Social marketing of reproductive health supplies in sub-Saharan Africa

DKT reported total combined results from operations in the various countries and these are not attributed directly to Sida's contribution. Impact-level results The key metrics provided by DKT are estimates calculated using MSIs Impact 2 Calculator, which uses the volume of contraception and safe abortion products sold, combined with demographic information, to indicate various impact results such as maternal deaths averted, unintended pregnancies averted, and unsafe abortions averted. In addition, DKT achieved the following impact-level results: - Over 40,000 maternal deaths were averted by the end of the programme (target set in 2018 = 63,000 maternal deaths, 65% achievement against target) - Over 2.28 million maternal disability-adjusted life years (DALYs) were averted by the end of the programme (target set in 2018= 3.5 million DALYs, 66% achievement against target) - Over 5.22 million unintended pregnancies were averted by the end of the programme (target set in 2018 = 9.6 million unintended pregnancies, 56% achievement against target) - Over 6.72 million unsafe abortions were averted by the end of the programme (target set in 2018 = 11.6 million unsafe abortions, 59% achievement against target) - In the first two years of the programme DKT also provided HIV-related data using PSIs impact calculator, however, PSI discontinued the calculator in 2021. In 2021 and 2022, DKT adopted a methodology developed by an external consultant based on Phil Harveys Estimate of Lives Saved by Contraception to estimate HIV infections averted. At the conclusion of the contract, DKT estimated that it had averted nearly 167,000 HIV transmissions (target set in 2018 = 76,000 HIV infections) and over 2.25 million HIV-related Disability-adjusted life years (DALYs) (target set in 2018 = 3.05 million HIV-related DALYs). Primary Outcome results The primary outcome indicator agreed with DKT was "couple years of protection" (CYPs) which is recognised internationally as a standard measure for "family planning", e.g. sexual reproductive health commodities. As with the impact-level indicators, CYPs are calculated using MSIs Impact 2 Calculator. During the programme, DKT delivered over 26.38 million CYPs in the countries covered by Sida's support (target set in 2018 = 34.4 CYPs, 78% achievement against target). As Impact and Outcome are calculated using impact calculators it is also important to report on the five output-level results in order to assess the objectives relating to whether there was an increase in knowledge of, and demand for, SRH products and SRHR among the beneficiaries, better quality, choice and supply of contraceptive and safe abortion services in the private sector, and gender transformative and equitable social marketing. These results follow below: Output 1 results - DKT's digital platform (Women First Digital) was key to contributing to improved access to SRHR information in the region. WFD online platforms saw a 94% increase in visitors relative to baseline, representing 124% achievement. Client engagement on WFD websites also saw a large increase with a 2,970% increase in interactions with WFD online chat or hotline platforms, representing a 655% achievement. DKT also reported a significant increase during COVID-19 lock-downs. - The number of clients who could name at least two methods of contraception increased by nearly 5% relative to the baseline at the start of the programme. DKT also noted a 6% increase from the baseline in clients who could name a channel or location where they could access contraception. Output 2 results - Male condom sales increased by 17% from the baseline, and DKT achieved 84% of target, while overall contraceptive sales increased by 40%, 95% cumulative achievement, and safe-abortion product sales by 173%, contributing to 99% cumulative achievement. DKT used this result to indicate that there had been an increase in demand. - In clinics, abortion services provided and individuals newly accepting a modern method of contraception saw little change relative to the baseline in Ethiopia despite exceeding targets (109% cumulative achievement). In Mozambique, the provision of abortion services increased from zero at the start of the programme (baseline) to over 440 services provided at endline. In Mozambique, DKT also saw an increase in individuals newly accepting a modern method of contraception, which increased by 42% compared to the baseline. Output 3 results - DKT also sought to improve the quality of SRH services by building capacity of providers to increase choice of contraceptives, provide judgment-free care, and promote choice. Specifically, providers trained who could provide accurate information on three contraceptive methods, including duration of use and side-effects, increased by 29 percent (84% average at endline compared to 55% at baseline). - To ensure better and more reliable access to contraceptive and safe abortion services, DKT reduced the number of centralised stockouts along the distribution chain. DKT reported a 17% decrease in stockouts at the end of the programme compared to the baseline. - DKT reported that during various trainings, it emphasized the importance of stigma-free counseling and product provision, which DKT states lead to an increase in the provision of non-judgmental services to young mystery shoppers, with 84% of mystery shoppers reporting they had not received discrimination (an increase of 30% from the baseline). Output 4 results - DKT also worked to increase choice of contraceptive methods for end-users. To this end, the number of outlets stocking at least three DKT products increased from 15,800 at baseline to over 32,400 at endline, representing 234% achievement against target. - DKT also worked to train providers, including pharmacists, to build the capacity of the private sector to provide modern contraceptive methods and safe abortion care. Periodically, DKTs training also reached public-sector providers, supporting the total market. Relative to baseline, DKT saw a significant increase in the number of providers trained, representing 235% achievement against target. Output 5 results - In strengthening initiatives to target underserved communities, DKT increased the percentage of outlets in areas serving clients below the poverty line by 16% (54% at endline). - Upon conducting an analysis on gender-sensitivity of DKT marketing strategies, an average 81% of clients (at endline) found that DKT adverts portrayed men and women in a positive light compared to 70% in the region at baseline. Other results Over the course of the contract DKT strengthened quality standards and took a more heightened approach to quality monitoring as a result of dialogue with Sida and other donors. DKT's cost to generate a CYP decreased (measured by dividing total CYPs by overall operational costs to arrive at an annual "cost per CYP" which was reported on annually by DKT to Sida) over the contract period, while overall financial sustainability increased to 75% for the entire organisation. Financial sustainability varied within the targets, with over 50% of DKT operations in Anglophone West Africa covered by DKT's own resources and 20% in Mozambique. Internally, following conversations with Sida and recommendations in the MTR, DKT reported that there were positive changes regarding gender parity and diversity among leadership within DKT and these also led to the creation of DKTs gender policy. Reaching the poor and underserved: DKT worked to increase SRH affordability through programmes offering free and subsidised SRH services, launching new and innovative products, and crowding-in the market. In turn, these initiatives helped strengthen consumers price index parity and alleviated poverty rates. Environmental impact: Throughout the contract period, Sida encouraged DKT to take a more active approach in addressing the environmental impact of our operations. DKT reported that it implemented its Environmental Sustainability Management Policy through activities such as reducing product packaging, air shipments, product waste, and unnecessary travel. Knowledge sharing: Based on recommendations from the MTR, DKT increased focus on collaborations with other SRHR organisations. DKT increasingly shared lessons learned and articles on key topics such as crowding-in with the broader reproductive health community. DKT also reported on examples of increased knowledge sharing between DKT country offices, and in 2020 Sida participated in a management event where country directors from countries in Africa met to share best practices and approaches. Although DKT competed with other social marketing organisations in some markets, it reported on how it shared information with MSI and PSI Articles shared by DKT included: Making Sustainable Markets Work for Low-Income People https://2umya83uy24b2nu5ug2708w5-wpengine.netdna-ssl.com/wp-content/uploads/2021/03/Making-Sustainable-Markets-Work-for-Low-Income-People-DKT-White-Paper.pdf Shaping the Emergency Contraception Market in French West Africa https://2umya83uy24b2nu5ug2708w5-wpengine.netdna-ssl.com/wp-content/uploads/2020/11/With-Links-Shaping-the-Emergency-Contraception-Market-in-French-West-Africa-3.pdf Women First Digital: An eHealth platform providing reproductive health solutions https://2umya83uy24b2nu5ug2708w5-wpengine.netdna-ssl.com/wp-content/uploads/2020/09/WFD-White-Paper-Digital-Final-Sept-2020.pdf DKT and Safe Abortion https://2umya83uy24b2nu5ug2708w5-wpengine.netdna-ssl.com/wp-content/uploads/2020/06/DKT-and-Safe-Abortion-providing-global-leadership-towards-increased-access-2.pdf How Social Marketing Changes Lives: https://2umya83uy24b2nu5ug2708w5-wpengine.netdna-ssl.com/wp-content/uploads/2021/01/DKTs-How-Social-Marketing-Changes-Lives.pdf How One Social Marketing Organization Is Transitioning From Charity to Social Enterprise - https://2umya83uy24b2nu5ug2708w5-wpengine.netdna-ssl.com/wp-content/uploads/2020/10/SMQ-How-One-Social-Marketing-Organization-Is-Transitioning-From-Charity-to-Social-Enterprise.pdf . Opinion: How will COVID-19 affect global access to contraceptives and what can we do about it? - https://www.devex.com/news/opinion-how-will-covid-19-affect-global-access-to-contraceptives-and-what-can-we-do-about-it-96745 Opinion: These 7 specific actions will help improve reproductive health: https://www.devex.com/news/opinion-these-7-specific-actions-will-help-improve-reproductive-health-106211 Private Sectors Potential to Deliver Sexual Reproductive Health: https://www.dktinternational.org/wp-content/uploads/2022/02/IJAHSS0306073-66-74.pdf

The programme was expected to contribute to progress on universal sexual and reproductive health and rights (SDGs 3.1, 3.3, 3.7, 5.6) through allowing women and girls the possibility of managing their fertility, and through giving women, men and young people better means to protect themselves from sexually transmitted infections (STIs) and HIV. According to the theory of change this would occur because of increased knowledge of, and demand for, SRH products and SRHR amongst the beneficiaries, better quality, choice and supply of contraceptive and safe abortion services in the private sector, and gender transformative and equitable social marketing (and advocacy efforts where relevant and possible). Inputs required to achieve these outputs were demand generation, commodity purchasing, sales and distribution, training and quality assurance, regional programming, and all with a poverty- and rights-based approach. DKT aimed to deliver more than 33.6 million couple years of protection (CYPs)*, averting over 9.5 million unintended pregnancies, 62,000 maternal deaths, 3.5 million maternal disability-adjusted life years (DALYs), 11.3 million unsafe abortions, 75,000 HIV infections, and 3 million HIV-related DALYs in the following countries in Sub-Saharan Africa: Component A: Regional Francophone West and Central Africa (FWACA) programme in Benin, Burkina Faso, Cameroon, Chad, Côte dIvoire, Gabon, Gambia, Guinea, Guinea Bissau, Mali, Mauritania, Niger, Senegal and Togo Component B: DRC, Liberia and Mozambique Component C: (2020-2021): Ethiopia, Kenya, Tanzania, Uganda. *Outcome indicator 1: CYPs Couple years of protection (CYPs) indicate the number of years a contraceptive or safe abortion product can protect a couple from unintended pregnancy. CYP calculations are based on sales data and rely upon DKT's theory of changes assumption that if a product is bought it is more likely to be used. Output 1: Increased knowledge of SRHR products among primary beneficiaries Output 2: Increased demand for SRH products and services among primary beneficiaries Output 3: Better quality SRH services Output 4: Increased choice of contraceptive methods Output 5: Gender-transformative and equitable social marketing