The Bill and Melinda Gates Foundation hired Mann Global Health to conduct an analysis of the state of condom programming for HIV prevention in five countries in sub-Saharan Africa. Concerned that funding for condom has declined, the Foundation sought greater insight into condom total markets – meaning the larger context of all condoms distributed in each country, whether via public, private non-pro t (including social marketing), or private commercial actors. The focus of this assessment is on sustainability and impact using the market development approach. The objective is to provide recommendations for building and sustaining equitable condom programs at scale, based on a clear understanding of how and why existing markets are failing, and how programs can be strengthened with future investments to ensure a healthy total market that aims for equity, sustainability and scale.
Botswana was one of the countries selected for analysis, as the government has adopted Total Market Approaches (TMA) to underpin its condom strategy. Botswana’s condom program presents a unique archetype of a country that has experienced sustained economic growth, combined with the relatively recent transition of social marketing brands to a regionally managed, self- sustaining social enterprise. This transition occurred just as the government increased allocation of domestic resources to ensure a consistent supply of free condoms in support of universal health coverage objectives.
The study aimed to understand the impact of this transition on condom use by priority and key populations such as sex workers and youth, as well as by the general population. Findings demonstrate that the departure of social marketing programs, paired with favorable government policy toward importing and marketing condoms, created the conditions under which the commercial sector grew to play a significant role in the sustainable provision of quality, affordable and widely available condoms. However, the departure of social marketing programs also left a significant gap within the overall leadership and coordination of condom programming in the country, effectively leaving the country without a supportive ‘condom champion’ to support the government in designing and implementing holistic condom interventions.