Analysis: Partners sell women's health

WASHINGTON, May 30 (UPI) -- From soap to birth control, cash-strapped public health groups are partnering with private companies to sell women's health products.

The cooperation harnesses the vast resources of the private sector, the groups say, and a self-sustaining private market means products will still be available even if donor aid dries up. But others say the partnerships are more about profit than public health.

"Family planning needs are currently outstripping available resources," said Ruth Berg, director of the PSP-One Project, a group that helps USAID develop such public-private partnerships.

Public health groups need private companies "because of the resources the private sector can bring," she said Tuesday at the International Conference on Global Health.

In the partnerships, a company agrees to sell a women's health product -- birth control pills for example -- at a price significantly lower than the cheapest commercially available product. In return, the company agrees to contribute toward direct-to-consumer marketing, and an international donor pays the rest of the cost for marketing the product to middle- and low-income women.

Many countries already have private markets for women's health products, but only wealthier women purchase them. Aid-supported social marketing can be successful in encouraging women across all income groups to purchase their health products.

Aid groups and businesses say the arrangements are win-win -- but only eventually.

The oldest project, started in Morocco in 1989, was a partnership between private companies Wyeth Pharmaceuticals and Schering and the Moroccan Ministry of Health. The project succeeded in increasing poor women's participation in the market by 72 percent, and by 2003, 50 percent of all oral contraceptives in the country were purchased commercially.

For the companies, however, the project did not become self-sustaining until 2003.

Still, most aid programs effectively have to shut down if donors withdraw, Berg said, and the successful, sustainable program is a success.

"Everyone ended up getting everything they wanted in this partnership," she said.

Another collaboration under way is between USAID and Hindustan Lever Limited, the Indian arm of Unilever, the giant multinational manufacturer of products like Dove and Vaseline.

The Indian company, looking to expand its market into rural areas, had already established a network of village-level women entrepreneurs called Shakti women. The women, with the help of microfinance loans, purchase then sell Lifebuoy soap and other products door-to-door in India's 634,000 villages with populations under 2,000.

Now the company is partnering with a group called PSP-One on a USAID project that will harness the Shakti network to educate women in rural areas about hand-washing while they sell the soap. Hand-washing is one way to prevent diarrhea, which kills more than 700,000 Indians each year, including many newborns.

The network is now slated to begin selling oral rehydration products manufactured by another company.

"It started as a business venture," said Shweta Harit, global Lifebuoy brand manager at Hindustan Lever Limited.

"There was a public vision and a business vision and they both matched."

New projects are even being planned that bring together developing countries. A project is under way to sell generic oral contraceptives from Asia in Nigeria.

The partnerships, however, also have downsides.

While there are good statistics on the business success of the programs, there is little research demonstrating long-lasting improvement in women's health.

Companies involved in the projects also have profit in mind, a fact that makes some public health advocates uncomfortable.

"The profit motive is there driving a lot of decisions," Berg said. "We worry about the profit motive compromising the quality of care and equity.

"The goals of partnerships need to be very clear, and equity concerns need to be negotiated within the partnership."

In the Indian partnership, for example, advocates for the poor protested the marketing of soap in areas with a severe shortage of potable water.

Programs have proven most successful in countries with an already functioning private market, and a surge in free donated supplies can derail efforts.

But advocates of the partnerships remain hopeful and urge patience.

"Developing these projects is not always easy," said Marguerite Farrell, a health development officer at USAID.

"It may take time."