_Private sector coverage of thefamily planning market_ _31_ and relative prices. It is an issue that warrants further study. Definitive evaluation of the contribution of social marketing to contraceptive use requires that sales analyses and consumer intercept studies be conducted in the context of a wider research effort, including contraceptive prevalence surveys that include better questions on source and financing and consumer responses to changes in relative prices.

Three CSM projects have terminated donor support and are therefore considered to be self-sufficient: Dominican Republic (orals), Barbados, and Indonesia (Dualima condoms). It should be noted that USAID/Indonesia has begun to finance a $4 million, four-year social marketing project to promote another product line which will directly compete with the earlier CSM brand. Stipulations that commercial partners will pick up promotional costs once project funding terminates have been made in Colombia, Ecuador, Bolivia, Brazil, the Dominican Republic, Peru, Indonesia, Morocco, and Turkey. Data on commercial investments are not forthcoming. Companies regard such information as trade secrets and do not reveal expenditures so that their competitors do not find out what they are doing.

Projects which do not achieve full self-sufficiency may be able to demonstrate that the CSM channel is less expensive than other subsidized approaches. For example, in Honduras, the gross direct cost of distributing oral contraceptives via social marketing was 16 percent lower than the implementing agency's CBD program; when net costs were calculated by subtracting revenues earned, the cost differential increased to 34 percent (Janowitz et al. 1991). Colombia Profamilia's CBD program works very much as a CSM approach; the costs of distributing temporary supply methods through the CBD program were two to almost four times cheaper than distributing the same methods through its clinical outlets (Chernichovsky and Anson 1989).

# _4.3.2. Subsidies to private practitioners, medical groups, and employer-supporled health plans_

Donor subsidies to commercial health outlets have been tested on a pilot basis in the hopes that these organizations would assume full costs once the market was established. Some projects attempted to increase demand for family planning, and others attempted to establish a wider supply base. Most of these projects have worked with third-party financing and organized medical groups, although one project in Mexico worked with individual private physicians.

In Indonesia, the Atma Jaya Hospital provides family planning to factory workers, mostly young women, in North Jakarta. In 1983-87, all service delivery costs were picked up by a donor, Family Planning International Assistance (FPIA). When funding ran out, the project turned to the Asia Family Planning Operations Research project and TIPPS for financial and technical assistance to market the same services, but with employers paying the service delivery costs. During the next two years, 27 factories signed up for health services, 17 of which contracted for family planning. Over 4,000 clients received family planning in the first 18 months. A slight increase in contraceptive prevalence (69.9 to 73.1 percent) was reported after the first six months, but this may have resulted from sampling error. More significantly, the project succeeded in attracting previous users of public facilities: the percentage of users who were served by government clinics dropped by a third (44 to 29 percent). The services also attracted previous users of commercial outlets; the percentage served by the commercial sector dropped by almost a quarter (37 to 28 percent). Revenue generated for Atma Jaya exceeded costs by the end of the first month (Hindarto et al. 1990).

In the Philippines, the Enterprise Project provided subsidies to an umbrella NGO, the Population Center Foundation (PCF) to market family planning services to nearby factories. Within