EECO Project Results Reporting: Sept 2017 – Oct 2018

The project was implemented by WCG Cares from October 2013 to September 2022, with a goal of expanding method choice for family planning and reproductive health. EECO secured the world's first and second registrations of the Avibela levonorgestrel intrauterine system (LNG-IUS) in Madagascar and Zambia, respectively. The product is the most affordable of the existing LNG-IUS products with Stringent Regulatory Authority approval and can be sold through the private sector as well as offered in the public sector. In addition, EECO completed the first registration of PATH's SILCS diaphragm in any FP2020 country in Niger. The project introduced affordable new LNG-IUS in Madagascar through a partial cost recovery model. From May to August 2018, the Ministry of Health and EECO trained 32 OB/GYN providers to offer Avibela alongside other methods of contraception in private clinics. As of September, providers had purchased 157 units and 84 clients had chosen Avibela from a broad range of options. Preliminary data from Madagascar showed that 71% of women who received the LNG-IUS and participated in a longitudinal study would have chosen either a short-term method or no method at all if the LNG-IUS had not been available. EECO also completed a regulatory dossier to enable WHO Prequalification of the progesterone vaginal ring (PVR) Progering, a new postpartum family planning option. The project developed the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) Common Technical Document (CTD)-formatted dossier for Progering. EECO is continuing to support the Progering manufacturer as well as partner and product developer Population Council to achieve WHO Prequalification. The project conducted a total market approach assessment for female condoms in Malawi and Zambia, evaluating the product category in two countries with high rates of unmet need for contraception and HIV incidence. The assessment identified market failures in the female condom ecosystem and opportunities for growing the market for this unique, woman-initiated, triple protection method. The results of the TMA assessment have been disseminated through various channels, including in-person meetings and webinars. EECO launched the Woman's Condom in Malawi and Zambia through a five-step product introduction process, evaluated the effects, and documented learning. From 2015 to 2018, the project sold 137,544 socially marketed female condoms in Malawi and Zambia. Innovations for Poverty Action (IPA) conducted an impact evaluation examining the effects of Woman's Condom promotion through interpersonal communication in Lusaka, Zambia. The results showed that youth who attended the project's interpersonal communication sessions were four times more likely to discuss contraceptives with their partner, five times more likely to be able to identify a female condom, and five times more likely to have used a female condom in the past six months. Implementation issues and constraints included delays in regulatory reviews, procurement delays, and quality assurance audit delays. EECO responded by persistently following up with the relevant parties and requesting their intervention. Challenges affecting method access included the transfer of public providers trained by EECO to sites outside of the project's LNG-IUS introduction zones in Zambia and the inability of clients in Madagascar to afford the LNG-IUS under the current pricing model. EECO is considering a temporary price reduction to address this challenge and has scheduled a refresher training workshop with interpersonal communication agents in Madagascar to improve their efforts to identify women with an ability to pay or to use health insurance to cover the cost of the method. The timing of the DOT introduction may depend upon when the results of the 13-cycle DOT efficacy trial are published. EECO will undertake a regulatory landscape assessment, develop a marketing plan, and pre-test messages for DOT while awaiting published evidence of a typical-use efficacy rate. EECO is also awaiting post-registration approval of the SILCS label from the National Regulatory Authority in Niger and is following up with the National Regulatory Authority every two weeks to ensure that the SILCS labeling update is included in the next dossier review meeting.