Dr. Kimberly Green, PATH kgreen@path.org

Why TMA in Vietnam?

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Vietnam is at a crossroads • HIV epidemic is concentrated in key populations;

prevention and treatment efforts have contributed to a steady decline in new infections

• MoH has committed to 90-90-90 by 2020, and elimination of HIV by 2030

• But, 77.2% of the national HIV program is donor funded, and…

• With Vietnam attaining lower middle income status, major donors have left or dramatically reduced size and geographic scope of programs

Source: MoH/VAAC Investment Case for HIV, 2014; National Health Account, VAAC/MoH 2015; Viet Nam AEM, 2014

Good news… • With the reduction of free/partially subsidized

condoms, there was an incentive for local condom manufacturers to produce for the local market

• Increasing purchasing power, and willingness/ preference to pay

And bad news… • Lack of government awareness of TMA

• Condom market was unregulated, no mandatory standards apply, abundance of low quality and fake products

Source: UNFPA 2014

In 2014, there was both

Enter Healthy Markets…

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Building a sustainable response

GOAL

Increase Local

and Private Sector

INVESTMENT

Objective 1

Increase DEMAND for HIV

Goods and Services

Objective 2 Increase private

sector SUPPLY of HIV

Goods and Services

Objective 3

TMA goals and steps

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1. Transition from a free and partially subsidized condom market to a full TMA for populations affected by HIV

2. Identify commercially viable ways to reach key populations with affordable and preferred condom brands

3. Support rational commodity planning by MoH and donors Targeting subsidized condoms to those who need

them most

4. Create new and consistent users through demand generation strategies and behavior change

Condom TMA goals in Vietnam

Key TMA steps in Vietnam

1. Analyze policy enablers and barriers related to condom market growth, regulation and management

2. Measure condom volume, value and growth and map existing distribution networks

3. Segment consumers by condom use, preferences and willingness to pay 4. Engage domestic condom manufacturers and distributors in the local market to

produce, brand & deliver quality affordable condoms (to key populations) 5. Boost and sustain demand for quality and affordable condoms 6. Advocate for an improved regulatory environment for condom quality assurance 7. Support national and key provincial HIV leaders to adopt TMA to plan and

prioritize use of finite resources for those most in need

Market analysis and segmentation

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Condom volume and growth

51% 68% 53% 59%

82% 14%

3% 24% 6%

2%

35% 29% 23% 36% 15%

0%

20%

40%

60%

80%

100%

2010 2011 2012 2013 2014

Market size by sector (Volume)

Free

Social Marketing

Commercial

Market forecasting Total market volume for three condom sectors: 2015 – 2019

Source: PATH/USAID Healthy Markets. Market Research on HIV Commodities & Services, 2015

26%

18%

9%

13%

9%

16%

61%

73%

75%

FSW (N=1133)

PWID (N=655)

MSM(N=1359)

Free distribution condom brands

Social marketing condom brands

Commercial condom brands

Condom brands procured in past 3 months Willingness to pay: Price point for one condom

0%10%20%30%40%50%60%70%80%90%

100%

1000 1500 2000 3000 4000 8000 12000 16000

FSW (N=1248) PWID (N=1296) MSM (N=1528)

Purchasing behavior and WTP

Source: PATH/USAID Healthy Markets. Market Research on HIV Commodities & Services: Consumer Survey, 2015

Commercial condom price range* • Low end: 1,700 dong (7 cents) per piece • Medium end: 3,000 (13 cents) • High end: 5,420 (24 cents) *Source: Condom Market in Vietnam, IMS, 2014

Optimal condom price for FSW is: 2,500 VND (10 cents), with an acceptable price range from 2,000 – 4,000 VND (9 – 17 cents)

Example: Price sensitivity analysis

Source: PATH/USAID Healthy Markets. Market Research on HIV Commodities & Services: Consumer Survey, 2015

Development of local condom brands and distribution systems

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Commercial brands for key populations and wider market

Key metrics (2015-2017) • 3 local manufacturers (Medevice3S, Vietnam

Rubber Trade, Dongkuk)

• 3 brands (OneTouch, Galant, Young Lovers)

• 43.9 million commercial condoms sold (~200% increase per year)

• 92 large and sub-distributors (including key population led CSOs and social enterprises)

• Other local condom suppliers (DKT, MSI and local pharmacy chains) shifted wholesale condom purchase from Thailand or Malaysia to domestic condom manufacturers

Live to Love are boosting sex workers’ access to high quality, affordable condoms in Hai Phong. PATH

Example: Gallant distribution system for KP and wider market

Medevice3s Gallant

Distributor DUMIYO

(24 provinces)

Hotel/guesthouse Pharmacies Supermarket

CSO/social enterprises

(28 in 8 provinces)

Key population clients

Pharmacies/ HIV Hotpots

Online

17%

71%

14% 13%

74%

21%

13%

69%

25%

10% 12%

74%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Fully subsidized Social Marketing Commercial

Availability of condoms in hotels and guesthouses by year and type

2010 2012 2013 2016

Shift in non-traditional outlet trends

Data sources: USAID/PATH Healthy Markets. Condom Retail Outlet Study, November 2016; USAID/PSI Condom Retail Outlet Surveys, 2011, 2012, 2013

Scaling TMA

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“TMA is a new and innovative response to HIV/AIDS in Vietnam. The approach is a valuable planning and budgeting tool to segment populations and better target finite resources. As external donor funding declines, we are committed to collaborating with new partners to increase access to HIV prevention commodities, growing the market in a responsible and sustainable way.”

Dr. Vu Van Chieu, Vice Chief of the General Planning Department, Vietnam Authority of HIV/AIDS Control

Scaling TMA in Vietnam: policies and investment

• MoH endorsement – MoH formally adopted the total market approach through its HIV annual planning and budgeting tool (Decision 4357, October 2017). Includes a TMA HIV commodity calculator for provincial planning.

• Quality enforcement – MoH approval of Circular 31 that mandates condom quality standards, product registration and spot checks (July 2017).

• Investment – Testing new ideas through an Innovation Fund (unique supply chain, retail outlets, mobile applications++).

Acknowledgments • MoH/VAAC: Dr. Nguyen Hoang Long, Dr. Phan Thi Thu Huong, Dr. Vu Van Chieu • USAID Vietnam: Ngo Minh Trang, Nguyen Thi Minh Huong, Dr. John Eyres, Mei Mei

Peng • PATH: Dr. Vu Ngoc Bao, Nguyen Vu Yen, Tran Tham, Tuan Hoang, Mona Byrkit, Chris

Brady, Keith Neroutsos • CCIHP: Dr. Trang Hong Minh, Dr. Vu Song Ha, Quach Thu Trang • Market research partners: TNS, IPSOS • Value chain: Medevice 3S, Dongkuk, OneTouch, Dumiyo, V-Smile, Hai Dang, G3VN, G-

Link • Media: T&A Ogilvy, MTV, Yan TV, Nghe An TV

THANK YOU! QUESTIONS? Kimberly Green kgreen@path.org

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