Towards Self-Reliance: Advancing a Total Market Approach for Condom Programming in Nigeria

By global consensus, condoms remain essential to HIV prevention and epidemic control. In 2015, the UN launched a 20×20 initiative to “increase access, use, and availability of 20 billion condoms by 2020.” Countries worldwide, including Nigeria, have signed on to this initiative.

The challenge

Globally, donor funding for condom programming is shrinking. Countries must look for new ways to sustain progress, while also targeting investments to reach at-risk populations who remain underserved. Despite a relatively low HIV prevalence (2.9 percent), Nigeria’s large population means that 3.6 million people were living with HIV in 2016, making it home to the second largest population of people living with HIV/AIDS. Certain key populations carry the burden—female sex workers, injecting drug users, and men who have sex with men.

Nigeria’s condom market is large and diverse, with more than 400 million condoms used annually and 100 brands available through retail outlets, socially-marketed channels, and free distribution, however, market inefficiencies limit equitable and sustainable access to condoms, particularly for the most vulnerable populations. A 2017 Condom Landscape Assessment revealed that “surges” of free condoms and inadequate targeting of free condom distribution were disrupting sales of commercial and socially marketed condom brands. This hindered overall market sustainability at a time when Nigeria was facing an $18 million per year funding gap for condoms.

The opportunity

Donors and the Federal Ministry of Health (FMOH) in Nigeria were keen to address the structural weaknesses affecting the condom landscape, says Olawale Durosinmi-Etti, Chief of Party for the Nigeria office of the Strengthening High Impact Interventions for an AIDS-free Generation (AIDSFree) Project, led by John Snow Research & Training Institute, Inc. “We received USAID funding to support market interventions that would address demand and supply side challenges identified in the 2017 condom assessment. We set out to strengthen coordination among market players, create a shared understanding of the respective strengths and dynamics across various sectors and programs and implement activities that would improve affordability, accessibility, availability and use of condoms.”

Our approach

JSI adopted a total market approach (TMA) to maximize the comparative advantage of the public, private for-profit, and nonprofit sectors to equitably and sustainably target and reach different population segments with condoms. Fundamental to the success of TMA is political stewardship to ensure greater self-reliance,” Durosinme-Etti says. “Hence, over a one year implementation period, we focused on three most pressing areas to set the foundation for a TMA:

1. Develop a shared understanding of TMA through market data and metrics to monitor progress. By sharing data on the total condom market—including patterns in market share, the policy and regulatory landscape, financing trends, and market projections—we established a common understanding of the condom landscape among donors, implementers, government and the private sector. By convening this group of market actors, we jointly identified priority areas for addressing market failures, including better targeting of condom promotion and distribution. To enhance data accessibility and use, we designed a visual dashboard to capture market information, monitor progress and inform decisions on critical TMA metrics, e.g., policy, financing, supply chain, demand, sustainability, and equity.
2. Strengthen political commitment and stewardship for a TMA. With a strong organizational and technical reputation in Nigeria, and as a neutral player in the condom market, we were able to establish trust and productive relationships to build commitment for a TMA from the start. Specifically, we worked alongside the FMOH and the National Agency for the Control of AIDS (NACA) to build their stewardship capacity in TMA. Key achievements included:
   • We established a TMA subcommittee to coordinate activities of all actors in the condom market. The TMA subcommittee is jointly led by co-chairpersons from the FMOH and NACA with membership selected from UN Agencies (UNFPA & UNAIDS), Donors (USAID), implementing partners, social marketing organizations, and private-sector distributors.
   • NACA adopted TMA as a pillar of HIV prevention which was integrated into the National Condom Strategy for 2018–2022.
   • Nigeria’s National Council on AIDS, the nation’s highest decision-making body on HIV, adopted TMA as a strategy for a sustainable HIV response.
3. Reaching consumers through targeted condom promotion and distribution “This is a major achievement, especially given the short timeframe,” Durosinmi-Etti says. He cites AIDSFree’s in-country relationships as advantages. “It helped that we’ve had field staff working with NACA, and a good relationship with the FMOH.” Market interventions were designed and implemented using concrete market data collected during annual market surveys and empirical studies such as the 2018 “willingness to pay study” conducted by AIDSFree.

Written by Stephanie Joyce