The Condom Program Pathway

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As resources for condom programming diminish, it is vital to improve understanding of how and why existing condom markets are failing to support condom use. These markets include consumers, suppliers, and all other actors whose efforts affect condom availability and use in a country.

The Bill and Melinda Gates Foundation (BMGF) commissioned this report to support global condom programming efforts, with a focus on making condom markets sustainable as funding dwindles; to make recommendations to strengthen condom programs; and to outline possible roles and investments for the Foundation and other donors.

Based on a literature review and stakeholder interviews that pointed to the key characteristics of effective condom programming, Mann Global Health created a framework that included a “Condom Program Pathway,” which described the critical building blocks required to support a sustainable, healthy condom market. Populating a Condom Program Pathway required the development of tools (adapting, where possible, existing tools already in use) to measure condom market success in five countries: Botswana, Kenya, Tanzania, Zambia and Zimbabwe. These countries were selected as ‘archetypes’ representative of different condom programs found in East and Southern Africa.

Similar themes emerged in the five countries, with some notable differences. Core principles for effective total markets are the following:

  1. In order for a condom market to perform well, it must first meet the total needs of the population, which, in all five of the countries studied, required that the total market grow. In none of the countries did condom use equal condom need. In other words, people who needed condoms (UNAIDS targeted need is 90% of high risk sex acts covered by condom use by 2020) were not using condoms.
  2. Condom markets must be equitable in meeting the needs of priority populations and the vulnerable. Equity includes reaching key populations such as sex workers and young people, and also reaching hard-to-reach people in rural areas. Equity also includes reaching the poorest populations as successfully as the wealthiest, the least educated as well as the most, etc.
  3. Finally, condom markets must be sustainable, where they are able to provide condoms to all who need them over the long term. Sustainable programs will eliminate or drastically reduce the reliance on external funding in the long run, and significantly reduce that reliance in the short run.