TERMS OF CYPS SHIPPED), AND MARKET SHARE (IN TERMS OF DOLLARS) BY YEAR CYP MIX (IN TERMS OF CYPS SHIPPED) MARKET SHARE (IN TERMS OF USD) SHIPMENT MIX (IN TERMS OF VOLUMES) 2011 2012 2013 2014 2015 2016 Condoms - Female 1.0% 0.8% 0.9% 1.3% 1.5% 1.8% Condoms - Male 79% 80% 79% 78% 81% 82% Implants 0.2% 0.2% 0.3% 0.3% 0.6% 0.8% Injectables 3.6% 4.7% 4.7% 5.9% 5.8% 4.2% IUDs 0.5% 0.4% 0.4% 0.5% 0.6% 0.9% Orals - Combined & Progestin Only 15% 14% 14% 14% 10% 10% Orals - Emergency 0.1% 0.5% 0.2% 0.3% 0.4% 0.5% Total Volumes 2.04 B 2.32 B 1.98 B 1.92 B 1.68 B 1.18 B EXHIBIT 4: COST PER CYP BY METHOD (USD) (CONTINUED) SU PP LI ER S H IP M EN T AN AL YS IS IUDs Implants - 5 Year Implants - 4 Year Injectables - 3 month Implants - 3 Year Condoms - Male Orals - Combined Orals - Progestin Only Injectables - 2 month Orals - Emergency Injectables - 1 month Condoms - Female Cost of Product per Year of Use in 2016 (USD) $0.10 $2.24 $2.66 $3.29 $3.40 $3.64 $3.95 $4.92 $4.94 $7.02 $10.70 $59.28 $0 $10 $20 $30 $40 $50 $60 CY P M ix Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female 2011 2012 2013 2014 2015 92 M 0% 20% 40% 60% 80% 100% 9% 14% 34% 17% 0.4% 22% 0.1% 12% 16% 34% 17% 0.2% 20% 0.1% 12% 17% 34% 15% 0.2% 23% 0.2% 10% 25% 37% 9% 0.3% 19% 0.2% 9% 43% 19% 0.1% 17% 0.2% 12% 110M 123M 110M 119M 123M 2016 27% 45% 7% 0.3% 12% 0.2% 8% 104M M ar ke t Sh ar e Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female 2011 2012 2013 2014 2015 0% 20% 40% 60% 80% 100% $277M $362M $273M $288M $274M 21% 29% 1% 26% 1% 25% 3% 15% 19% 1% 30% 1% 29% 3% 17% 18% 1% 27% 1% 32% 5% 15% 32% 2% 18% 1% 29% 5% 14% 2016 $196M 40% 2% 16% 1% 21% 5% 15% 2% 35% 0% 22% 4% 16% 8 SU PP LI ER S H IP M EN T AN AL YS IS 38% 30% 2% 3% 56% 9% 29% 2% 4% 57% 8% 32% 2% 1% 54% 11% 23% 2% 1% 60% 13% 2% 4% 43% 14% M ar ke t Sh ar e Unknown FP2020 Region Asia & Pacific Latin America & Caribbean Sub-Saharan AfricaMiddle East & North Africa 2011 2012 2013 2014 2015 $277 M $362M $273M $288M $274M 0% 20% 40% 60% 80% 100% 19% 2% 2% 68% 9% 2016 $196M EXHIBIT 6: TOTAL FP2020 MARKET SHARE BY REGION MARKET VALUE BY REGION (USD) 2011 2012 2013 2014 2015 2016 Asia & Pacific $105M $110M $80M $93M $64M $37M Latin America & Caribbean $4M $6M $6M $5M $6M $5M Middle East & North Africa $10M $9M $10M $4M $3M $4M Sub-Saharan Africa $120M $202M $155M $154M $165M $134M Known Regions $239M $328M $251M $256M $238M $179M Unknown FP2020 Region $38M $34M $21M $32M $37M $17M Total $277M $362M $273M $288M $274M $196M *The “Unknown FP2020 Region” represents the proportion of shipment volumes to procurer warehouses where the final FP2020 destination is unknown. See Appendix C for further details. Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding * 9 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, May 2017; [3] USAID, “Couple-Years of Protection (CYP),” May 2017 SU PP LI ER S H IP M EN T AN AL YS IS 9% 48% 7% 7% 7% 5% 4% 4% 3% 3% 3% Ethiopia Tanzania Zimbabwe Nigeria Kenya Bangladesh Democratic Republic of Congo Ghana Uganda Burkina Faso Other FP2020 Countries EXHIBIT 7: TOP 10 COUNTRIES IN TERMS OF MARKET SIZE, 2016 EXHIBIT 8: TOP 10 MARKETS IN TERMS OF MARKET VALUE (DETERMINED BY 2016 DATA) AND OTHER FP2020 MARKETS Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding To ta l M ar ke t Si ze (M ill io ns U SD ) Top 10 Countries Other FP2020 Countries 2011 2012 2013 2014 2015 2016 $277M $273M $274M $196M $288M $362M $0M $50M $100M $150M $200M $250M $300M $350M $400M $150M $219M $143M $136M $137M $133M $155M $119M $156M $101M $95M $128M * Top 10 countries include Ethiopia, Tanzania, Zimbabwe, Nigeria, Kenya, Bangladesh, Democratic Republic of Congo, Ghana, Uganda and Burkina Faso. * 10 FROM 2015 TO 2016 THERE WAS A SUBSTANTIAL DECREASE IN DONOR SPENDING18 IN THE 69 FP2020 COUNTRIES, AS RECORDED IN RHI19. PRIOR TO 2016, DONOR SPENDING WAS RELATIVELY STABLE FROM YEAR TO YEAR. THESE TRENDS ARE CONSISTENT WITH THE SUPPLIER SHIPMENT ANALYSIS FOR THE PERIOD OF 2011 TO 2016. FROM 2015 TO 2016, DONOR SPENDING DECREASED FROM US$186 MILLION TO US$137 MILLION. CONSEQUENTLY, TOTAL CYPS FROM DONOR-FUNDED SHIPMENTS DECREASED BY 9 MILLION CYPS, FROM 65 MILLION CYPS IN 2015 TO 56 MILLION CYPS IN 2016. D O N O R FU N D IN G A N AL YS IS This section uses shipment data from RHI to construct and analyze the donor-funded, FP2020 market for product-based modern methods, defined as volumes shipped from USAID, UNFPA, and other donors20, for the 69 FP2020 focus countries. It analyzes donor spending and donor-funded CYP trends from 2011 to 2016 as a subset of the overall FP2020 public sector market, as defined in the Supplier Shipment Analysis. Despite an annual decrease of 4 percent in donor spending between 2011 and 2016, donor-funded CYPs declined only by 1 percent annually during that period due to the CYP mix shift towards implants. Donor spending decreased from US$172 million in 2011 to US$137 mil- lion in 2016, driven by the decline of donor-funded shipments across all methods, with the exception of implants. As a result, total CYPs shipped from donor-funded shipments remained relatively flat during this period, from 59 million CYPs shipped in 2011 to 56 million in 2016. (Exhibits 9, 10) The value of donor-funded shipments declined significantly between 2015 and 2016, with USAID showing a particular- ly noticeable decrease, potentially related to procurement patterns, which is explored further on page 14. A decrease in non-donor funded shipments was also apparent. UNFPA’s spending for the total FP2020 public sector market was US$80 million in 2016 compared to US$92 million in 201521, a decrease of 13 percent. The value for USAID’s funded shipments declined from US$89 million in 2015 to $US53 million in 2016, a decrease of 40 percent. Other donors’ spending decreased as well by 17 percent, from US$5 million to US$4 million, over the period. Finally, additional global markets vis- ibility volumes21, which represent non-donor funded shipments in the total FP2020 public sector market as implied by supplier shipment data, decreased by 33 percent, from US$89 million in 2015 to US$59 million in 2016. (Exhibit 9) The purchasing patterns of both USAID and UNFPA reflect a notable shift in the CYP mix towards LARCs between 2011 and 2016. As USAID’s CYP mix moved towards LARCs, USAID’s shipments of short-acting methods decreased, from 66 percent of the CYP mix in 2011 to just over 50 percent in 2016. UNFPA’s CYP mix also shifted to LARCs from short-acting methods. Short-acting methods made up half of UNFPA’s CYP mix in 2011 and were only a third of the CYP mix in 2016. (Exhibit 11) LARCs now account for 63 percent of the donor-funded ship- ments CYP mix, but only 40 percent of donor spending. Although there was a decrease in donor-funded implants shipments from eight million in 2015 to six million in 2016, implants continued to rank first in terms of donor spending for contraceptive methods and CYPs shipped. Implants accounted for 39 percent of the total market value and 35 percent of the total donor-funded CYPs shipped in 2016. By contrast, the next two highest ranked methods, injectables and male condoms, each represented approximately 20 percent of the 2016 donor spending and around 15 percent of the donor-funded CYPs shipped. 18. Donor spending and value represented by donor-funded shipments is calculated as the average of UNFPA and USAID prices multiplied by the total units shipped in a particular year. 19. RHI data is supplemented with data from USAID/ PSM systems to include the USAID-funded shipments not currently captured in RHI due to data integration issues. 20. See Appendix D for further details on donors included. 21. The previous Family Planning Market Report (2016) stated that UNFPA spent US$94 million in 2015; the figure reported here is likely the result of data updates in RHI. 11 Although 2016 donor-funded shipments still accounted for 54 percent of the total CYPs shipped to the FP2020 public sector market compared to 53 percent in 2015, donor-funded CYPs declined by 14 percent between 2015 to 2016. The total number of CYPs shipped from UNFPA remained relatively flat between 2015 and 2016; UNFPA shipped 31 million in total CYPs in 2016 compared to 33 million in 2015. USAID’s total CYPs shipped declined D O N O R FU N D IN G A N AL YS IS CY Ps S hi pp ed fr om P ro du ct -b as ed M od er n M et ho ds in F P2 02 0 co un tr ie s (M ill io ns ) 2011 2012 2013 2014 2015 110M 123M 110M 119M 123M 104M 0M 20M 40M 60M 80M 100M 120M 33M 28M 33M 11M 50M 31M 43M 7M 29M 39M 30M 3M 47M 29M 33M 3M 1M 58M 2016 20M 31M 5M 48M 18M 8M 50M Donor Total USAID-funded Donor-funded, UNFPA-procured Additional Global Markets Visibility Volumes Other Donor-funded 59M 73M 81M 72M 65M 56M Co m m od it y Sp en di ng (M ill io ns U SD ) 2011 2012 2013 2014 2015 2016 $277M $362M $273M $288M $274M $196M $0M $50M $100M $150M $200M $250M $300M $350M $400M $107M $93M $92M $38M $138M $79M $110M $14M $70M $88M $95M $10M $95M $89M $92M $5M $89M $53M $80M $4M $59M $41M $24M $105M Donor Total USAID-funded Donor-funded, UNFPA-procured Additional Global Markets Visibility Volumes Other Donor-funded $172M $224M $203M $193M $186M $137M EXHIBIT 9: DONOR-SUPPORTED CYPS & COMMODITY SPEND EXHIBIT 10: CYPS IMPLIED BY DONOR-FUNDED SHIPMENTS BY METHOD *Additional global markets visibility volumes is derived from subtracting the donor-funded volumes as seen in RHI from the supplier-reported data. This high-level calculation assumes the supplier-reported data includes the majority of donor-funded volumes and thus the remainder can be attributed to other donor volumes not captured by RHI, and/or other public and social sector volumes. * * 2011 2012 2013 2014 2015 2016 Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female 0M 10M 20M 30M 40M 50M 60M 70M 80M 5M 11M 22M 8M 0.2M 16M 0.1M 14M 18M 26M 9M 0.1M 16M 0.2M 12M 16M 18M 7M 0.1M 19M 0.2M 11M 25M 12M 6M 0.1M 12M 0.2M 11M 19M 8M 0.1M 13M 0.2M 13M 59M 73M 81M 72M 65M 20M 16M 4M 0.1M 9M 0.1M 8M 56M D on or -F un de d CY Ps S hi pp ed in F P2 02 0 co un tr ie s (M ill io ns ) Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, May 2017 [3] UNFPA Contraceptive Price Indicator, 2011–2016; [4] USAID, “Couple-Years of Protection (CYP),” May 2017; [6] IAP Implant Price Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding sharply from 29 million in 2015 to 20 million in 2016, a 33 percent de- crease for the year. Other donor-funded CYPs increased by 54 percent, from three million to five million from 2015 to 2016, while the additional global markets visibility CYPs, which represent non donor-funded CYPs in the total FP2020 public sector market as implied by the supplier-re- ported data, decreased by 17 percent, from 58 million in 2015 to 48 million in 2016. (Exhibits 9, 10) 12 D O N O R FU N D IN G A N AL YS IS EXHIBIT 11: CYP MIX IMPLIED BY USAID & UNFPA PROCUREMENT 10% 10% 22% 14% 0.1% 31% 0.3% 22% 9% 33% 0% 23% 0.2% 21% 13% 16% 37% 6% 0% 22% 0.2% 19% 32% 14% 12% 0.1% 19% 22% 0.3% 7% 46% 10% 0% 24% 0.2% 13% 23% 43% 8% 0% 17% 0.2% 9% 33% 32% 10% 11% 0.2% 33% 0.4% 14% 30% 8% 0.1% 18% 0.4% 10% 44% 17% 6% 0.2% 21% 0.3% 12% 24% 16% 0% 26% 0.3% 24% 33M 28M 31M USAID UNFPA 39M 29M 18M 33M 43M 30M 33M 2011 2012 2013 2014 2015 2011 2012 2013 2014 2015 Condoms - Male Injectables Implants IUDs Orals - EmergencyOrals - Combined andProgestin Only Condoms - Female 0% 20% 40% 60% 80% 100% 24% 25% 9% 0% 19% 22% 0.4% 20M 2016 48% 21% 6% 16% 9% 0.2% 31M 2016 CY P M ix Sources: [1] RHI Shipment Data, May 2017 [2] USAID, “Couple-Years of Protection (CYP),” May 2017 13 AD D IT IO N AL A N AL YS IS O N H IG H V O LU M E CO U N TR IE S PUBLICLY AVAILABLE DATA FROM BANGLADESH, INDIA, AND INDONESIA SUPPORTS THE HYPOTHESIS THAT NON DONOR-FUNDED LOCAL/REGIONAL SUPPLIERS22 ARE PLAYING A LARGER ROLE IN PROCUREMENT IN THESE COUNTRIES. This section uses publicly available data sources, e.g. MOHFW or government tender documents, to further examine high volume countries, as previously published in the 2016 Family Planning Market Report. In Bangladesh, the procurement of product-based modern contraceptives has decreased from 13 million CYPs to eight million CYPs from 2015 to 2016. However, consumption has remained steady over the same period. The Bangladesh Ministry of Health and Family Welfare (MOHFW) procured 13 million CYPs for the 2015 calendar year, as compared to eight million CYPs23 for the 2016 calendar year. Procurement contracts for product-based contraceptives were awarded primarily to regional and local suppliers, including (but not limited to): Essential Drugs Co. Ltd., Helm AG, HLL Lifecare Limited, Khulna Essential Latex Plant (KELP), Maneesh Pharma, MSD/Organon (India) Pvt Ltd.24, MSD B.V.25, M/S, Re- neta Ltd., Popular Pharma, Sarban International Ltd., and Techno Drugs from Bangladesh. As noted, since coverage for this report is limited to those participating suppliers, only the data from a subset of these manufacturers26 is included in the current calculation of market value derived from the supplier shipment data. By applying the same prices27 used for 2015 and 2016 supplier shipment volumes to the volumes from the Bangladesh MOHFW procurement contracts, we estimated the im- plied value from those contracts to be US$41 million and US$31 million for 2015 and 2016, as compared to the US$19 million to US$9 million implied by the 2015 and 2016 supplier shipment data. In addition, a review of Bangladesh’s supply chain reports revealed that consumption of contraceptive commodities has been fairly consistent, between 13 and 14 million CYPs from 2011 to 2016, and that the lower 2016 procurement levels did correspond to a decrease in year-end stock levels, but that it did not affect the level of consumption. In India, there was a slight increase in the number of CYPs procured from product-based modern methods between the 2010/2011 fiscal year and the 2014/2015 fiscal year, while ster- ilization remained constant at around four million operations per year. Based on India’s Ministry of Health and Family Welfare (MOHFW) Annual Report28 for the 2014/2015 fiscal year, which ends on March 31, CYPs from product-based modern methods29 totaled 58 million for that fiscal year, compared to 54 million in the 2010/2011 fiscal year while steriliza- tions remained steady at four million performed for the 2014/2015 fiscal year. While the MOHFW annual report shipment volumes are based on the 2014/2015 fiscal year instead of the calendar year used in this report, by applying the same prices27 used for 2014 and 2015 supplier shipment volumes, we estimate that implied market value from the annual reports is approximately US$68 million in 2014/2015 fiscal year, as compared to the US$1 to US$5 million implied by the 2014 and 2015 supplier shipment data30. In Indonesia, CYPs procured from product-based modern methods increased from 17 million in 2015 to 23 million in 2016. Data from public tender documents published by National Family Planning Coordinating Body (BKKBN) indicated an increase in CYPs procured from product-based methods31, from 17 million in 2015 to 23 million in 2016. By applying the same prices27 used for the 2015 and 2016 supplier shipment volumes, we estimate that the total implied market value from these tender documents is US$57 million in 2015 and US$75 million in 2016, as compared to the less than US$1 million and US$3 million implied by the 2015 and 2016 supplier shipment data. The data also shows that the Indonesian procurement contracts were awarded primarily to regional and local suppliers, including: PT Catur Dakwah Crane Farmasi, PT Harsen Laboratories, PT Kimia Farma, PT Triyasa Nagamas Farma, PT Pratapa Nirmala, PT Sunthi Sepuri, and PT Tunggal. Among them, PT Tunggal is the only supplier currently partici- pating in this report, as part of the GEMs Caucus32. Additional information about these three markets can be found in Appendix E. 22. Many of these suppliers are not participating in this report; CHAI is actively seeking the participation of relevant suppliers to increase market visibility. 23. Procured methods from Bangladesh’s MOHFW report include male condoms, orals, inject- ables and implants. 24. MSD/Organon (India) Pvt Ltd. is a Merck/MSD company and therefore not a regional or local supplier. 25. MSD B.V. is a Merck/MSD company and therefore not a regional or local supplier. 26. Manufacturers participating in this report include Helm AG from Germany, Merck/MSD from the Netherlands, and Techno Drugs from Bangladesh. 27. See Appendix C for more details on unit prices used for market value calculations. 28. While the MOHFW Annual Reports do not record identities of the awarded suppliers, a US- AID report has enabled the identification of local suppliers and the contraceptives that supply to the government and SMO programs as of 2006, including (but not limited to): Indian Drug and Pharmaceutical Ltd. (IDPL), HLL Lifecare Limited, Phaarmasia, Pregna International, SMB Corporation, Cipla, Win-Medicare, and Famy Care, now known as Mylan. This list was further validated by in-country partners. Of these suppliers, Pregna International, SMB Corporation, Cipla, and Mylan currently participate in this report. 29. Procured methods from India’s MOHFW reports include male condoms, IUDs, orals, and emergency contraception. 30. The latest data from India referenced in this report is from the 2014 to 2015 fiscal year and thus is compared to the corresponding supplier shipment data from 2014 and 2015. 31. Procured methods from Indonesia’s MOHFW reports include implants, injectables, and orals. 32. The Generic Manufacturers Caucus for Reproductive Health (GEMS Caucus) comprises generic pharmaceutical manufacturers throughout Asia, Africa, and Europe, united in their commitment to provide safe, quality-assured family planning products that enable women to make choices about their reproductive health; available at https://www.rhsupplies.org/activi- ties-resources/groups/generic-manufacturers-caucus/. 14 CHAI CONSULTED KEY PARTICIPATING SUPPLIERS AS WELL AS OTHER FAMILY PLANNING PARTNERS AND STAKEHOLDERS TO IDENTIFY POTENTIAL REASONS FOR THE 2015 TO 2016 FP2020 PUBLIC SECTOR MARKET DECLINE, THE MOST COMMON OF WHICH ARE DISCUSSED HERE. FURTHER RESEARCH BEYOND THE SCOPE OF THIS REPORT WOULD BE REQUIRED TO CONFIRM THESE HYPOTHESES. EX PL O RI N G P O TE N TI AL C O N TR IB U TI N G F AC TO RS T O T H E 20 15 T O 2 01 6 M AR KE T D EC LI N E Hypothesis #1: The decline in overall FP2020 public sector shipments may be a real decline driven by decreased do- nor-funded shipments. Governments and other procurers may not be sufficiently covering the shortfall. From 2012 to 2016, CYPs shipped to the total FP2020 public sector de- creased by 19 million, and donor-funded CYPs shipped also declined by a similar amount of 17 million, which could indicate that there is direct correlation between the lower volumes of donor-funded contraceptives shipped and the decline in overall FP2020 public sector shipments. Hypothesis #2: A greater share of public sector procurement may have shifted to local and regional suppliers not yet par- ticipating in this report. Certain currently participating suppliers contend that, in large countries such as Bangladesh, India, Indonesia, and Pakistan, procurement is shifting from donor-supported suppliers to local and regional suppliers who are not donor-supported. CHAI refreshed its 2016 analysis of Ban- gladesh, India, and Indonesia for this report, and the data derived from purchase orders and procurement reports from these three countries’ governments seem to support this hypothesis.33 CHAI’s work to expand market visibility in such large countries has enabled the identification of these local and regional suppliers and provided CHAI with the opportunity to solicit their participation in the report. So far, one additional supplier has signed on and its data is included in this year’s report. Moving forward, CHAI will continue to engage and actively seek the participation of relevant suppliers to increase visibility. 33. In the 2016 FP Market Report, CHAI conducted additional markets visibility analyses into three of these countries, Bangladesh, India, and Indonesia. This analysis has been refreshed and the outcomes detailed on page 13 of this report. 34. Procurement Planning and Monitoring Report is available at http://ppmr.rhsupplies.org/ content?id=1. See Appendix B for more details. Hypothesis #3: The significant decline in shipment volume from 2015 to 2016 may have been part of the natural fluctua- tion in procurement patterns from year to year and may not necessarily be indicative of current consumption trends. It is widely understood among supply chain and procurement profes- sionals that countries procure stock based on their unique in-country supply chains and in-country demand, both of which may vary year to year as programs are scaled up or down. Therefore, some plausible explanations for the 2016 shipment decline could include: there were sufficient inventory levels at the end of year 2015 in certain countries, thus said countries decided to procure less in 2016; some countries may have decided to procure the bulk of their shipments in late 2015 and early 2017 (Bangladesh appears to be one such example based on the government procurement reports); and, 2016 was a transition year for USAID as it moved from one procurement agent, USAID | DELIVER, to another, USAID Procurement and Supply Management (PSM), which may have contributed to overstocking in prior years and under-procurement in 2016. Procurement Planning and Monitoring Report (PPMR) data34 for 34 countries provides an encouraging picture, with overall consumption remaining relatively stable from 2015 to 2016 in addition to a stable trend reflected in the Bangladesh MOHFW supply chain reports from 2011 to 2016 specifically. This evidence could thus indicate that procure- ment patterns are indeed simply following their natural fluctuation. 15 FU TU RE O U TL O O K THE AVAILABILITY OF FUTURE FUNDING FOR CONTRACEPTIVE COMMODITIES COULD SIGNIFICANTLY IMPACT THE FAMILY PLANNING COMMODITY MARKET. A number of recent analyses, including RHSC’s 2016 Global Contracep- tive Commodity Gap Analysis35, have identified significant funding gaps based on current and existing family planning spending levels. US$500 million would be needed from 2017 to 2020 to address the public sector funding gaps in 2036 of the largest FP2020 countries alone37. In addition, there is continued uncertainty with regard to the U.S. government’s financial commitment to family planning moving forward38. Any signif- icant funding cuts could exacerbate the funding constraint as USAID’s estimated contribution to family planning accounts for 28 percent of 35. RHSC Global Contraceptive Commodity Gap Analysis, available at https://www.rhsupplies. org/uploads/tx_rhscpublications/Global_Contraceptive_Commodity_Gap_Analysis_2016.pdf 36. The 20 countries include: Bangladesh, Burkina Faso, Cameroon, Democratic Republic of Congo, Côte d'Ivoire, Ethiopia, Ghana, Kenya, Lao PDR, Liberia, Malawi, Mauritania, Mozam- bique, Niger, Nigeria, Rwanda, Senegal, Tanzania, Togo, and Uganda. 37. In 2016, these countries represented ~57 percent of the 69 FP2020 public sector market, as defined by this report. 38. In May 2017, the current U.S. administration proposed to eliminate funding for international family planning programs for fiscal year 2018 (FY 2018). (https://www.whitehouse.gov/sites/ whitehouse.gov/files/omb/budget/fy2018/msar.pdf, accessed July 17th 2017). In July 2017, the the direct funding for contraceptives and distribution in the developing world39. Further, it is unclear whether the committed funding stemming from new initiatives such as SHE DECIDES and the recent 2017 London Family Planning Summit will be sufficient to cover the funding gaps. Should the funding challenges remain unaddressed, there could be a decline in the public sector family planning commodity market and subsequently, in the number of users of modern methods of contracep- tion. House Committee on Appropriations approved the FY 2018 State & Foreign Operations (SFOPs) Bill. (https://appropriations.house.gov/uploadedfiles/bills-115hr-sc-ap--stateforop-fy2018state- foreignoperationsappropriations.pdf, accessed September 22nd, 2017). In September 2017, the Senate Committee on Appropriations approved the FY 2018 SFOPs Bill. (https://www. appropriations.senate.gov/imo/media/doc/FY2018%20State%20Foreign%20Operations%20 Appropriations%20Bill%20-%20S1780.pdf, accessed September 22nd 2017). 39. Available at https://www.vox.com/policy-and-politics/2017/5/24/15681216/trump-bud- get-cuts-funding-global-family-planning-famine-relief 16 G LO BA L M AR KE TS V IS IB IL IT Y PR O JE CT A CK N O W LE D G EM EN TS About the Global Markets Visibility Project The Global Markets Visibility Project is a landmark initiative that re- sulted in the publication of the first Family Planning Market Report in May 2015, which provided the community with its first detailed glimpse into the public sector family planning market across the 69 FP2020 countries. This is the third iteration of the report. The initiative provides insightful and strategic outputs for donors, MOHs, implementing orga- nizations, and suppliers to develop and implement more effective strat- egies aimed at ensuring that an additional 120 million women in the world’s 69 poorest countries are enabled to use family planning prod- ucts and services by 2020. This report is a joint collaboration with the Reproductive Health Supplies Coalition (RHSC). The initial 2015 report comprised data from 11 manufacturers. Each manufacturer entered into a formal MOU with CHAI or provided their information through collabo- rations with the Generic Manufacturers Caucus for Reproductive Health (GEMs) and i+solutions. Coverage has expanded since the publication of the initial report, with 14 suppliers currently participating in the project. Donors, suppliers, and partners expressed strong interest to continue this project, build on our progress, and strengthen the family planning community’s market knowledge. About the Participating Suppliers Bayer Bayer is a Germany-based life science company with core competencies in health care and agriculture. Its contraceptive product portfolio in- cludes contraceptive implants, LNG-IUS, combined oral contraceptives, and injectables. CR Zizhu China Resources Zizhu Pharmaceutical Co., Ltd. (CR Zizhu) is a manufac- turer of reproductive health products based in China. Its contraceptive product portfolio includes emergency oral contraceptives and com- bined oral contraceptives. Cipla Cipla Limited is an India-based generic manufacturer with over 1,500 products in the areas of respiratory diseases, HIV/AIDS, malaria, MDRTB, and reproductive health. Its contraceptive product portfolio includes emergency contraceptives and combined oral contraceptives. Cupid Cupid Limited is a manufacturer of both male and female condoms based in India. Its services include contract manufacturing (e.g., Playboy condoms, Trust condoms) and research and development, as well as the marketing and manufacturing of its own branded products. Mylan Mylan is a U.S. based healthcare company with over 7,500 marketed products. Its contraceptive product portfolio includes orals (combined, progestin only, and emergency) and injectable contraceptives, IUDs, and tubal rings used for female sterilization40. Helm AG Helm AG is a Germany-based family owned multifunctional distribution company specializing in: Chemicals (Feedstocks and Derivatives), Crop Protection, Active Pharmaceutical Ingredients, Pharmaceuticals and Medical Products, and Fertilizers. Its main contraceptive product is a 3-month injectable DMPA IM. Merck/MSD Merck/ MSD is a U.S. based healthcare company. Its contraceptive product portfolio includes contraceptive implants (Implanon) NXT, oral contraceptives (Exluton, Marvelon, Cerazette), and the contraceptive vaginal ring (NuvaRing). Pfizer Pfizer is a U.S. based healthcare company. Its contraceptive product portfolio includes 3-month injectable DMPA IM (Depo-Provera) and 3-month injectable DMPA SC (Sayana Press). Pregna Pregna is a manufacturer of contraceptive products based in India. Its contraceptive product portfolio includes LNG-IUS (Eloira), IUDs, and tubal rings used for female sterilization. PT Tunggal PT. Tunggal Idaman Abdi (PT Tunggal) is a pharmaceutical manufacturer focusing on reproductive healthcare based in Indonesia. Its contra- ceptive product portfolio includes a monthly injectable, a 3-month injectable, a combined oral contraceptive, and an emergency oral contraceptive. Shanghai Dahua Shanghai Dahua Pharmaceutical Co., Ltd (Dahua) is a manufacturer of contraceptive implants based in China. On June 30th, 2017, the World Health Organization (WHO) pre-qualified Dahua’s Levoplant (formerly known as Sino Implant II). SMB SMB is a manufacturer of medical devices, including IUDs and surgical sutures, based in India. Its key contraceptive product is IUDs, including its Copper T 380A, TCu 380Ag, TCu 380 Plus, and SMB Cu 375. Market Definition, Scope, and Coverage The total FP2020 public sector market referenced in this report only includes data for the public sector in the 69 FP2020 countries, which is defined as volumes purchased by institutional buyers (USAID, UNFPA, SMOs, etc.) and MOH or government-affiliated procurers. Although significant efforts have been deployed to collect as much data as possible, it should be noted that this report may not represent the entirety of institutional purchases for the FP2020 public sector, as it includes data from the majority, but not all of the suppliers associated with these markets. 40. The procurement of products used for sterilization such as tubal rings are not covered in this report as the scope is limited to product-based modern methods of contraception. 17 G LO BA L M AR KE TS V IS IB IL IT Y PR O JE CT A CK N O W LE D G EM EN TS Techno Drugs Techno Drugs Ltd. is a manufacturer of both human and veterinary medicines based in Bangladesh. Its contraceptive product portfolio includes combined oral contraceptives and injectables. For injectables, Techno Drugs has also served as a supplier to Helm AG previously. Veru Healthcare Veru Healthcare, formerly known as the Female Health Company prior to the merger with Aspen Park Pharmaceuticals, Inc., is a biopharma- ceutical company based in the US, focusing on urology and oncology. The company's division, the Female Health Company, is focusing on the global public health sector business with its FC2 female condom. FC2 is approved by FDA and WHO pre-qualified for offering dual protection against sexually transmitted infections and unintended pregnancy. 18 APPENDIX A 41. Female condoms are aggregated with male condoms by country in order to protect data confidentiality. 42. Other FP2020 shipment volumes include shipments to procurer (USAID, UNFPA, SMOs) warehouses in non-FP2020 countries, such as Belgium, Denmark, France, Germany, Nether- lands, Norway, Sweden, Switzerland, UK, and US. Although these volumes were shipped to 69 FP2020 COUNTRIES MARKET VOLUMES BY METHOD41 AND COUNTRY42, 2011–2016 EXHIBIT A.1: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2011 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 19,572,826 0 1,395,200 67,000 807,674 Bangladesh 112,426,800 422,109 18,984,000 475,000 138,631,121 Benin 13,249,064 48,600 10,300 21,000 0 Bhutan 2,880,000 0 475,200 1,600 88,002 Bolivia 1,570,360 2,350 0 35,000 210,000 Burkina Faso 0 2,000 0 0 1,597,501 Burundi 14,673,200 44,600 0 39,000 33,335 Cambodia 1,764,000 19,000 0 20,000 20,000 Cameroon 0 11,500 0 31,000 50,200 Central African Republic 6,410,600 500 200 0 91,403 Chad 1,567,600 15,000 52,000 1,000 0 Comoros 1,008,000 1,024 26,800 100 0 Democratic Republic of Congo 73,252,800 8,500 350,000 26,000 1,295,595 Congo Rep 20,566,352 10 1,412,400 500 391,905 Cote d'Ivoire 34,967,400 0 630,800 10,000 2,613,145 Djibouti 590,240 0 0 1,500 0 Egypt Arab Rep 50,400 17,500 4,780,000 2,135,000 3,000,000 Eritrea 7,804,000 5,100 0 5,500 61,672 Ethiopia 146,223,384 382,704 5,471,200 420,000 7,752,440 Gambia 1,585,000 100 10,000 500 433,337 Ghana 5,514,000 57,674 3,044,000 0 0 Guinea 7,932,400 1,000 546,240 11,000 233,335 Guinea-Bissau 1,555,000 5,000 0 0 5,001 Haiti 54,534,096 0 976,800 0 200,001 Honduras 19,202,400 0 148,000 22,453 943,300 India 0 0 193,201 1,959,570 8,661,563 Indonesia 210,000 0 0 316,721 50,001 Iraq 0 0 0 75,000 2,633,250 Kenya 48,266,720 505,209 1,370,032 0 15,136,914 Korea Dem Rep 1,267,200 0 0 36,150 139,500 Kyrgyz Republic 5,202,600 0 0 160,000 0 Lao PDR 8,484,208 6,200 650,000 0 922,112 Lesotho 8,356,936 2,000 65,000 0 63,000 non-FP2020 countries, the end shipment destination of these volumes would likely be the 69 FP2020. As a result, these non-FP2020 volumes were included in the total shipments to 69 FP2020 countries after it was confirmed that the specific non-FP2020 volumes were associated with institutional purchases. APPENDIX A AP PE N D IC ES 19 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, May 2017. APPENDIX A EXHIBIT A.1: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2011 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Liberia 22,048,800 3,000 423,200 0 0 Madagascar 24,254,800 124,318 1,913,600 4,500 324,550 Malawi 11,886,001 46,452 540,000 0 50,000 Mali 1,000 53,600 1,292,625 41,501 0 Mauritania 3,600,000 3,728 6,000 5,500 533,336 Mongolia 10,002,880 1,000 0 0 321,000 Mozambique 96,394,000 5,010 1,241,400 41,000 5,393,262 Myanmar 56,563,712 4,000 0 0 6,918,499 Nepal 33,641,000 0 327,600 10,000 250,000 Nicaragua 13,356,000 0 332,100 50,000 842,001 Niger 10,000 4,612 814,000 2,800 400,000 Nigeria 78,948,652 32,900 3,157,500 209,000 1,055,335 Pakistan 249,431,800 25,300 5,862,000 200,000 400,299 Papua New Guinea 2,500,000 2,000 0 0 1,663,200 Philippines 740,800 0 0 0 6,639,745 Rwanda 30,211,488 0 1,768,400 18,600 0 Sao Tome and Principe 2,190,600 0 852,075 200 47,129 Senegal 11,400,000 10,350 0 3,000 220,000 Sierra Leone 4,515,800 91,700 0 35,500 1,206,269 Solomon Islands 30,000 0 0 0 24,000 Somalia 0 0 0 0 0 South Sudan 4,161,000 0 0 0 0 Sri Lanka 779,600 10,000 0 80,000 2,191,240 Sudan 10,591,344 3,500 0 2,000 1,167,875 Tajikistan 10,105,072 5,440 0 150,000 0 Tanzania 29,772,456 240,104 6,176,400 25,000 1,410,170 Timor-Leste 57,600 1,100 0 3,500 145,002 Togo 14,392,368 16,500 0 6,400 12,663 Uganda 82,319,600 86,688 2,089,800 83,785 334,220 Uzbekistan 5,414,112 0 0 1,500,000 600,000 Vietnam 15,049,000 9,000 1,180,000 1,772,000 0 West Bank and Gaza 4,521,600 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 829,440 6,625 2,001,875 30,000 3,971,120 Zambia 58,807,168 0 1,544,200 0 748,000 Zimbabwe 126,944,000 61,900 782,500 2,600 14,836,223 Other FP2020 Shipment Volumes 6,937,864 692,800 385,700 145,850 76,285,355 AP PE N D IC ES 20 EXHIBIT A.2: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2012 COUNTRY CONDOMS MALE & FEMALE 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 21,806,400 16,500 0 19,000 0 Bhutan 3,456,000 0 70,000 0 97,899 Bolivia 121,000 25,300 0 6,000 3,000 Burkina Faso 16,741,200 117,100 1,369,900 16,500 2,348,935 Burundi 6,272,000 120,000 996,000 175,000 608,160 Cambodia 748,656 29,676 307,600 58,650 1,125,338 Cameroon 3,162,000 12,300 0 20,000 17,840 Central African Republic 3,415,400 13,600 198,400 1,000 1,031,664 Chad 70,000 25,800 30,000 3,000 0 Comoros 576,000 500 15,000 0 17,199 Democratic Republic of Congo 148,830,600 46,800 1,344,000 39,000 4,210,965 Congo Rep 7,018,400 300 800,000 0 0 Cote d'Ivoire 37,371,000 16,456 700,000 0 2,455,000 Djibouti 519,680 0 0 500 96,000 Egypt Arab Rep 2,185,920 45,000 5,000,000 338,000 4,746,366 Eritrea 100,000 100 0 0 21,600 Ethiopia 173,877,714 1,471,188 16,429,200 257,200 8,545,593 Gambia 1,000 5,000 1,000 0 24,000 Ghana 7,605,000 196,460 2,172,000 0 120,000 Guinea 4,428,640 7,000 713,000 2,600 1,650,800 Guinea-Bissau 730,000 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 0 691,900 19,400 1,810,800 India 0 0 134,494 2,973,600 5,750,000 Indonesia 250,000 0 0 588,850 0 Iraq 0 0 0 0 3,252,000 Kenya 151,368,000 176,556 9,631,025 25,000 4,503,281 Korea Dem Rep 2,592,000 0 51,000 30,000 351,999 Kyrgyz Republic 26,602,800 0 5,600 255,000 482,880 Lao PDR 2,865,600 1,600 605,000 13,000 2,676,480 Lesotho 1,749,200 0 110,000 0 0 Liberia 6,286,945 18,000 0 0 4,860 Madagascar 3,151,400 174,336 2,896,200 0 2,881,680 Malawi 19,956,960 182,744 4,922,400 6,000 125,791 Mali 6,433,920 55,000 168,800 18,000 2,314,375 APPENDIX A AP PE N D IC ES 21 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, May 2017. APPENDIX A EXHIBIT A.2: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2012 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 20,000 0 13,400 0 0 Mongolia 6,073,000 5,120 120,000 0 652,797 Mozambique 98,478,960 30,000 2,490,000 0 6,419,170 Myanmar 9,785,112 0 1,501,600 18,000 6,864,858 Nepal 66,400,720 88,000 237,600 104,600 0 Nicaragua 4,229,280 0 450,400 11,896 822,055 Niger 24,400 3,108 200,600 10,000 740,850 Nigeria 199,399,440 328,212 14,321,300 872,634 3,025,137 Pakistan 252,501,000 70,768 857,600 90,700 226,701 Papua New Guinea 600,000 26,500 800,000 600 6,335 Philippines 2,001,600 1,536 200,000 447,514 14,565,234 Rwanda 15,724,568 20,060 776,400 0 105,000 Sao Tome and Principe 1,682,600 6,100 15,000 5,000 125,400 Senegal 14,407,000 77,056 1,478,400 14,000 1,002 Sierra Leone 1,122,000 0 250,000 15,990 739,073 Solomon Islands 0 0 0 0 0 Somalia 0 2,000 0 0 20,000 South Sudan 2,400,000 5,004 0 0 0 Sri Lanka 0 74,800 250,000 1,800 2,167,010 Sudan 3,335,968 25,040 0 9,000 3,968,200 Tajikistan 1,800,600 0 41,500 140,000 432,480 Tanzania 52,549,408 351,500 4,155,900 47,000 2,105,540 Timor-Leste 2,592,000 5,450 0 2,000 128,571 Togo 43,054,408 26,000 322,400 0 27,000 Uganda 89,421,536 396,829 6,249,200 76,896 114,400 Uzbekistan 3,635,000 0 445,000 800,000 1,121,280 Vietnam 52,546,800 23,976 900,000 800,000 138,999 West Bank and Gaza 0 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 3,801,888 24,000 180,000 95,000 3,443,504 Zambia 39,274,440 38,300 2,010,800 0 1,655,200 Zimbabwe 99,270,000 113,600 634,200 6,050 14,254,948 Other FP2020 Shipment Volumes 15,667,176 721,200 12,500 84,400 51,712,916 AP PE N D IC ES 22 EXHIBIT A.3: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2013 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 23,181,800 0 1,550,000 0 17,001 Bangladesh 10,111,950 0 14,200,000 0 76,298,840 Benin 6,790,800 44,200 32,400 32,000 180,000 Bhutan 295,200 0 0 2,000 126,420 Bolivia 3,457,460 34,500 500,000 70,000 429,840 Burkina Faso 1,411,200 257,196 215,650 28,000 565,200 Burundi 640,833 0 1,000,000 0 574,080 Cambodia 2,160,000 51,399 0 2,000 4,320,008 Cameroon 0 30,300 12,800 57,659 1,494,720 Central African Republic 10,449,800 6,000 183,000 1,500 1,003,797 Chad 1,337,200 44,100 628,400 13,000 2,701,920 Comoros 1,252,800 1,600 93,300 500 48,720 Congo Dem Rep 81,658,344 187,168 1,219,300 118,000 2,384,472 Congo Rep 20,000 800 273,500 500 2,457,988 Cote d'Ivoire 18,607,800 14,000 240,000 2,500 4,584,370 Djibouti 2,288,000 0 7,600 500 8,640 Egypt Arab Rep 100,800 10,801 1,000,164 2,340,100 0 Eritrea 100,000 600 0 0 50,400 Ethiopia 75,766,296 981,740 6,159,396 160,000 15,082,178 Gambia 1,001,800 5,000 110,000 0 253,160 Ghana 34,302,000 144,348 1,025,500 10,000 451,280 Guinea 9,150,400 13,000 0 4,000 0 Guinea-Bissau 1,759,600 21,400 20,600 5,500 42,840 Haiti 51,940,800 1,700 1,646,400 2,000 223,920 Honduras 11,505,600 5,056 670,000 0 1,879,920 India 0 0 18,260 650,800 17,671,399 Indonesia 0 113,500 0 727,409 0 Iraq 0 0 0 0 3,000,000 Kenya 945,600 635,043 12,635,755 1,250 6,269,302 Korea Dem Rep 2,462,400 0 0 15,000 96,000 Kyrgyz Republic 5,299,200 0 15,000 0 570,300 Lao PDR 655,200 0 279,200 5,000 178,962 Lesotho 37,442,000 100 120,000 15,000 238,800 Liberia 17,500,000 15,200 244,800 0 400,320 Madagascar 4,547,768 239,980 5,733,542 0 2,376,836 Malawi 74,791,080 193,048 1,742,327 15,610 1,590,523 Mali 20,041,008 87,700 1,197,198 0 0 APPENDIX A AP PE N D IC ES 23 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, May 2017. APPENDIX A EXHIBIT A.3: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2013 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 12,548,900 5,120 156,700 0 726,480 Mongolia 4,633,152 17,744 80,000 35,000 435,482 Mozambique 30,528,579 127,000 3,072,000 16,000 8,425,200 Myanmar 5,459,032 0 821,000 23,000 10,240,559 Nepal 6,370,788 10,000 655,200 30,000 0 Nicaragua 4,003,200 300 339,000 7,500 1,094,813 Niger 3,394,000 90,016 503,400 0 3,183,760 Nigeria 88,696,740 344,663 2,142,300 0 2,303,072 Pakistan 315,871,100 45,492 9,151,200 200,400 0 Papua New Guinea 19,924,800 38,790 0 4,000 1,313,583 Philippines 0 85,056 1,485,000 0 9,331,385 Rwanda 14,132,000 27,000 928,000 0 1,477,200 Sao Tome and Principe 5,000 500 0 0 6,000 Senegal 10,385,200 0 1,159,000 26,000 0 Sierra Leone 11,122,800 36,600 733,000 18,000 1,652,870 Solomon Islands 0 0 0 500 0 Somalia 0 1,000 0 0 148,700 South Sudan 8,601,000 10,940 0 500 775,200 Sri Lanka 0 93,000 233,500 110,000 2,068,050 Sudan 2,389,600 30,572 0 0 2,456,292 Tajikistan 7,096,200 0 0 105,000 0 Tanzania 29,769,000 309,621 0 55,000 2,009,270 Timor-Leste 57,600 2,100 0 0 225,863 Togo 11,465,520 68,000 606,500 0 108,960 Uganda 185,409,800 471,635 12,243,775 143,000 142,000 Uzbekistan 9,553,400 0 300,000 800,000 1,367,760 Vietnam 31,968,000 56,136 870,000 1,700,000 71,665 West Bank and Gaza 3,998,304 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 6,082,704 56,192 1,126,284 471,459 17,423,472 Zambia 86,409,000 75,000 1,656,900 0 2,669,480 Zimbabwe 111,075,000 244,180 2,460,400 3,500 24,101,441 Other FP2020 Shipment Volumes 54,175,200 678,000 251,400 84,430 72,725,087 AP PE N D IC ES 24 EXHIBIT A.4: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2014 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 17,329,040 3,000 109,600 5,500 424,560 Bangladesh 0 0 15,500,000 400,000 88,795,560 Benin 3,993,400 61,300 462,400 50,500 1,011,681 Bhutan 1,440,000 0 0 0 156,150 Bolivia 877,250 27,500 0 0 0 Burkina Faso 12,588,200 298,500 1,476,400 12,900 2,346,480 Burundi 0 207,900 1,500,200 6,860 470,200 Cambodia 2,995,200 30,588 520,000 55,000 4,417,848 Cameroon 10,545,460 69,400 0 2,000 639,339 Central African Republic 200,000 3,500 142,300 0 155,024 Chad 3,738,240 41,100 644,800 0 0 Comoros 0 500 0 0 59,997 Democratic Republic of Congo 163,406,800 50,212 267,600 14,000 964,695 Congo Rep 9,243,540 2,108 21,400 105,000 468,597 Cote d'Ivoire 21,745,600 75,700 1,698,200 15,500 4,770,310 Djibouti 0 0 3,800 0 15,000 Egypt Arab Rep 468,000 140,032 365,000 591,111 0 Eritrea 0 500 20,000 0 108,000 Ethiopia 44,350,736 495,112 12,226,888 430,500 5,894,456 Gambia 1,440,000 9,048 160,000 0 67,860 Ghana 45,105,600 120,696 6,003,800 20,250 2,630,160 Guinea 8,955,000 20,800 45,800 0 194,400 Guinea-Bissau 2,426,400 31,000 25,000 0 8,280 Haiti 57,184,080 0 1,199,200 4,000 0 Honduras 18,254,736 40,000 119,400 21,500 2,860,830 India 0 0 10,094 2,039,273 13,244,150 Indonesia 12,000 0 0 768,575 0 Iraq 5,078,880 0 0 5,039 1,513,029 Kenya 36,198,800 481,336 2,681,620 0 3,617,640 Korea Dem Rep 0 0 0 0 96,000 Kyrgyz Republic 0 0 40,000 0 0 Lao PDR 2,793,456 3,024 382,000 0 1,141,200 Lesotho 44,934,736 600 1,000 0 26,640 Liberia 9,574,000 0 457,000 0 352,080 Madagascar 27,001,200 77,440 8,058,500 0 1,057,362 Malawi 55,827,800 104,324 6,531,650 0 630,006 Mali 32,271,400 100,600 1,190,600 21,000 2,673,306 APPENDIX A AP PE N D IC ES 25 EXHIBIT A.4: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2014 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 43,000 1,200 35,000 0 83,520 Mongolia 882,720 0 0 25,000 158,420 Mozambique 44,553,600 22,000 6,868,050 0 129,600 Myanmar 14,708,640 5,000 6,087,300 20,000 13,108,816 Nepal 13,462,400 44,700 3,795,800 35,149 2,558,000 Nicaragua 0 0 95,150 0 0 Niger 504,000 171,024 762,200 3,500 1,918,800 Nigeria 68,370,144 323,168 7,747,600 141,100 920,802 Pakistan 253,485,000 34,080 10,367,600 2,163,550 0 Papua New Guinea 11,238,800 42,000 1,322,400 10,000 1,125,519 Philippines 0 149,023 2,000 0 18,456,458 Rwanda 5,403,000 32,816 1,727,200 0 60,480 Sao Tome and Principe 7,160 0 0 0 39,600 Senegal 30,213,112 33,600 1,149,600 42,000 691,000 Sierra Leone 6,756,880 0 414,600 0 549,360 Solomon Islands 7,000 0 0 0 34,560 Somalia 28,800 28,000 60,000 8,500 68,880 South Sudan 5,205,600 15,000 0 0 24,999 Sri Lanka 0 63,000 406,800 0 6,619,680 Sudan 2,628,000 29,440 6,600 0 1,589,396 Tajikistan 7,438,096 0 43,600 40,000 193,440 Tanzania 31,370,600 458,644 1,492,400 75,000 2,421,591 Timor-Leste 0 10,500 181,400 0 205,359 Togo 7,278,801 48,200 63,000 0 69,104 Uganda 134,701,296 479,202 6,172,050 0 533,130 Uzbekistan 4,809,600 0 0 1,457,500 0 Vietnam 0 43,322 0 0 0 West Bank and Gaza 0 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 2,367,360 25,088 306,500 48,000 2,338,860 Zambia 54,777,800 136,600 2,532,100 3,500 1,576,800 Zimbabwe 129,833,000 149,100 0 3,000 14,795,070 Other FP2020 Shipment Volumes 47,544,044 1,405,100 390,400 171,201 102,973,716 APPENDIX A Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, May 2017. AP PE N D IC ES 26 EXHIBIT A.5: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2015 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 4,728,000 4,500 0 30,000 300,000 Bangladesh 0 50,000 15,100,000 0 24,000,000 Benin 12,169,800 222,536 125,500 66,500 525,600 Bhutan 1,936,800 0 111,000 0 129,999 Bolivia 0 3,500 0 0 0 Burkina Faso 19,747,510 244,044 564,000 35,500 3,559,057 Burundi 5,760,000 134,500 1,639,267 0 594,600 Cambodia 5,730,480 11,000 200,000 30,000 9,551,557 Cameroon 26,245,443 125,052 10,000 46,550 48,465 Central African Republic 0 500 37,900 0 23,841 Chad 100,000 7,600 0 0 0 Comoros 1,303,200 1,008 78,400 0 35,001 Democratic Republic of Congo 65,606,368 308,230 1,189,200 0 3,124,218 Congo Rep 7,104,840 11,000 622,360 0 0 Cote d'Ivoire 100,000 15,664 212,000 0 5,224,561 Djibouti 0 500 296,667 0 93,327 Egypt Arab Rep 0 0 0 258,200 0 Eritrea 0 0 120,000 0 108,000 Ethiopia 31,052,091 1,180,607 2,000,000 650,000 8,478,983 Gambia 2,900 30,048 265,000 0 156,240 Ghana 13,995,000 403,236 1,992,000 0 1,993,464 Guinea 10,080,000 32,500 907,448 0 484,880 Guinea-Bissau 3,384,720 59,400 27,500 0 78,000 Haiti 60,014,400 9,300 421,400 0 228,571 Honduras 10,000,800 93,656 1,725,800 62,000 3,505,905 India 0 0 795,252 1,273,927 325,000 Indonesia 20,000 25,086 0 171,000 0 Iraq 0 0 0 0 0 Kenya 45,779,200 905,900 2,231,000 70,000 3,142,535 Korea Dem Rep 0 0 0 0 0 Kyrgyz Republic 1,527,264 0 80,000 0 0 Lao PDR 10,875,960 20,000 333,000 0 1,530,720 Lesotho 21,016,000 1,500 81,800 0 124,369 Liberia 9,009,780 44,600 846,800 0 459,270 Madagascar 1,500,000 72,722 9,349,250 35,996 595,605 Malawi 68,274,192 278,786 6,099,200 0 552,795 Mali 39,764,195 195,805 432,840 18,393 948,953 APPENDIX A AP PE N D IC ES 27 EXHIBIT A.5: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2015 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 0 86,264 41,200 0 140,640 Mongolia 5,752,800 0 90,000 0 242,382 Mozambique 41,712,000 95,000 3,025,500 0 0 Myanmar 42,282,008 108,156 7,231,700 900 1,134,860 Nepal 8,304,000 127,500 1,067,000 0 2,304,779 Nicaragua 0 2,000 65,050 3,000 188,640 Niger 0 12,700 820,800 10,425 2,495,670 Nigeria 97,478,368 379,591 8,132,250 75,000 2,725,901 Pakistan 290,853,000 210,484 0 3,024,116 0 Papua New Guinea 3,480 100,800 1,327,200 0 16,399 Philippines 0 731,244 0 82,336 4,135,001 Rwanda 18,626,900 28,752 727,667 5,768 334,166 Sao Tome and Principe 0 0 9,400 0 66,329 Senegal 18,858,530 65,384 760,000 0 1,471,680 Sierra Leone 7,926,120 68,500 726,800 0 1,214,340 Solomon Islands 0 0 15,000 0 0 Somalia 151,200 52,016 158,900 0 262,080 South Sudan 9,036,000 53,100 89,350 0 147,902 Sri Lanka 0 56,000 574,000 130,000 1,589,760 Sudan 3,000 30,568 474,200 0 3,851,868 Tajikistan 24,812,640 3,500 90,000 0 270,000 Tanzania 846,800 1,241,695 9,935,400 194,124 150,195 Timor-Leste 0 12,000 240,000 2,000 79,902 Togo 4,810,000 59,672 495,400 0 261,468 Uganda 35,316,096 258,060 8,235,050 48,300 258,123 Uzbekistan 0 0 701,600 2,408,900 1,989,949 Vietnam 0 0 0 1,005,000 0 West Bank and Gaza 0 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 5,256,000 25,536 14,300 75,000 8,386,917 Zambia 66,167,400 245,900 3,399,400 13,000 3,770,375 Zimbabwe 141,429,280 98,500 889,100 1,900 9,400,083 Other FP2020 Shipment Volumes 85,564,584 1,564,900 352,600 113,550 197,242,875 APPENDIX A Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, May 2017. AP PE N D IC ES 28 EXHIBIT A.6: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2016 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 1,010,880 14,200 19,000 20,000 211,440 Bangladesh 0 150,000 8,200,000 0 0 Benin 3,708,000 277,028 70,000 27,000 5,040 Bhutan 0 0 237,000 0 0 Bolivia 50,400 67,800 3,000 0 5,760 Burkina Faso 12,911,000 427,800 1,123,500 0 1,600,971 Burundi 14,555,999 1,600 0 0 70,240 Cambodia 5,719,248 58,960 1,000,000 30,000 10,539,359 Cameroon 18,205,048 82,488 482,975 0 500,000 Central African Republic 3,628,800 6,200 147,600 500 262,296 Chad 0 41,024 15,600 0 0 Comoros 1,442,448 1,972 113,000 0 77,040 Democratic Republic of Congo 12,148,999 688,089 0 10,000 1,026,756 Congo Rep 3,600,000 1,008 6,720 29,650 2,880 Cote d'Ivoire 16,569,000 97,256 3,023,395 10,000 997,500 Djibouti 0 0 663,000 0 44,280 Egypt Arab Rep 0 140,000 0 2,680,434 0 Eritrea 0 0 100,000 0 126,640 Ethiopia 36,840,000 1,022,105 7,570,056 751,144 6,625,921 Gambia 2,880,000 20,016 313,000 0 565,200 Ghana 32,898,960 141,432 3,889,100 15,410 2,751,660 Guinea 7,488,000 77,000 90,000 0 512,644 Guinea-Bissau 0 50,000 13,000 0 10,080 Haiti 38,349,000 5,300 0 1,500 30,240 Honduras 25,005,600 0 1,977,000 0 1,385,280 India 5,000 0 23,984 865,062 6,137,520 Indonesia 5,000 350,000 0 120,074 0 Iraq 0 1,000 0 0 0 Kenya 54,090,024 742,864 95,000 37,500 3,403,080 Korea Dem Rep 0 0 905,200 0 0 Kyrgyz Republic 2,440,080 0 0 0 0 Lao PDR 0 53,200 850,600 0 1,405,440 Lesotho 11,262,000 23,452 260,400 0 218,160 Liberia 12,461,280 44,600 0 0 251,040 Madagascar 4,500,000 303,932 1,440,600 0 849,600 Malawi 12,520,000 33,700 2,475,200 0 0 Mali 12,604,704 27,072 25,000 17,300 20,160 APPENDIX A AP PE N D IC ES 29 APPENDIX A AP PE N D IC ES EXHIBIT A.6: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2016 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 3,110,400 2,500 39,000 0 164,160 Mongolia 6,796,800 3,100 30,000 0 405,108 Mozambique 59,034,000 0 90,000 13,000 205,920 Myanmar 16,169,472 147,348 1,800 0 7,560,366 Nepal 32,161,800 98,400 25,400 31,950 228,066 Nicaragua 1,500,000 4,008 0 15,000 0 Niger 0 50,400 1,317,700 0 3,141,960 Nigeria 149,734,200 771,763 1,278,600 90,030 3,320,703 Pakistan 109,244,976 800 0 1,872,716 15,120 Papua New Guinea 1,994,400 103,000 22,600 0 11,520 Philippines 0 0 0 1,070,737 0 Rwanda 16,056,000 65,294 1,734,900 0 2,439,900 Sao Tome and Principe 0 0 0 0 63,360 Senegal 5,094,000 179,864 10,000 32,675 860,949 Sierra Leone 1,080,000 73,000 280,200 5,500 955,860 Solomon Islands 0 0 0 0 0 Somalia 0 0 1,950 0 19,000 South Sudan 9,681,120 30,000 150,000 0 172,080 Sri Lanka 0 50,500 650,000 100,000 6,049,600 Sudan 7,216,992 49,104 29,800 3,500 338,345 Tajikistan 17,392,200 0 93,000 25,000 415,440 Tanzania 428,800 986,112 4,741,200 486,000 5,621,360 Timor-Leste 0 10,500 0 0 0 Togo 14,036,128 46,656 315,800 0 27,360 Uganda 19,200,000 234,524 1,184,250 45,200 5,740,520 Uzbekistan 6,228,720 0 848,400 432,800 0 Vietnam 0 0 0 1,096,080 0 West Bank and Gaza 0 0 800 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 8,102,880 0 157,000 75,000 1,141,120 Zambia 32,762,600 142,000 443,000 0 0 Zimbabwe 106,975,000 140,656 661,800 1,800 19,521,550 Other FP2020 Shipment Volumes 20,389,000 1,016,700 392,800 198,850 216,000,206 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, May 2017. 30 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: 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 contraceptive manufacturers and received his- torical shipment data by product and country for each of the 69 FP2020 focus 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). 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 14 manufacturers across five family planning product categories. APPENDIX B — DATA SOURCES 43. RHI, available at https://www.unfpaprocurement.org/rhi-home. Reproductive Health Interchange (RHI)43 Hosted by UNFPA, RHI collects data on past and upcoming contraceptive volume 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. For this report, the full RHI data was downloaded in May 2017 and supplemented with data from USAID/ PSM systems to include the USAID-funded shipments not currently captured in RHI due to data integration issues. AP PE N D IC ES 31 The FP2020 public sector market size was constructed using the best available data sources: historical supplier-reported shipment data and RHI shipment data. Participating Suppliers’ Representation of the RHI Market Within the RHI shipment data, the suppliers participating in the Global Markets Visibility Project held 96 percent or more of shipment vol- umes44 in every category with the exception of IUDs, where suppliers held 51 percent of the volumes (Exhibit C.1.) The historical supplier-reported shipment data captured a more comprehensive view of the FP2020 public sector market for female condoms, implants, injectables, IUDs, and orals relative to RHI, and thus served as the primary data source for these product markets. Because APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE AP PE N D IC ES CHAI has not yet received male condom data from any suppliers, RHI data was relied upon for the male condom volumes. The data is quanti- fied by the units of measurement outlined in Exhibit C.2. The following section describes the data source and market size esti- mation in more detail. Historical Supplier-Reported Data To date, the Global Markets Visibility Project has collected historical supplier-reported shipment data from 14 manufacturers – Bayer, Cipla, CR Zizhu, Cupid, Helm AG, Mylan, Merck/MSD, Pfizer, Pregna, PT Tunggal, Shanghai Dahua, SMB, Techno Drugs, and Veru Healthcare45. Collectively, the total volumes cover institutional sales (USAID, UNFPA, MSI, etc.) and MOH tenders across five family planning product categories.46 44. Shipment volumes were calculated as cumulative from 2011 to 2016. 45. Female Health Company was acquired by Veru Healthcare in 2016. EXHIBIT C.1: GLOBAL MARKETS VISIBILITY PROJECT PARTICIPATING SUPPLIER VOLUMES WITHIN RHI BY METHOD FOR THE FP2020 PUBLIC SECTOR MARKET METHOD PARTICIPATING SUP- PLIER VOLUMES IN RHI 2011 – 2016 ALL SUPPLIERS VOLUMES IN RHI 2011 – 2016 % OF TOTAL METHOD VOLUMES Condoms - Female 129 M 133 M 97% Implants 31 M 32 M 98% Injectables 350 M 363 M 96% IUDs 13 M 26 M 51% Orals 652 M 672 M 97% Total 1.17B 1.23 B 96% EXHIBIT C.2: UNIT OF MEASUREMENT METHOD UNIT OF MEASURE Condoms - Female Piece Condoms - Male Piece Implants Set Injectables Vial IUDs Piece Orals - Combined Cycle Orals - Progestin Only Cycle Orals - Emergency Doses EXHIBIT C.3: GLOBAL MARKETS VISIBILITY PROJECT PARTICIPANTS AND PRODUCTS MANUFACTURER CONDOMS - FEMALE IMPLANTS INJECTABLES IUDS ORALS Bayer • • • Cipla • CR Zizhu • Cupid • Helm AG • • Mylan • • • Merck/MSD • • Pfizer • Pregna • PT Tunggal • • Shanghai Dahua • SMB • Techno Drugs • • Veru Healthcare • Source: [1] Historical Supplier-Reported Shipment Data. 46. Total shipment of oral contraceptives includes combined, progestin-only, and emergency oral contraceptives. 32 Aggregating across female condoms, implants, injectables, IUDs, and orals in the 69 FP2020 countries and methods, sup- pliers have shipped an average of 378 million units of family planning commodities annually from 2011 to 2016.47 It is important to note that there were several shipments to procurer (USAID, UNFPA, SMOs) warehouses in non-FP2020 countries, such as Belgium, Denmark, France, Germany, Netherlands, Norway, Sweden, Switzerland, UK, and US. Although these volumes were shipped to non-FP2020 countries, the end shipment destination of these volumes would likely be the 69 FP2020 countries. As a result, these non-FP2020 country volumes were included in the total shipments to 69 FP2020 countries after it was confirmed that the specific non-FP2020 country volumes were associated with institutional purchases. CHAI analyzed and assessed the aggregated historical supplier-report- ed shipment data to confirm the coverage across various FP2020 prod- uct markets was greater relative to RHI shipment data for the 69 FP2020 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. Fur- ther, although some countries report national procurements, most na- tional procurements are not reported into the RHI database. Compared to RHI, the total historical supplier-reported shipment volumes to 69 FP2020 countries and procurer warehouses is consistently greater than RHI volumes across four family planning methods: implants, inject- ables, IUDs, and orals.48 Thus, for these product markets, the suppli- er-reported shipment data captures a more comprehensive view of the family planning market in the 69 FP2020 countries. For female condoms, the RHI volumes are actually greater than supplier shipment data in 2013 and 2014; however, the difference is relatively small in 2014. AP PE N D IC ES 47. Negative volumes and volumes with no associated shipment destination have been exclud- ed. 48. Similar to the historical supplier-reported shipment totals, RHI volumes to Belgium, Denmark, Germany, France, Netherlands, Norway, Sweden, Switzerland, UK, and the US are included in the total. For the UK, shipments to IPPF or MSI warehouses are included in total Source: [1] Historical Supplier-Reported Shipment Data. volumes. For Belgium, Denmark, Germany, France, Netherlands, Norway, Sweden, Switzerland, UK, and the US, shipments funded or procured by USAID and UNFPA are included in total vol- umes. We assume the end shipments destination of these volumes are likely to the 69 FP2020 countries and thus, include the volumes in the total FP2020 market estimate. EXHIBIT C.4: SUPPLIER-REPORTED SHIPMENT VOLUMES TO FP2020 COUNTRIES BY METHOD, 2011–2016 METHOD 2011 2012 2013 2014 2015 2016 Condoms – Female 20.0 M 18.9 M 17.4 M 25.1 M 25.3 M 21.7 M Implants 3.1 M 5.8 M 6.1 M 6.2 M 10.2 M 9.2 M Injectables 73.3 M 109.1 M 93.7 M 113.9 M 97.6 M 49.6 M IUDs 10.3 M 9.1 M 8.1 M 8.8 M 9.9 M 10.2 M Orals - Combined & Progestin Only 311.0 M 319.5 M 283.4 M 267.5 M 172.6 M 113.7 M Orals - Emergency 3.0 M 10.9 M 4.9 M 4.9 M 6.5 M 6.1 M Total 420.7 M 473.1 M 413.6 M 426.4 M 322.1 M 210.5 M APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE 33 Sources: [1] Historical Supplier Shipment Data; [2] RHI Shipment Data, May 2017. EXHIBIT C.5: RHI VS. SUPPLIER-REPORTED SHIPMENT VOLUMES TO FP2020 COUNTRIES BY METHOD, 2011–2016 IMPLANTS IUDS INJECTABLES ORALS CONDOMS - FEMALE AP PE N D IC ES 2011 2M 3M 4M 6M 5M 6M 6M 6M 8M 10M 2012 2013 2014 2015 2016 RHI Shipments Historical Supplier-Reported Shipments 0M 2M 4M 6M 8M 10M 12M 6M 9M Im pl an t Se ts (M ill io ns ) 58M 53M 73M 68M 69M 78 M 94M 109M 114M 98M 2011 2012 2013 2014 2015 RHI Shipments Historical Supplier-Reported Shipments Vi al s (M ill io ns ) 0M 20M 40M 60M 80M 100M 120M 2016 38M 50M 2011 4M 5M 9M 8M 6M 4M 3M 9M 6 M 10M 10M 10M 2012 2013 2014 2015 RHI Shipments Historical Supplier-Reported Shipments IU D P ie ce s (M ill io ns ) 0M 2M 4M 6M 8M 10M 2016 3M 2011 2012 2013 2014 2015 RHI Shipments Historical Supplier-Reported Shipments Cy cl es (M ill io ns ) 0M 50M 100M 150M 200M 250M 300M 350M 132M 132M 138M 114M 91M 314M 330M 228M 272M 179M 120M 2016 66M 20M 20M 18M 17M 19M 28M 27M 25M 25M 22M 2011 2012 2013 2014 2015 RHI Shipments Historical Supplier-Reported Shipments Pi ec es (M ill io ns ) 0M 5M 10M 15M 20M 25M 30M 22M 2016 19M 34 Male Condom Market Because CHAI has not yet received data from male condom suppliers, historical RHI shipment data for male condoms was used to capture a more comprehensive view of the family planning market for the 69 FP2020 countries. We used RHI shipment volume data from 2011 to 2016 and included all male condom shipment volumes to 69 FP2020 countries as well as volumes associated with procurer warehouses in non-FP2020 focus countries.49 The male condom market reflected by the RHI data includes 21 manufacturers and 18 funding sources. The historical supplier-reported volumes for female condoms, implants, injectables, IUDs, and orals, together with RHI shipment volumes for male condoms, represent the estimated FP2020 public sector market from 2011 to 2016. 49. Total yearly volumes are based on the year that the product was shipped. Source: [Exhibit C.6] RHI Shipment Data, May 2017. Source: [Exhibit C.7] Historical Supplier-Reported Shipment Data; RHI Shipment Data, May 2017. EXHIBIT C.6: RHI MALE CONDOM SHIPMENT VOLUMES, 2011–2016 METHOD 2011 2012 2013 2014 2015 2016 Condoms - Male 1.62 B 1.84 B 1.57 B 1.49 B 1.36 B 0.97 B EXHIBIT C.7: 69 FP2020 CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2011–2016 METHOD 2011 2012 2013 2014 2015 2016 Condoms – Female 20.0 M 18.9 M 17.4 M 25.1 M 25.3 M 21.7 M Condoms – Male (RHI) 1.62 B 1.84 B 1.57 B 1.49 B 1.36 B 0.97 B Implants 3.1 M 5.8 M 6.1 M 6.2 M 10.2 M 9.2 M Injectables 73.3 M 109.1 M 93.7 M 113.9 M 97.6 M 49.6 M IUDs 10.3 M 9.1 M 8.1 M 8.8 M 9.9 M 10.2 M Orals – Combined & Progestin Only 311.0 M 319.5 M 283.4 M 267.5 M 172.6 M 113.7 M Orals – Emergency 3.0 M 10.9 M 4.9 M 4.9 M 6.5 M 6.1 M Total 2.04 B 2.32 B 1.98 B 1.92 B 1.68 B 1.18 B AP PE N D IC ES APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE 35 APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE Source: [1] USAID, “Couple-Years of Protection (CYP),” May 2017. EXHIBIT C.8: VOLUMES TO CYPS SHIPPED CONVERSION FACTORS, 2011–2016 METHOD UNITS PER CYP Condoms - Female 120.00 Condoms - Male 120.00 Implants - 3 Year 0.40 Implants - 4 Year 0.31 Implants - 5 Year 0.26 Injectables - 1 month 13.00 Injectables - 2 month 6.00 Injectables - 3 month 4.00 IUDs 0.22 Orals – Combined 15.00 Orals – Progestin Only 15.00 Orals – Emergency 20.00 Total FP2020 Public Sector Market In Terms of Total FP2020 Public Sector Market In Terms of CYPs CHAI translated shipment volumes to CYPs by dividing shipment volumes by each method’s corresponding couple-years of protection (CYP) factor. CHAI divided all shipment volumes by the corresponding CYP factor published by USAID. CYP is the estimated protection provided by con- traceptive 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.50 Because various methods may have different CYPs associated with different sub-types of that method (e.g. there are different CYP factors for three-, four-, and five-year implants), the corresponding CYP of the method sub-type is used. The following exhibit shows the conversion factors used to translate volumes to CYPs. 50. 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. AP PE N D IC ES 36 APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC SECTOR MARKET SIZE Total FP2020 Public Sector Market Size The total value of contraceptives was 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 simplicity.51 Finally, the Implant Access Program price of US$8.50 was applied to Sources: [1] UNFPA Contraceptive Price Indicator, 2011–2016; [2] IAP Implant Prices. Notes: [1] For 2013-2016 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. 51. UNFPA, "UNFPA Contraceptive Price Indicator–Year 2016", available at http://www.unfpa. org/sites/default/files/resource-pdf/UNFPA_Contraceptives_Price_Indicator_2016_Published. pdf, UNFPA Contraceptive Price Indicator–Year 2015,” available at: https://www.unfpa.org/sites/ default/files/resource-pdf/UNFPA_Contraceptive_Price_Indicators.pdf, “UNFPA Contraceptive Price Indicator–Year 2014,” available at http://www.unfpa.org/resources/con traceptive-price- indicator-2014 , “UNFPA Contraceptive Price Indicators–2013,” available at http://www.unfpa. org/sites/default/files/resource-pdf/UNFPA%20Contraceptive%20Price%20Indicators%20-%20 2013.pdf, “UNFPA Contraceptive Price Indicators–2012,”available at http://www.unfpa.org/sites/ default/files/resource-pdf/UNFPA%20Contraceptive%20Price%20Indica tors%20-%202012.pdf, “UNFPA Contraceptive Price Indicators–2011", UNFPA. implant volumes from 2013 to 2016. The average price only includes the cost of the product and does not account for additional costs associat- ed with procurement such as testing, insurance, and shipping costs. To maintain consistency across dollar-value comparisons, this average pricing was applied to all market size and donor-funding trends across supplier-reported and RHI reported volumes. As a result, numbers may differ from the RHI reported value field. EXHIBIT C.9: AVERAGE UNIT PRICE PRICE RANGE 2011 2012 2013 2014 201552 201653 Method Minimum Maximum Unit Price Unit Price Unit Price Unit Price Unit Price Unit Price Condoms - Female $0.49 $0.56 $0.56 $0.55 $0.54 $0.53 $0.52 $0.49 Condoms - Male $0.03 $0.03 $0.03 $0.03 $0.03 $0.03 $0.03 $0.03 Implants $8.50 $18.65 $18.65 $17.98 $8.50 $8.50 $8.50 $8.50 Injectables $0.81 $0.83 $0.82 $0.82 $0.83 $0.81 $0.81 $0.82 IUDs $0.43 $0.48 $0.43 $0.43 $0.43 $0.48 $0.47 $0.46 Orals - Combined $0.26 $0.31 $0.31 $0.30 $0.28 $0.30 $0.28 $0.26 Orals - Progestin Only $0.31 $0.33 $0.32 $0.32 $0.31 $0.31 $0.32 $0.33 Orals - Emergency $0.30 $0.49 $0.34 $0.49 $0.44 $0.30 $0.37 $0.35 52. The 2015 unit pricing is an average of UNFPA 2015 prices and USAID 2014 prices as USAID 2015 prices were unavailable. 53. The 2016 unit pricing is UNFPA 2016 price only as USAID 2016 pricing is unavailable, with the exception of IUDs where the average of USAID 2014 price and UNFPA 2016 price was taken to avoid significant fluctuations. AP PE N D IC ES 37 To protect customer confidentiality, suppliers were not asked to dis- close customer information associated with shipment volumes. Instead, CHAI relied upon RHI to estimate the donor-funded volumes and in turn, CYPs and costs. RHI data contains shipment volume data reported by central procurement offices of major contraceptive orders and other organizations that procure contraceptives. This includes organiza- tions such as IPPF, MSI, PSI, USAID, and UNFPA. From 2011 to 2016, the following funding sources were associated with shipment volumes to 69 FP2020 countries and shipment volumes to procurer warehouses that are reported into RHI: APPENDIX D – ESTIMATING TOTAL FP2020 DONOR-FUNDED VOLUMES Source: [1] RHI Shipment Data, May 2017. EXHIBIT D.1: FP2020 FUNDING SOURCES REPORTING TO RHI, 2011–2016 FUNDING SOURCES AFDB IPPF PSI BMGF KFW UNDP CDC MOH UNFPA DFID MSI UNPEACE DKT NETHERLANDS USAID GLOBALFUND OTHER USDOD ICA OTHERGOV WORLDBANK 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. AP PE N D IC ES 38 APPENDIX E – ADDITIONAL MARKETS VISIBILITY CHAI conducted supplementary research and analysis using publicly available sources of data in three large markets: Bangladesh, India, and Indo- nesia—key countries where it was identified in the 2016 Family Planning Market Report that there may be significant public sector local and regional procurement not captured in the Global Markets Visibility Volumes. Due to the limitations of these data sources, CHAI cannot confirm comprehensive coverage of the public sector markets in these countries. Rather, the data is meant to be used as initial confirmation of local and regional procurement in these markets that are not covered by the suppliers participating in this report. EXHIBIT E.1: MOHFW SUPPLY CHAIN CONTRACEPTIVE SHIPMENT RECEIPT DETAILS PRODUCT NAME SUPPLIER NAME 2015 2016 CONDOM ESSENTIAL DRUGS CO. LTD. 50,000,000 68,850,000 CONDOM KHULNA ESSENTIAL LATEX PLANT((KELP) 100,000,000 35,000,000 ECP (2 TAB/PACK) M/S, RENETA LTD. 100,000 100,000 IMPLANT (2 ROD) SOCIAL MARKETING COMPANY (SMC) - 17,000 IMPLANT (SINGLE ROD) JAMES INTERNATIONAL - 5 IMPLANT (SINGLE ROD) Merck Sharp & Dohme B.V(MSD B.V.). - 150,000 IMPLANT (SINGLE ROD) MSD-NV Organon, Organon(India) Private Ltd. 50,000 - INJECTABLES (DMPA IM) Helm-AG 14,000,000 - INJECTABLES (DMPA IM) TECHNO DRUGS Ltd 2,500,000 8,100,000 IUD (CT-380A) SARBAN INTERNATIONAL LTD. 400,000 - IUD (CT-380A) SOCIAL MARKETING COMPANY (SMC) 73,679 - ORAL CONTRACEPTIVE PILL (SHUKHI) HLL Lifecare Limited 22,469,025 - ORAL CONTRACEPTIVE PILL (SHUKHI) M/S, RENETA LTD. 20,730,975 54,750,000 ORAL CONTRACEPTIVE PILL (SHUKHI) Maneesh Pharmaceuticals Limited 22,289,280 - ORAL CONTRACEPTIVE PILL (SHUKHI) Popular Pharmaceuticals Ltd. 10,800,000 14,250,000 ORAL CONTRACEPTIVE PILL (SHUKHI) TECHNO DRUGS Ltd 1,710,720 - ORAL PILL APON M/S, RENETA LTD. 1,000,000 3,500,000 Source: Bangladesh MOHFW, Supply Chain Management Portal, 2017. 54. Government of Bangladesh, Ministry of Health and Family Welfare, “MOHFW Supply Chain Management Portal – National Receive Details; Product Group: Contraceptive; Product Name: ALL; Warehouse; ALL” available at: https://scmpbd.org/index.php/wims-reports/national-re- ceive-details 55. The fiscal year for Bangladesh runs from July 1 to June 30, but for the purposes of this analysis, CHAI summed up the monthly data by calendar year for 2015 and 2016. Data is not reported prior to February 2015, thus the 2015 calendar year may be missing data for the month of January. AP PE N D IC ES Bangladesh CHAI used data from the government of Bangladesh’s Ministry of Health and Family Welfare (MOHFW)54 for 2015 and 2016.55 39 APPENDIX E – ADDITIONAL MARKETS VISIBILITY India CHAI looked at data from the Indian government’s MOHFW Annual Reports56 for fiscal years 2013/2014, and 2014/201557 for the India market. The MOHFW distributes contraceptives to the states/UTs through Free Supply Scheme and Social Marketing Scheme; only modern contracep- tive methods including condoms,58 oral pills (orals – combined), IUDs, and ECPs (orals – emergency) are included in this analysis. While the Source: India MOHFW Annual Report, 2015-2016. *Figures are Provisional 56. Government of India, Ministry of Health and Family Welfare, “Annual Report of Department of Health & Family Welfare for the year of 2015-16”, “Annual Report of Department of Health & Family Welfare for the year of 2014-15”, “Annual Report of Department of Health & Family Welfare for the year of 2013-14”available at: http://www.mohfw.nic.in/documents/publications 57. The fiscal year for India runs from April 1 to March 31, as such 2015/2016 figures were not included in this analysis as the reported data is not a full fiscal year. 58. Condoms are reported in millions whereas all other methods are reported as “lakh” – the Indian unit of 100,000. EXHIBIT E.2.1: QUANTITIES SUPPLIED TO STATES/UTS CONTRACEPTIVES 2013-14 2014-15 2015-16 (UP TO NOV. 15) Condoms (In million pieces) 394 350.9 465.4 Oral Pills (In lakh cycles) 361.24 551.32 255.2 IUDs (In lakh pieces) 60.42 88.244 37.62 Tubal Rings (In lakh pairs) 19 27.145 7.82 ECP(in lakh packs) 75.8 75.8 41.92 Pregnancy Test Kits (in lakhs) 100.14 122.4 166.12* EXHIBIT E.2.2: PERFORMANCE OF SOCIAL MARKETING PROGRAMME IN THE SALE OF CONTRACEPTIVE CONTRACEPTIVES 2012-13 2013-14 2014-15 2015-16 (UP TO NOV. 2015) Condoms (Million pieces) 618.18 698.33 683.93 157.05 Oral Pills (Social Marketing) (lakh cycles) 376.82 290.27 276.44 80.23 SAHELI (in Lakh tablets) 270.76 279.35 314.6 8.787* EXHIBIT E.2.3: EMERGENCY CONTRACEPTIVE PILLS [ECP] ITEM 2013-14 2014-15 2015-16 (NOV.2015) ECP 75.80 75.80 41.92 EXHIBIT E.2: ANNUAL REPORT OF DEPARTMENT OF HEALTH & FAMILY WELFARE FOR THE YEAR OF 2015-16 (INCLUDES FULL FISCAL YEARS 2013-14 TO 2014-15) MOHFW Annual Reports do not record who the awarded suppliers are, a report from USAID has identified local suppliers and the contraceptives they supply to the government and SMO programs as of 2006, including Indian Drug and Pharmaceutical Ltd. (IDPL), HLL Lifecare Limited, Phaar- masia, Pregna International, SMB Corporation, Cipla, Win-Medicare, and Famy Care, which is now Mylan. AP PE N D IC ES 40 APPENDIX E – ADDITIONAL MARKETS VISIBILITY EXHIBIT E.3: ANNUAL REPORT OF DEPARTMENT OF HEALTH & FAMILY WELFARE FOR THE YEAR OF 2013-14 (INCLUDES FULL FISCAL YEARS 2010-11 TO 2012-13) EXHIBIT E.3.1: QUANTITIES SUPPLIED TO STATES/UTS CONTRACEPTIVES 2010-11 2011-12 2012-13 2013-14 (UP TO SEPT. 2013) Condoms (In million pieces) 290.137 295.000 367.866 234.271 Oral Pills (In lakh cycles) 237.998 298.135 226.793 205.573 IUDs (In lakh pieces) 90.000 73.500 87.508 34.005 Tubal Rings (In lakh pairs) 34.534 30.359 31.22 18.274 ECP (in lakh packs) 21.540 18.300 75.919 14.098 Pregnancy Test Kits (in lakhs) 211.74 21174 222.186 0.00 EXHIBIT E.3.2: QUANTITIES SUPPLIED TO STATES/UTS CONTRACEPTIVES 2010-11 2011-12 2012-13 2013-14 (UP TO SEPT. 2013) Condoms (Million pieces) 581.44 677.91 618.18 315.19 Oral Pills (Social Marketing) (lakh cycles) 358.08 471.975 376.82 124.79 SAHELI Weekly Oral Pill (in lakh tablet) 234.31904 244.56 270.76 0.042* EXHIBIT E.4: LOCAL MANUFACTURERS & THEIR PRODUCTS IN INDIA* METHOD SUPPLIER NAME Condoms HLL Lifecare Limited Injectables HLL Lifecare Limited Famy Care (Mylan) IUDs Pregna International SMB Corporation Famy Care (Mylan) Orals Indian Drug and Pharmaceutical Ltd. (IDPL) HLL Lifecare Limited Phaarmasia Famy Care (Mylan) Win-Medicare Cipla *Figures are Provisional * USAID, “Assessment of India’s locally manufactured contraceptive product supply”, 2006, available at: http://pdf.usaid.gov/pdf_docs/Pnadf989.pdf *Figures are Provisional EXHIBIT E.3.3: EMERGENCY CONTRACEPTIVE PILLS [ECP] CONTRACEPTIVES 2010-11 2011-12 2012-13 2013-14 (UP TO SEPT. 2013)* ECP 21.54 18.30 75.919 14.098 Sources: [Exhibit E.3] India MOHFW Annual Report, 2013-2014. [Exhibit E.4] [1] USAID Assessment, 2006; [2] Historical Supplier Shipment Data. AP PE N D IC ES 41 APPENDIX E – ADDITIONAL MARKETS VISIBILITY Indonesia For the Indonesian market, CHAI looked at the awarded government tender documents from the National Family Planning Coordinating Body (BKKBN)60 for 201561 and 201662 to sum up the quantities by method. The 2016 tender documents indicate the manufacturer; however, the 2015 documents refer only to distributors. Sources: [Exhibit E.5] BKKBN Tender Documents, 2015. [Exhibit E.6] BKKBN Tender Documents, 2016. 60. Family Planning and Reproductive Health Unit, National Family Planning Coordinating Body (BKKBN) 61. Tender Winner Announcement documents available at http://lpse.bkkbn.go.id/eproc/ EXHIBIT E.5: MULTIPLE TENDER WINNER ANNOUNCEMENTS YEAR PRODUCT DISTRIBUTOR QUANTITY 2015 Combination Pills PT Indofarma Global Medika 11,776,656 2015 Combination Pills PT Perintis Bina Utama Farmasi 15,114,124 2015 Combination Pills PT Kimia Farma Trading & Distribution 4,042,768 2015 3-month Injectables PT Indofarma Global Medika 13,019,861 2015 3-month Injectables PT Trijaya Medika Farma 12,950,506 2015 3-month Injectables PT Trijaya Medika Farma 13,067,747 2015 3-month Injectables PT Trijaya Medika Farma 13,497,338 2015 2-rod implants w/ inserters PT Djaja Bima Agung 164,710 2015 2-rod implants w/ inserters PT Djaja Bima Agung 166,270 2015 2-rod implants w/ inserters PT Djaja Bima Agung 192,793 2015 2-rod implants w/ inserters PT Djaja Bima Agung 172,010 EXHIBIT E.6: MULTIPLE TENDER WINNER ANNOUNCEMENTS YEAR PRODUCT DISTRIBUTOR QUANTITY 2016 Combination Pills PT Harsen Laboratories 11,648,300 2016 Combination Pills PT Kimia Farma 17,626,000 2016 Combination Pills PT Pratapa Nirmala 8,793,200 2016 Combination Pills PT Sunthi Sepuri 8,829,100 2016 Combination Pills PT Triyasa Nagamas Farma 17,540,300 2016 3-month Injectables PT Catur Dakhwah Crane Farmasi 7,289,160 2016 3-month Injectables PT Harsen Laboratories 21,895,860 2016 3-month Injectables PT Triyasa Nagamas Farma 14,474,540 2016 3-month Injectables PT Tunggal Idaman Abadi 7,348,980 2016 2-rod implants w/ inserters PT Catur Dakhwah Crane Farmasi 633,680 2016 2-rod implants w/ inserters PT Harsen Laboratories 633,660 2016 2-rod implants w/ inserters PT Triyasa Nagamas Farma 633,660 62. Tender Winner Announcement documents available at https://e-katalog.lkpp.go.id/backend/katalog/list_produk/63 AP PE N D IC ES 42 APPENDIX F – EXPLORING POTENTIAL CONTRIBUTING FACTORS TO THE 2015 TO 2016 MARKET DECLINE CHAI analyzed consumption data from the Procurement Planning and Monitoring Report (PPMR)63 for 34 countries. First, CHAI estimated the annual consumption of products using the average monthly consump- tion (AMC) figures by country by method for each year. Then, CHAI di- vided the product volumes for each method by the corresponding CYP per unit to derive the annual consumption in total CYPs. The exhibit F.1 shows annual consumption data by method. CHAI also analyzed consumption data for Bangladesh from the MOHFW supply chain reports64. CHAI summed up the data by year to get annual consumption in product volumes and divided the volumes for each method by the corresponding CYP per unit to derive the annual con- sumption in total CYPs. The table below shows annual consumption data by method. AP PE N D IC ES EXHIBIT F.1: ANNUAL PPMR CONSUMPTION DATA METHOD (CONSUMPTION IN MIL- LIONS OF CYPS) 2015 2016 Implants 15.0 M 16.2 M IUDs 13.8 M 13.5 M Injectables 19.5 M 19.0 M Condoms - Male 13.6 M 12.0 M Condoms - Female 0.2 M 0.2 M Orals - Combined & Progestin Only 12.9 M 11.9 M Orals - Emergency 12.0 M 11.1 M Total 75.1M 73.1M EXHIBIT F.2: ANNUAL MOHFW BANGLADESH CONSUMPTION METHOD (CON- SUMPTION IN MILLIONS OF CYPS) 2011 2012 2013 2014 2015 2016 Condoms 0.8 M 0.8 M 0.8 M 1.0 M 1.1 M 1.1 M Implants 1.3 M 1.3 M 1.2 M 1.1 M 1.1 M 1.1 M Injectables 3.4 M 3.4 M 3.3 M 3.4 M 3.3 M 3.2 M IUDs 1.1 M 1.1 M 1.2 M 1.2 M 1.2 M 1.2 M Orals 7.3 M 7.3 M 7.1 M 7.1 M 6.9 M 6.6 M Total 13.8 M 13.9 M 13.6 M 13.8 M 13.5 M 13.3 M Sources: [Exhibit F.1] Procurement Planning and Monitoring Report (PPMR), May 2017. [Exhibit F.2] Bangladesh MOHFW Supply Chain Management Portal 63. Procurement Planning and Monitoring Report (PPMR): Produced monthly by the USAID | Global Health Supply Chain Program-Procurement and Supply Management (GHSCP-PSM), this online database provides information on consumption and current/desired stock levels of contraceptive products on a country-by-country basis for 34 countries as of June 2015. Data is provided by MOHs, partners such as MSH, SMOs (MSI, PSI, DKT), and UNFPA. Available at http://ppmr.rhsupplies.org/content?id=1 64. Available at https://scmpbd.org/index.php/lmis-report/month-wise-consumption 43 APPENDIX G – KEY TERMS AND DEFINITIONS CYP Couple Years of Protection (CYP) is the estimated protection provided by contraceptive methods during a one-year period e.g. 120 condoms provide a couple protection for one year. CYP mix CYP mix refers to the percentage distribution of CYPs shipped by method. Market Value Market value refers to the supplier-reported shipment volume multiplied by the average prices of UNFPA and USAID for the specific years. Market Share Market share is the percentage of total value of shipment volumes in a market captured by a certain contraceptive method. Shipments or Shipment Volumes Shipment volumes refers to the amount of a particular contraceptive method that has been transported. Total FP2020 Public Sector Market The total FP2020 public sector market is based on volumes purchased by institutional buyers and MOH or government-affiliated procurers based on RHI data (male condoms) and historical supplier-reported shipment data (female condoms, implants, injectables, IUDs, and orals) for the 69 FP2020 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. AP PE N D IC ES 44 APPENDIX H – ACRONYMS CHAI CLINTON HEALTH ACCESS INITIATIVE CYP COUPLE-YEARS OF PROTECTION FP FAMILY PLANNING FP2020 FAMILY PLANNING 2020 GEMS GENERIC MANUFACTURERS FOR REPRODUCTIVE HEALTH IUD INTRA-UTERINE DEVICE LAM LACTATIONAL AMENORRHEA METHOD LARC LONG-ACTING REVERSIBLE CONTRACEPTIVES MOH MINISTRY OF HEALTH MOHFW MINISTRY OF HEALTH AND FAMILY WELFARE RHSC REPRODUCTIVE HEALTH SUPPLIES COALITION RHI REPRODUCTIVE HEALTH INTERCHANGE SMO SOCIAL MARKETING ORGANIZATION USAID UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT UNFPA UNITED NATIONS POPULATION FUND AP PE N D IC ES

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