Family planning

An Initiative that’s Right on Target

Interview with Ulrike von Gilardi und Ariane Püttcher

Ulrike von Gilardi and Ariane Püttcher lead the Contraceptive Security Initiative within Social HealthCare Programs and managed the launch locally in Kenya.

In 2010, Bayer together with USAID started the “Contraceptive Security Initiative” (CSI). Within the framework of the program, the oral contraceptive Microgynon Fe was launched in African countries south of the Sahara and offered in pharmacies at a reasonable price as a sustainable offer for middle class African women. After successful launches in Ethiopia, Uganda, Tanzania, Rwanda and Ghana the initiative started in Kenya in the summer of 2013, with great success. Ulrike von Gilardi and Ariane Püttcher, who lead the project within Social HealthCare Programs, attended the launch event in Nairobi.

Ms von Gilardi, you mentioned that the launch of the "Contraceptive Security Initiative" in Kenya was a particular highlight – why?

UvG: This was clear: The enormous enthusiasm of all the local participants was unique. We had invited 160 pharmacists, physicians and healthcare providers; over 300 came! Normally traffic comes to a standstill for about two hours in Nairobi on a Friday evening. We therefore chose a location in the city center so that everybody could come by foot. Pharmacists, physicians, midwives and reporters were still queuing even after the event had started, determined to get into the meeting room. The majority of the participants later expressed their thanks for the lectures and after the official part was over, many stayed on to interact with their colleagues. The discussions were interesting and lively. The second event in Mombasa was exactly the same: The event was smaller with 80 invitations – but here too, 140 guests came with the same enthusiasm as in Nairobi.

At the launch event in Nairobi the number of participants doubled those invited and many had to stand in the back rows

Ms Püttcher, how do you explain the great interest?

AP: I think the initiative acknowledges the huge need for modern contraceptives. Pharmacists and physicians in Kenya – and in other countries too – see CSI as a useful offer which addresses the clear need of women. Our Kenyan colleagues said to us: Women will be pleased when they hear that they can now get a Bayer pill at an attractive price. In Africa, Bayer is a recognized brand standing for high quality. The pharmacists at the launch event confirmed this perception: There was spontaneous applause when we announced the price of the newly available oral contraceptive!

The price for a monthly pack of Microgynon Fe is about as high as the cost of a Cappuccino. Why doesn't Bayer distribute the Pill for free?

UvG: Family planning programs, which distribute medicines for free, are naturally irreplaceable for people in need. CSI however addresses a different target group. In a city like Nairobi – the same applies to Kampala or Accra – there are many working women who would not want to stand in a queue at a distribution point to get contraceptives for free. In industrialized countries too, charitable offers are not used by people with mid-incomes simply because these are for free.

AP: It is important not to think of Africa in clichés: Of course many people live in poverty in Africa and the standard of living is lower than in the western industrialized nations. But there are also PR agencies, car showrooms, cafés – and a growing middle class who make use of what is offered. They buy their contraceptives in the pharmacy but cannot afford or do not want to pay for premium products. Our program offers these women the Pill at a reasonable price.

The Program is called "Contraceptive Security Initiative" – which “Security” is provided?

UvG: The security that our Pill is always available in the pharmacies. Other products are also available in the low-price segment but we are the only company to offer a sustainable approach. The entire chain from production through to distribution and the final consumer is guaranteed through the selling price. There is no dependence on state subsidies or donations; this is very important. State-subsidized programs often have expensive administration and can suddenly be cut or even deleted. The result: supply gaps. The fact that a woman goes to the pharmacy and her next monthly pack is not available is not an acceptable situation.

The pharmacist Dr. Titus Muhu Kahiga (photo) appealed to his colleagues to take their advisory role seirously and using the pack, to explain to women how to take the pill step-by-step.

And with CSI you can reliably avoid such supply gaps?

AP: Yes, by using our existing commercial distribution channels for Microgynon Fe. Orders do not go through aid organizations but directly through wholesalers and pharmacists. In this way, we ourselves as a manufacturer can estimate the need based on monthly sales figures, we can remind our local partners to stock-up and in the case of growing sales, we can adapt the production. Through their share of sales, local wholesalers and pharmacists have an interest to ensure that the product is available.

Unlike other African countries Kenya has its own Bayer subsidiary. Did this simplify implementation?

UvG: To a certain extent, yes. For example, the Kenyan colleague responsible for Regulatory Affairs was able to discuss the required approvals with the local authorities in Kenya instead of communicating across country borders. This was more complex in other countries.

AP: Since the Bayer East Africa office is in Nairobi, the colleagues were able to support us with the launch event. For us, it was much more convenient to use the well-established IT and workplace infrastructure and work from Bayer office instead of a hotel.

The posters from CSI campaign show young couples to underline that contraception is not just the responsibility of women. Since it is important in Africa to show local differences in features and stature, posters were produced for each country with local models. Right: the poster from Kenya.

What comes next – how will women in Kenya become aware that they can buy Microgynon Fe in pharmacies?

AP: Most important is to inform women that Microgynon Fe is available in their country at an attractive price. For this purpose, we have initiated various information campaigns in the countries informing women that they can now practice contraception with a Bayer Pill. In Ghana, for example, advertising of medical products to consumers is allowed. Therefore, we installed poster walls and developed radio spots. We also addressed the topic in local women's networks where there is a lot of information exchange. This intensive information campaign had a positive effect on the sales figures: The demand for Microgynon Fe in Ghana exceeded our expectations.

UvG: But in other countries where "Direct-to-Consumer" approach is not allowed, as for example in Tanzania, there are also possibilities. Aid organizations are allowed to talk about contraception and in this context mention initiatives such as CSI. Here we rely on our partner USAID. Furthermore, we are exploring the regulatory possibilities and continuously submit ideas to the authorities to see which options may be allowed. This is an important learning process for us and, in the long run, the initiative will benefit too. For Kenya, the launch event with an expert audience was definitely an important first step. Pharmacists, physicians, midwives and the press are important multipliers and we hope they will communicate their enthusiasm to women.

CSI has already been launched in six countries. Malawi is planned to follow in September. In 2014, the launch of the initiative in four further African countries is planned.