Exploring the Demand and Supply Dynamics of 4% Chlorhexidine in Madagascar

Neonatal infections are estimated to account for over one million newborn deaths annually, almost half of which happen in Africa. Community-based trials in Asia applying a 4% chlorhexidine (4% CHX) to the umbilical cord showed reduction in newborn death by 23% and a three-quarters reduction in serious umbilical infections. Effectiveness trials to generate evidence in Africa are underway in Tanzania and Zambia and are expected to be completed in 2014. However, if 4% CHX is found effective based on these studies, uncertainties about efficient product delivery channels, consumer product preference, and policy and local production capacities are likely to delay operational application. Such delay in evidence translation to policy and action is not uncommon. This project's objective is to understand the supply and demand dynamics of 4% CHX in Madagascar to provide policy makers and program implementers with timely evidence-based tools to accelerate progress in newborn health. PSI and PATH propose to conduct formative research to: 1) understand urban and rural consumers and providers cord care practices, and product formulation and packaging preferences; 2) explore consumer willingness to pay; and 3) investigate the policy context and local production capacity. The innovation of this proposed exploratory work is its ability to understand the supply and demand dynamics using market-based approaches, and to position them to shorten the time to operational use of 4% CHX - avoiding delays in rendering benefit to consumers. The results of this project are expected to facilitate rapid adoption in other African countries.