market research for 7.1% chlorhexidine digluconate: nigeria · two-phase approach • initiated in...

Market Research for 7.1% Chlorhexidine Digluconate: Nigeria

November 2014

Photo: PATH/Evelyn Hockstein

Goals, Objectives, and Research Methodology


Goals and Objectives

Goals

• Support the development of effective introduction plans.

• Help manufacturers create business plans.

Objectives

• Segment the market and estimate demand by segment.

• Identify the priority market segments.

• Identify effective distribution and communication strategies to reach the priority market segments.

Two-phase approach

• Initiated in January 2014 after securing national and state-level approvals and pretesting the research tools.

• Implemented in two phases.

• Phase 1: Qualitative research

• Identified factors relevant to market segmentation.

• Phase 2: Quantitative research

• Segment the market and identify priority segments.

• Estimate the size of priority segments.

• Identify effective distribution and communication strategies to reach each segment.

Phase I Methodology

Performed desk and qualitative research in four states.

• Four focus group discussions (FGDs) with 30 potential users in Osun and Nasarawa states.*

• Kano, Nassarawa, Osun and Cross River

• 26 in-depth interviews with stakeholders at both the national and state levels (four states).

* Potential users include currently pregnant women (CPWs) who have at least one child and recently delivered women (RDWs) who have children < 3 months old.

Phase II Methodology

• Conducted data collection in the same four states:

• 38 key informant interviews (KII).

• 16 FGDs.

• 2 FGDs in rural areas and 2 FGDs in urban areas per state with 123 participants.

• 401 individual interviews through home visits.

States Interviews KII FGD

Kano 100 10 25

Nasarawa 100 9 30

Osun 102 9 32

Cross River 99 10 32

Total 401 38 123

Respondent distribution



By rural vs. urban By religion

153 166

3943

0

50

100

150

200

250

Rural Urban

CPW/RDW Relatives

146167

40

42

0

50

100

150

200

250

Christianity Islam

CPW/RDW Relatives

Nu

mb

er o

f p

arti

cip

ants

Nu

mb

er o

f p

arti

cip

ants


By age By income level

62

171

85

13

48

21

0

50

100

150

200

250

High income Moderateincome

Low income

CPW/RDW Relatives

0

50

100

150

200

250

16 - 25 26 - 35 36 - 45 46 - 55 56+

CPW/RDW Relatives

Nu

mb

er o

f p

arti

cip

ants

Nu

mb

er o

f p

arti

cip

ants

Characteristics of respondents: FGD participants

State

Characteristics of participants

# of

participantsType Rural/Urban SEC Age Education

Kano Husbands Urban H >30 Secondary school education and above 7

Women Urban M >20 Secondary school education and above 6

Women Rural M >15 Primary school education and below 6

Women Rural L >15 Primary school education and below 6

Cross

River

Husbands Urban H 20-39 Secondary school education and above 10

Women Urban M 20-39 Secondary school education and above 10

Women Rural M 20-39 Primary school education and below 10

Women Rural L 20-39 Primary school education and below 6

Osun Women Urban H 20-40 Secondary school education and above 6

Women Urban M 20-39 Secondary school education and above 10

Husbands Rural M 20-39 Primary school education and below 6

Women Rural L 20-39 Primary school education and below 10

Nasarawa Women Urban H >15 Secondary school education and above 6

Husbands Urban M >30 Secondary school education and above 8

Women Rural M >15 Primary school education and below 8

Women Rural L >15 Primary school education and below 8

SEC: Socio-economic class; H: High income; M: Moderate income; L: Low income

Characteristics of respondents: KII participantsState Respondents type Organization Total

Kano Policymakers Primary Health Care Coordinator, Kano Municipal; Primary Health care

Coordinator, Makoda Local Government; Deputy Director Public Health, Kano

State Ministry of Health

2

Influential

stakeholders

Chairman, National Association of Community Health Practitioners of Nigeria;

Chairman, Association of Patent Proprietary Medicine Vendors Makoda

3

Providers TBA PPMV/Environmental Health Officer; Pharmacist; Community Health

Extension Worker; Chief, Matron Maternity Ward Muritala Mohammed Hospital

5

Total 10

Osun Policymakers Maternal and Child Health Coordinator; Deputy Director Community Health

Officer

2

Influential

stakeholders

President, PPMV/Ilesha West Zone; Chairman, National Association of Nigeria

Nurses and Midwives Ilesha West Zone

2

Providers TBA; PPMV; medical doctor; Assistant Community Health Extension Worker;

Registered Nurse

5

Total 9

TBA: trained birth attendant; PPMV: proprietary patent medicine vendors

Characteristics of respondents: KII participants (cont.)State Respondents type Organization Total

Nasarawa Policymakers Head of Health, Primary Healthcare Department, Obi local government Area;

Clinical Department Ministry of Health

2

Influential

stakeholders

State Chairman, MHWUN; Chairperson, Traditional Birth Attendant Association

Obi Local Government Area

2

Providers TBA; PPMV; Pharmacist; Nurse; Doctor 5

Total 9

Cross

River

Policymakers Maternal and Child Health Focal Person, RSPHCMB Rivers State; Medical Officer,

Health, Emuoha Local Government Area

2

Influential

stakeholders

Secretary NAPMED; Chairperson NACHP Obiakpor Local Government Area 2

Providers TBA; PPMV; pharmacist; medical doctor, Primary Health Center Rumueme;

Community Health Extension Worker, Primary Health Center, Rumueme;

Midwife, Primary Health Center, Rumueme

6

Total 10

MHWUN: Medical Health Workers Union of NigeriaTBA: trained birth attendantPPMV: proprietary patent medicine vendorsRSPHCMB: Rivers State Primary Health Care Management BoardNAPMED: Nation Association of Patent Medicine DealersNACHP: National Association of Community Health Practitioners

Key findings

Photo: PATH/Mike Wang

Antenatal care (ANC): % of women receiving ANC and timing of first visit

Receiving ANC By timing of first visit

Trimester Trimester Trimester

Per

cen

t o

f p

arti

cip

ants

Antenatal care (ANC):Place of ANC

Antenatal care (ANC):Place by rural vs. urban and socioeconomic status

By rural vs. urban By income level

Per

cen

t o

f p

arti

cip

ants

Per

cen

t o

f p

arti

cip

ants

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Public hospital Privatehospital

Missionhouse/church

TBA home Within thecommunity

Rural Urban

Place of delivery

Place of delivery


Per

cen

t o

f p

arti

cip

ants

Per

cen

t o

f p

arti

cip

ants

ANC vs. delivery: Place

Where did you receive

antenatal care?

Where did you

deliver the baby?

Public

hospital

Private

hospital

Mission

house/

church

TBA home Within the

community

Total

Home (assisted by a

caregiver)

12 1 0 0 2 15

Home (assisted by a TBA) 23 0 0 6 0 29

Home (self-delivery) 33 0 0 0 0 33

Church facility/premises 15 0 3 0 0 18

TBA facility/premises 13 2 1 10 1 27

Health facility (public) 132 4 0 0 1 137

Health facility (private) 17 28 0 0 0 45

Others (specify) 5 0 0 0 1 6

Total 250 35 4 16 5 310

Number = number of respondents

ANC vs. delivery: Personnel

Personnel assisting delivery Personnel providing ANC

12%

48%

1% 3%

21%

5% 7%3% 1%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Per

cen

t o

f p

arti

cip

ants

Per

cen

t o

f p

arti

cip

ants

Substances currently purchased for cord care

Percent procurement

Procurement by state

Purchased88%

Did not purchase

9%

Missing3%

Per

cen

t o

f p

arti

cip

ants


Nu

mb

er o

f p

arti

cip

ants

Substance



Per

cen

t o

f p

arti

cip

ants

Per

cen

t o

f p

arti

cip

ants

Substances currently used for cord care:Who influenced what cord care substances should be used?

Substances applied

Reasons

Methylated spirit

Hot compress

Mentholatum ToothpasteNative

substanceOthers Total

Used in the family 31 30 4 18 11 2 96

Used in the village 8 9 1 9 4 1 32

Told by the TBA 24 13 7 14 4 6 68

Told by CHEW/CHW 67 12 3 1 0 2 85

On the hospital list 26 10 8 1 0 0 45

Told by health care providers

79 23 18 2 1 12 135

Available 4 3 0 1 0 0 8

Others 3 2 0 2 0 2 9

Missing 9 6 2 1 0 0 18

Total 251 108 43 49 20 25 496

Number = number of respondents


Timing of purchase Place of purchase

24.8%

44.2%

21.3%

6.9%2.8%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Beforedelivery

(notduringANC)

Beforedelivery(duringANC)

At thetime ofdelivery

Others MissingP

erce

nt

of

par

tici

pan

ts

Per

cen

t o

f p

arti

cip

ants

Substances currently purchased for cord care:Place of purchase


Per

cen

t o

f p

arti

cip

ants

Per

cen

t o

f p

arti

cip

ants

Substances currently purchased for cord care: Price

Average price of methylated spirits = NGN200/bottle

Price (in NGN)

Nu

mb

er o

f re

spo

nd

ents

Source of information for ante- and post-natal care

Respondents stated that personnel who assist with delivery are the best positioned to determine cord care practices.

Clean delivery kits (CDK):Knowledge and use

Knew about and used CDK9%

Knew about, but did not use CDK24%

Did not know about CDK67%

7.1% chlorhexidine digluconate: Preferred dosage form

Liquid46%

Gel54%

7.1% chlorhexidine digluconate:Preferred dosage form

By state By rural vs. urban

By socioeconomic class

46%49% 49%

37%

54%51% 51%

63%

0%

10%

20%

30%

40%

50%

60%

70%

Kano Nasarawa Osun River

Liquid Gel

46% 46%

54% 54%

40%

45%

50%

55%

60%

Rural UrbanLiquid Gel

60%

42% 42%40%

58% 58%

0%

20%

40%

60%

80%

High income Middle income Low income

Liquid Gel

Per

cen

t o

f p

arti

cip

ants

Per

cen

t o

f p

arti

cip

ants

Per

cen

t o

f p

arti

cip

ants

Cross

7.1% chlorhexidine digluconate:Perceptions about gel and liquid

Gel Liquid

Stays on the cord • Covers the cord well.• No need for reapplication; requires

small amount.• Easy to see how much is applied.

Afraid of spillage • Doesn’t cover the cord.• May require reapplication; requires

larger amount due to wastage.• Cannot determine how much

remains on the cord.

Covers the cord well, thereby protecting the cord.

Cannot cover the cord.

Can apply with finger. Requires an applicator (i.e., cotton balls).

Similar to toothpaste (the substance the respondents currently use for cord care).

Similar to methylated spirits (the substance that the respondents currently use for cord care).

7.1% chlorhexidine digluconate:Preferred places to obtain

Place for obtaining chlorhexidine

Current place for obtaining substances for cord care

29.8%

17.0%

3.3%

14.1%17.8% 18.5%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Per

cen

t o

f p

arti

cip

ants

Per

cen

t o

f p

arti

cip

ants

7.1% chlorhexidine digluconate:Timing for obtaining

Timing of obtaining chlorhexidine

Timing for obtaining current cord care substances

18.2%

73.1%

2.5%5.8%

0.4%0%

10%

20%

30%

40%

50%

60%

70%

80%

Beforedelivery

(notduringANC)

Beforedelivery(duringANC)

At thetime ofdelivery

Afterdelivery

Anytime

Per

cen

t o

f p

arti

cip

ants

Per

cen

t o

f p

arti

cip

ants

7.1% chlorhexidine digluconate:Price for single dose

7.1% chlorhexidine digluconate Substance currently used

Nu

mb

er o

f p

arti

cip

ants

Nu

mb

er o

f p

arti

cip

ants

7.1% chlorhexidine digluconate:Difference in price for single dose

By rural vs urban By income level

0%

5%

10%

15%

20%

25%

30%

35%

<100 100-150 150-200 200-250 >250

Rural Urban

0%

5%

10%

15%

20%

25%

30%

35%

<100 100-150 150-200 200-250 >250

High income Moderate income

Low income

Segmentation


Segmentation factors

• Respondents’ locations of residence (rural or urban) and socioeconomic status.

• These factors affect:

• Place where they deliver babies, which therefore affects providers who assisted births.

• Substances purchased for cord care.

• Place where substances for cord care are purchased.

Segmentation factors

• Places where the respondents currently buy/obtain cord care substances.

• Current behaviors are good indicators of future behaviors:

• Places and times where respondents currently obtain cord care substances are similar to places and times where respondents could obtain chlorhexidine.

Factors considered but not utilized for segmentation

• Location of ANC and location of deliveries:

• Virtually all respondents (97.2%) receive ANC.

• Cannot segment respondents based on whether they did or did not receive ANC.

• Locations where respondents receive ANC and locations where they deliver their babies are, in turn, influenced by the location of their residences and their socioeconomic status.

• The majority of respondents currently obtain cord care substances at locations different from where they receive ANC or from where they deliver their babies.

SegmentationRDW and CPW

Rural (153)

High income (0)Moderate

income (70)

Chemist/PPMV

(33)

Pharmacy

(3)

HC Facility

(1)

Market/shop

(17)

TBA

(7)

Other Traditional

(7)

Family/friend

(1)

Don’t know

(1)

Low income (83)

Chemist/PPMV

(37)

Pharmacy

(3)

HC Facility

(5)

Market/shop

(27)

TBA

(5)

Family/friend

(1)

Other

(3)

Don’t know

(2)

Urban (166)

High income (62)

Chemist/PPMV

(20)

Pharmacy

(20)

HC Facility

(6)

Market/shop

(13)

TBA

(1)

Other

(1)

Missing (1)

Moderate income (101)

Chemist/PPMV

(34)

Pharmacy

(23)

HC facility

(19)

Market/shop

(16)

TBA

(1)

Family/friend

(2)

Other

(1)

Don’t know

(2)

Missing (3)

Low income (2)

Pharmacy

(1)

HC Facility

(1)

Target:

Overall, these segments represent an 63.3%of CPW/RDW women enrolled in this survey.

Characteristics of target segment: Rural

Characteristics

Rural women, moderate income,

purchasing from

chemists/PPMVs

(N=33, 10.3%)

Rural women, low income,

purchasing from

chemists/PPMVs

(N=37, 11.6%)


purchasing from markets/shops

(N=27, 8.5%)

Age range

16-25 years

26-35 years

36-45 years

46-55 years

30.3%

42.4%

27%

--

43.2%

43.2%

8.2%

5.4%

48.1%

48.1%

3.7%

--

Occupation

Artisans

Traders

Housewives

Civil servants

Teachers

Farmers

36.4%

36.4%

18.2%

6.1%

6.1%

--

18.9%

27.0%

32.4%

--

--

18.9%

22.2%

48.1%

14.8%

--

--

11.1%

Number Of children

1 child

2 children

3 children

4 children

> 4 children

9.1%

33.3%

30.3%

3%

24.2%

10.8%

35.1%

8.1%

32.4%

13.5%

22.2%

29.6%

22.2%

7.4%

18.5%


Characteristics

Rural women, moderate

income, purchasing from

chemists/PPMVs

(N=33, 10.3%)


purchasing from

chemists/PPMVs

(N=37, 11.6%)


purchasing from

markets/shops

(N=27, 8.5%)

Place of ANC

Public Hospital

Private Hospital

Mission house/church

TBA

Community help

Missing

78.8%

9.1%

6.1%

--

--

6.1%

86.5%

2.70%

--

5.4%

--

5.4%

74.1%

--

3.7%

18.5%

3.7%

--

Place of delivery

Home - assisted by caregivers

Home - assisted by TBAs

Home - self-delivery

Church facility/premises

TBA facility/premises

Health facility - public

Health facility - private

Others - specify

0.0%

12.1%

18.2%

9.1%

9.1%

36.4%

15.2%

0.0%

5.4%

29.7%

21.6%

5.4%

8.1%

21.6%

5.4%

2.7%

7.4%

14.8%

14.8%

11.1%

22.2%

29.6%

0.0%

0.0%

Cord care practices

Methylated spirits

Traditional substances

72.7%

27.3%

62.2%

37.8%

3.7%

96.3%


Characteristics

Rural women, moderate


chemists/PPMVs

(N=33, 10.3%)


purchasing from

chemists/PPMVs

(N=37, 11.6%)


purchasing from

markets/shops

(N=27, 8.5%)

Formulation preference

Liquid

Gel

45.5%

54.5%

35.1%

64.9%

51.9%

48.1%

Sources of information

Radio

TV

Health workers (during ANC)

Health workers (outside of ANC)

TBAs

Market place

Friends

Female relatives

Trade groups

Wife of religious leader

72%

59%

54%

51%

29%

18.9%

13.5%

5.4%

5.4%

5.4%

75.6%

32.4%

54%

56.7%

45.9%

16.2%

8.1%

10.8%

--

21.6%

88%

62.9%

33.3%

59.2%

48.1%

--

25.9%

44.4%

14.8%

--

Characteristics of target segment: Urban

Characteristics

Urban women, high


chemists/ PPMVs

(N=20, 6.3%)

Urban women, high


pharmacy

(N=20, 6.3%)

Urban women, moderate


chemists/PPMVs

(N=34, 10.7%)

Urban women, moderate


pharmacy

(N=23, 7.2%)

Age range

16-25 years

26-35 years

36-45 years

45-55 years

45%

40%

15%

--

30%

55%

15%

--

35.3%

52.9%

11.8%

--

30.4%

52.2%

17.4%

--

Occupation

Artisans

Traders

Housewives

Civil servants

Teachers

Clerical work

Health workers

Professionals

Bankers

Businesswomen

Student

--

25%

10%

35%

15%

--

--

--

--

--

--

--

25%

5%

20%

5%

15%

15%

10%

5%

--

--

23.5%

35.3%

14.7%

5.9%

5.9%

2.9%

5.9%

2.9%

2.9%

--

--

----

43.5%

21.7%

8.7%

4.3%

--

--

4.3%

--

4.3%

4.3%

Number of children

1 child

2 children

3 children

4 children

> 4 children

15%

45%

2%

15%

15%

25%

30%

20%

15%

10%

9%

47%

29%

6%

9%

9%

61%

13%

4%

13%


Characteristics

Urban women, high

income level,

purchasing from

chemists/ PPMVs

(N=20, 6.3%)

Urban women, high

income level,

purchasing from

pharmacy

(N=20, 6.3%)

Urban women,

moderate income

level, purchasing from

chemists/PPMVs

(N=34, 10.7%)

Urban women,

moderate income

level, purchasing

from pharmacy

(N=23, 7.2%)

Place of ANC

Public Hospital

Private Hospital

TBA

Community help

90%

10%

--

--

85%

15%

--

--

70.6%

23.5%

2.9%

2.9%

82.6%

17.4%

--

--

Place of delivery

Home - assisted by caregivers

Home - assisted by TBAs

Home - self-delivery

Church facility/premises

TBA facility/premises

Health facility - public

Health facility - private

Others - specify

10.0%

0.0%

5.0%

10.0%

0.0%

50.0%

25.0%

0.0%

--

5.0%

--

--

--

75.0%

20.0%

--

9%

12%

0%

6%

3%

56%

15%

0%

4%

4%

--

--

--

74%

17%

--

Cord care practices

Methylated spirits

Traditional substances

60%

40%

70%

30%

55.9%

44.1%

69.6%

30.4%


Characteristics

Urban women, high

income level,

purchasing from

chemists/ PPMVs

(N=20, 6.3%)

Urban women, high

income level,

purchasing from

pharmacy

(N=20, 6.3%)

Urban women,

moderate income

level, purchasing from

chemists/PPMVs

(N=34, 10.7%)

Urban women,

moderate income

level, purchasing

from pharmacy

(N=23, 7.2%)

Formulation preference

Liquid

Gel

Missing

60%

40%

--

75%

25%

--

41.2%

55.9%

2.9%

39.1%

56.5%

4.3%

Sources of information

Radio

TV

Health workers (during ANC)

Health workers (outside of ANC)

TBAs

Market place

Friends

Female relatives

Trade groups

Wife of religious leader

85%

80%

45%

80%

15%

--

--

--

--

--

80%

80%

45%

60%

5%

--

--

--

--

10%

79.4%

79.4%

76.5%

26.5%

5.9%

20.6%

5.9%

0.0

--

6.6%

78.3%

73.9%

65.2%

26.1%

4.3%

--

4.3%

8.7%

--

4.3%

Recommendations for 7.1% chlorhexidine digluconate

Photo: PATH/Amy McIver

Recommendations: General

• Introduce the liquid form of 7.1% chlorhexidine gluconate if the demand size for the chlorhexidine products becomes large enough to accommodate two product forms (splitting small demand into two product forms will lead to a low production quantity and high production cost for each product form).

• Overall, the gel form is slightly preferred over the liquid form, but a few target segments prefer the liquid form over the gel form.

• Respondents are willing to pay more for the liquid form, so potential for a secondary market is present.

Recommendations: Distribution

• Sell 7.1% chlorhexidine digluconate product at PPMVs and pharmacies to increase availability and usage.

• The vast majority of the respondents are already buying cord care substances at these outlets.

• They are willing to pay for 7.1% chlorhexidine digluconate.

• Drugfield Pharmaceuticals has sufficient distribution channels to gain market access to all 36 states and the Federal Capital Territory at Abuja.

• Augment with social marketing to reach women/families in rural areas and with low income level.

• Markets/shops are also popular places to obtain cord care products but they are not allowed to sell drugs. Supporting distribution of product at market/shops would not be appropriate.

Recommendations: Distribution (cont.)

• Continue to use the public-sector channels to maximize opportunity for women to access the product and to raise awareness about product use among families.

• Integration into national government programs such as the SURE-P MCH, the Midwives Service Scheme, etc.

• Use the Drug Revolving Fund.

• Putting the product into clean delivery kits (CDKs) is not an effective way to distribute the product.

• Current low awareness and low usage rates of CDKs make it an unattractive distribution channel for chlorhexidine.

Recommendations: Awareness raising

• Use ANC as an educational avenue for women, including community-based ANC outreach programs conducted by CHEWs.

• Almost everyone accesses ANC.

• Those who provide delivery care are the ones most influential in determining which cord care products to use and which practices to employ.

• Personnel who provide delivery care are currently providing ANC.

Recommendations: Mass media/demand generation

• Use mass media (TV and radio) as an avenue for communication

• Convey different messaging to those who use methylated spirits and those who use traditional substances.

• For those currently using methylated spirits, emphasize proven efficacy and ease of application

• For those currently using traditional substances, focus on dispelling myths.

market research for 7.1% chlorhexidine digluconate: nigeria · two-phase approach • initiated in...

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