Interview with Francoise Armand Time: 9:28 Date: Friday April 18, 2008 3:34pm

Conducted by Vanessa Mitchell and Heather Sanders, The INFO Project

Vanessa Mitchell: What is your professional background and when did you become interested in social marketing?

Francoise Armand: I come from a commercial marketing background. My first job was in the international division of L’OREAL, a large French cosmetic and pharmaceutical company with a worldwide presence, including many developing countries. So I came to social marketing knowing nothing about public health, very little about development, but I had the necessary skills and experience to adapt marketing techniques to a social context. I was hired by Population Services International (PSI) to help market a whole range of products, including contraceptives, condoms, insecticide treated nets, and water treatment products.

VM: What is social marketing, and how does it work?

FA: Social marketing is the use of techniques that have been proven to work in a commercial setting, in order to achieve a social goal. That could be a public health goal, a national security goal, or an environmental goal. The idea is to encourage positive behavior that benefits society--not just the individual.

For this approach to work, one must have a good understanding of people's needs. Once those needs are understood, programmers can develop approaches that meet people’s needs and also achieve the social goal. That's really the essence of social marketing.

In the developing world, social marketing is often confused with product promotion and distribution. But in my view, social marketing is about behavior change. There are four things that you can manipulate to influence people's behavior. These "Four P's" constitute the "marketing mix:"

• The Product, which can be a tangible product, a service, a person, or even a cause
• The Price, which refers to cost (it can be tangible, as in money, or psychological, as in the cost of going somewhere. Time is also a cost.)
• The Placement, meaning where the behavior is taking place (that would be the place you're selling a product; or providing a service)
• The Promotion, which refers to the messages that are being conveyed to a target audience about the behavior we want to promote

So those 4 elements (also called the marketing mix) are the various interventions at the disposal of social marketers that can be combined to achieve maximum impact – maximum behavior change.

VM: What challenges do family planning programmers face when trying to implement social marketing strategies?

FA: The challenges vary with the context, but you can basically enumerate all the challenges using the Four P's. For example, in the product area, many programs have problems finding low cost products. There may also be some challenges in marketing less known or more difficult products. One that comes to mind is the female condom – it is not an easy product to sell in spite of its public health benefits.

There may also be issues around price, because some people may not be able to pay the price that we need to charge in order to recover costs. There is sometimes a need for subsidies, and deeply subsidized programs imply long-term financial sustainability issues. Placement and distribution used to be challenges in some developing countries, but less-so today. I can think of countries likes Mozambique where it used to be very difficult to distribute products because the private sector was in shambles and commercial networks had to be rebuilt. And then there is promotion, or communication; that, in my opinion, is the biggest challenge: how to communicate with people, with specific target groups in a way that resonates with them and addresses their needs. We constantly have to use research in order to develop effective communication strategies, and that can be very expensive.

VM: Who can the private sector reach with social marketing that the public sector cannot?

FA: The private sector can reach anyone who accesses private sector communication channels or distribution channels: people who go to pharmacies, commercial outlets, convenience stores, or use private sector venues like bars and restaurants. Those people may not be as easily reached by the public sector. There are gender issues as well. I think men are easier to reach through the private sector and are not great public sector clients. There's also research showing that you can reach young people fairly easily through private sector communication approaches like the mass media and entertainment-based programs.

VM: Can you describe the characteristics of private sector contraceptive logistics supply distribution and production?

FA: I wish more people would ask that question, because it's very critical. Of course, you are referring to social marketing programs that involve selling products (not all programs do). Social marketing programs borrow heavily from commercial distribution principles: someone makes the product, and someone else distributes the product – puts it in the truck and carries it out to different wholesalers. Then it goes to retail outlets and on to the consumer. In this system, market forces play a big part. For products to move through the channels, you need a “push” element and a “pull” element. The “push” consists in making sure there is adequate stocking of the product, a good transportation network, and a good inventory and forecasting system to ensure adequate supply. However, supply only happens if there is demand for a product. The “pull” aspect consists in generating demand from consumers through advertising, promotion, educational activities, etc. This is a very important condition for using a social marketing approach: it has to work within the commercial system As a result; social marketing is not a good way to supply products that are in low demand unless a substantial investment is made in demand creation.

VM: How would the private sector and the public sector cooperate in logistical matters? How does a multi-sector strategy work to ensure contraceptive security?

FA: In fact, the two sectors complement each other, because there are things the private sector will do that the public sector will not and vice versa. Sometimes they overlap and compete with one another. True collaboration would imply that the public sector only serves people who cannot afford or access private sector services and leaves the rest to the private sector, because that's inherently more sustainable; it taps into household resources or third-party insurance payers. Ideally you want to save those precious public sector resources for people who really need them: vulnerable populations, people with low resources, or hard-to-reach populations. Of course, it's very difficult to get to this ideal situation.

VM: Can you give an example of successful social marketing and pharmaceutical partnerships?

FA: Between 2002 AND 2007, The Commercial Market Strategies (CMS) project and the follow-on Private Sector partnerships-One (PSP-One) project implemented a social marketing program to increase the presence of low-osmolarity oral rehydration salts (ORS) on the Indian market. Back in 2002, there were a lot of formulations of ORS on the Indian market that were not very effective. This was a collaborative effort with select manufacturers to encourage the production and promotion of WHO-approved ORS brands. The project also increased awareness among consumers, pharmacists and service providers that there was a better and more effective formulation out there. And it worked. Other companies then thought "We're going to be out-marketed here, so we need to join this effort." It was an interesting exercise in changing industry practices, even better than trying to get companies to cut prices or increase distribution efforts. It was really an achievement.

In the past I think there have been a lot of successful partnerships with condom and oral contraceptive manufacturers. In Morocco, the USAID-funded SOMARC project worked with two pharmaceutical companies to promote a lower-price pill. Each company contributed a pill brand and lowered its price, which helped increase demand for oral contraceptives. After that, some people graduated to more expensive products. So this initiative had benefits for both parties, the public health program and the manufacturers, because it grew the overall market.

VM: How can increasing demand for contraception be met by the private sector?

FA: Demand for contraceptives is increasing all over the world, faster in some regions than others. Africa is still dragging a bit – there is a lot more marketing to do there. There is rapid growth in the former Soviet Union, as well as in Latin America and Asia. Some publicly-funded commodities programs are already being out-paced by demand. For me the answer is rather obvious: the private sector can serve a big chunk of that market because some of is the growth comes from the middle and higher-income households. Even low-income consumers can be served by the private sector because there are now plenty of new suppliers of affordable contraceptives, especially generic manufacturers from Asia, that are now able to produce good quality products at a low cost.

In the former Soviet Union, contraceptive commodities are provided overwhelmingly by the private sector. There are gaps, of course: some products are not really available and some are very expensive. But in that region, as well as in some countries that have graduated from donor support (Turkey, Morocco, Mexico, Colombia), most of the supplies are now coming from the private sector (some of it from non-profit organizations, including family planning associations).

VM: How can private sector partnerships lend to sustainability?

FA: Assuming we're talking about financial sustainability – there is this whole big debate around programmatic and institutional sustainability and market sustainability – the private sector is inherently sustainable, because it's profit-driven and therefore sustainable if there is enough demand. Its main aspects, such as commercial distribution of pharmaceutical and consumer goods products are there to stay forever. Internet-based sales are growing as are other channels for disseminating product and information. What may not be sustainable are those programs that need continued donor support. However, it's really important not to assume that once we farm it all out to the private sector, things will all be taken care of--that is absolutely not the case. What can be left to the private sector should not be donor-funded, but there's always a need for public resources to fill the gap, or correct market failure.

Partnerships can allow the private sector to minimize the overlap between publicly funded programs and private-sector initiatives. When we have an overlap, the private sector usually withdraws – who wants to pay for something that you can get for free? Partnerships allow some room for the private sector to grow, while leaving that safety net for people who really need those public resources. They may involve properly-targeted subsidies but also allow the private sector to capture market share and to invest, playing a role in increasing the use of family planning and contraceptives.

VM: Can you give examples of successful social marketing partnerships?

FA: There are many examples and our project tries to document them. I mentioned two successful partnerships earlier. Partnering is not the only way to acknowledge and leverage the private sector. Our project PSP-One just collaborated with John Snow Inc. (JSI) on a USAID-funded initiative to compile best practices in increasing the use of family planning methods in the Eastern European and Eurasian region. We combined our private sector best practices with JSI’s experience of effective strategies in the public-sector and generated a joint paper. We are disseminating the document (entitled Ten Best Public and Private Sector Practices in Reproductive Health and Family Planning in the E&E region) to USAID missions, Ministries of Health, and all the family planning implementation organizations. It is tailored to the E&E region but the best practices are pretty universal.

VM: How can family planning professionals maximize the private sector's contribution to family planning?

FA: The secret to maximizing private sector participation is to figure out how much people can pay for products and services. The private sector may also be persuaded to reduce prices and fees if the context is right for market growth.

For anyone involved in family planning, understanding how much the private sector can contribute – private companies and providers but also social marketing organizations, NGOs, women's groups, civil society groups – is very important. Non-profit groups tend to be donor-supported but they serve a large percentage of low-income users. The commercial sector also serves a substantial proportion of the population. If you look at population-based data, you will see that a lot of people use the for-profit commercial sector for their health services. Any FP professional should take a “whole market approach,” which means researching the different suppliers (public and private) of products and services and who they serve. Once you have done this kind of research, you can either concentrate on meeting the needs of those who are not being served, or try to engage the private sector to serve more people in exchange for activities that increase demand for their products.