World Development Report 1984

clients may develop can be promptly treated. quarter of couples who used contraception in 1983:
Finally, supervisors and fieldworkers must travel it accounted for 67 percent of total condom use, 12
frequently, and contraceptive supplies must be percent of oral contraceptive use, and 70 percent of
made available in an increasing number of remote spermicide use. In 1981 about half of all pill users
outlets. Money for transport is often first to be and 80 percent of condom users in Sri Lanka
sacrificed when budgets are cut, yet the whole obtained supplies from the social marketing prostrategy
depends on extensive travel and good gram.
logistics. Reliance on commercial distributors does not lift
all the burden off the public sector, however. The
ENCOURAGING PRIVATE SUPPLIERS. Another way in public sector still has to provide advertising, prowhich
governments have increased access to fam- motion, contraceptive supplies, distribution, and
ily planning services is by encouraging wider pri- medical backup. Some training is necessary for
vate involvement. This strategy makes fewer commercial suppliers to dispense oral contracepdemands
on scarce public funds and on adminis- tives and to advise clients how to use them proptrative
capacity. Policies include subsidizing erly, as has been done in Jamaica, Korea, Nepal,
commercial distribution of contraceptives, coordi- and Thailand. Failing that, some system of referral
nating with and encouraging private nongovern- or prescriptions must be developed.
mental organizations (NGOs), and removing legal Although government subsidies to the commerand
other barriers to private and commercial provi- cial sector are usually provided for contraceptive
sion of contraception. supplies only, some governments also subsidize
Subsidized provision of contraception through IUD insertion, abortion, and sterilization by pricommercial
outlets-often called social market- vate physicians. In Korea more than 2,300 physiing-has
been tried with some success in at least cians have been trained and authorized by the govthirty
countries. Social marketing programs use ernment to provide family planning services. The
existing commercial distribution systems and retail government pays the entire cost of sterilization,
outlets to sell, without prescription, contraceptives but the cost of IUD insertion is shared-two-thirds
that are provided free or at low cost by govern- by the government, one-third by the client. The
ments or external donors. The first social market- involvement of private physicians has been a cruing
scheme was in India, selling subsidized cial factor in the success of the Korean program,
"Nirodh" condoms. Almost all countries with although in 1978 about 60 percent of rural townsuch
schemes sell condoms, and at least seventeen ships still had no authorized physician.
are known to sell oral contraceptives, sometimes Access to services has also been increased by colseveral
brands. Spermicides, in the form of sup- laborative efforts between government and NGOs.
positories, creams, pressurized foam, and foaming This collaboration has taken many forms: subsiditablets
are also commonly sold. Until recently, zation of or grants to NGO services, coordination
social marketing schemes have been limited to of NGO and government services to assure maximethods
that do not require clinical services for mum coverage and allocation of responsibilty for
distribution. But Egypt now sells subsidized lUDs critical functions or services in certain regions to
through private doctors and pharmacies. And in NGOs. In Bangladesh and Indonesia, for example,
Bangladesh there are plans to test-market inject- government services are allocated to rural areas,
able contraceptives through social marketing leaving NGOs to provide a large share of urban
arrangements. services. Since 1973 the Brazilian Family Planning
Social marketing makes family planning sup- Association (BEMFAM) has worked with the govplies
more easily accessible by increasing the num- ernments of several states in Brazil to establish
ber and variety of outlets through which they can community-based programs for low-income
be obtained: pharmacies, groceries, bazaars, street groups in the Northeast. The private nonprofit
hawkers, and vending machines. In Sri Lanka some program in Thailand acts as an extension of the
6,000 commercial outlets sell subsidized condoms government's rural health service and recruits
and pills-more than five times the number of gov- local distributors to promote family planning and
ernment family planning outlets. In the late 1970s sell subsidized contraceptives donated by the govsocial
marketing schemes accounted for more than ernment and international agencies. By mid-1978
10 percent of total contraceptive use in Jamaica, there were some 10,000 distributors covering one-
Colombia, Thailand, and Sri Lanka. In Bangladesh quarter of the 600 districts in Thailand. In Kenya in
the social marketing program supplied about one- 1980, NGOs were operating 374 out of 1,204 rural
142