In recent years Nepal has progressed from a “low HIV prevalence” country to one with a so-called concentrated HIV epidemic in certain sub-groups of the population (e.g. sex workers and injecting drug users). Responding to this, national HIV/AIDS prevention efforts have focused on increasing correct and consistent usage of condoms among these groups. To support these efforts, this innovative research project was designed to use GIS to measure condom coverage, quality of coverage and access to condoms among women working in hot-zones, so as to facilitate more targeted marketing and distribution of condoms in these high-risk areas. The study was carried out in 15 of the 75 districts (defined administrative boundaries) of Nepal to assist evidence-based program-related decisions, and to monitor product and service performance. These 15 districts are combined into four geographically-defined study areas: (1) Kathmandu valley, (2) Dhading-Nabalparasi-Chitwan and Makawanpur district; (3) Rupandehi-Kailali Districts and (4) Kaski districts (see map 1). The study focused on geographic areas where high-risk commercial heterosexual activity was known to take place, as women working in these areas are the largest group infected with HIV. The study uses two sets of tools: GPS units to collect GIS coordinates, and audit administration in retail outlets to collect relevant information on condom products in the 19 sample hot-zones in each of the four study areas using systematic random sampling as suggested by the Lot Quality Assurance Survey (LQAS) method. This is pioneering work because it has created well defined hot-zones for targeted programmatic interventions. The hot zones can also be used to collect additional information that can be linked to assess program performance as well as monitor market performance over time, particularly the objectively verifiable product/service delivery. This study found that overall condom coverage in Nepal is good, with over 70 percent of hot zones having at least one condom-selling retail outlet per five high-risk meeting places. Donor subsidized condom (subsidized by donor and distributed by the social marketing company of Nepal) coverage ranged from 35 percent to 95 percent, while non-subsidized (condom sold by private marketers) condom brand coverage ranged from 20 percent to 85 percent. Despite this good condom coverage, the quality of condom coverage remains very poor, primarily due to low product and promotional material visibility, as well as few hot zones having the appropriate number of condom-selling outlets open at night. The ‘access to condom’ indicator was moderately strong in Kathmandu, with approximately 60 percent of hot spots having a condom-selling outlet within 100 meters. Outside of the Kathmandu valley, however, the results for this indicator were poor: approximately 15 percent of hot spots had a condom-selling outlet within 100 meters. The study has highlighted the need to focus programmatic efforts to enhance accessibility to condom-selling outlets and quality of coverage. For accessibility, resources should be used to increase the number of condom-selling outlets in hot zones. For quality of coverage, efforts should focus on increasing the number of outlets displaying condoms and promotional materials and the number of outlets open at night, perhaps through an incentive scheme. The research findings are the proof to improve condom provision in practice through public-donor-private partnership.
Pant, P. D.; Shrestha, M.; and Oyloe, P., "GIS for Measuring Product Performance and Strategic Planning: Mapping Condom Coverage, Quality of Coverage and Access to Condoms in Hot-Zone in Nepal" (2008). Partnerships, Proof and Practice - International Nonprofit and Social Marketing Conference 2008 - Proceedings. Paper 15.