C. Price and procurement

The high initial investments required to manufacture the female condom, as well as the material used, contribute to the price of the product. Because the female condom is made of polyurethane, a material that is more expensive than latex which is used in the manufacture of male condoms, it is unlikely that it will ever be as inexpensive as the male condom. However, the Female Health Company (FHC), as the sole manufacturer of the female condom, continues to work with the international community in order to offer the lowest possible price. FHC and UNAIDS have negotiated a special public sector price that offers a reduced price of £0.38 per female condom. Furthermore, FHC is continually looking for ways to reduce the manufacturing costs of the product in order to lower the price. Finally, preliminary findings from a study in South Africa indicate that reuse of the female condom may be a possibility. In countries where this practice would be culturally acceptable, reuse will reduce the price per protected sexual act. Final results of the South Africa study are eagerly awaited.

However, numerous examples and experiences indicate that the price of the female condom is just one of many factors that are important when determining the feasibility of using the product within a country’s reproductive health method mix. One important approach is to examine the cost-effectiveness of the female condom. Mathematical modeling indicates that, for many countries in eastern and southern Africa, the female condom is a cost-effective contraceptive and STD prevention method, both in terms of disability-adjusted life years (DALYs) and also in terms of cost per STD case averted. At the consultation the mathematical model was demonstrated with statistics from Zambia, a country that has high STD/HIV rates, similar to many countries in the region.

Mathematical modeling is just one of a number of approaches that should be considered when evaluating the feasibility of making the female condom available within a country.

Other criteria include

· cost effectiveness of incremental risk reduction (which assesses the introduction of the female condom in environments where the male condom is already widely distributed);

· incremental cost effectiveness of alternatives (which assesses the cost effectiveness of the female condom in comparison with alternative methods of contraception and STD/HIV prevention);

· economies of scale (which assesses how widely the product will be distributed within a given environment);

· institutional strength (which assesses the ability of different institutions to manage the packaging and distribution of the product and the training of providers);

· use dynamics (which examines the needs of specific target groups and their access to other methods of contraception and STD/HIV prevention);

· cost recovery (which assesses how much of the cost can be passed on to the consumer); and

· the epidemiological context.

When a comprehensive analysis that includes the above criteria reveals a potential for the female condom within a country’s reproductive health method mix, then funding should be aggressively sought. Resources can come from a variety of sources including public and private sectors, local and international organizations, commercial, and project-related funds.