Abstract
The Bill and Melinda Gates Foundation hired Mann Global Health to conduct an analysis of the state of condom programming for HIV prevention in ve countries in sub-Saharan Africa. Concerned that funding for condoms has declined, the Foundation sought greater insight into condom total markets – meaning the larger context of all condoms distributed in each country, whether via the public sector, private non-pro t actors (including social marketers), 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 planning and investments.
Kenya is an archetype of a country with strong condom programming and support in the public sector. Against this largely positive picture, however, is a relatively recent government devolution of health programming to 47 counties, a move that raises issues about how county health departments will address supply and demand creation issues for condoms — equitably and sustainably. The key question in the Kenyan condom market will therefore be whether the gains made in programming within the public sector can continue in a country moving towards decentralization of condom programming. In addition, there is the question of whether strong social marketing and commercial players can help ensure sustainability of the national condom program. As a country archetype, Kenya provides a window into issues that are common across other countries, such as the over-reliance on external funding for condom programming and the need to grow condom markets sustainably while addressing equity and health impact objectives.
