Safe
Water System Manual
6.0
Decide on methods of distribution
Tasks:
The
project will need to make water disinfectant and safe storage vessels available
and easily accessible to target households. This will require procurement, storage
and distribution of both products.
Factors
to remember when planning for distribution are:
•
What geographical area will be covered?
•
What systems or infrastructures for distribution already exist?
The most common
options for distribution are:
A.
government systems
B.
non-government systems
C.
commercial sector
D.
social marketing
These
systems may be used singly or in combination. Whatever system or systems are selected,
education and promotional activities are also necessary to create demand for the
products and ensure that households know how to use them correctly. Planning a
strategy for behavior change is described in section 7.0.
The system of distribution and the behavior change methods must be planned to
work together.
Similar
steps are involved to plan and implement a project through any system:
•
procure products
•
establish price
•
plan distribution through recognized, reputable and convenient sites
•
work out logistics of transportation and distribution
•
prepare educational materials
•
train or inform staff at outlets
•
manage flow of products and money
•
plan for emergency response
•
evaluate
6.1
Consider possible methods of distribution including existing systems or infrastructures
A.
Government Systems
Distribution
can be organized through government systems in one or more different ways:
•
adding distribution of Safe Water System products onto a distribution infrastructure
that is already in place, for example, for supplying government health centers
• an
`ad hoc' approach using government vehicles to deliver products from central government
stores to more peripheral government offices, health centers or other outlets
• establishing
a separate distribution system specifically for water vessels or disinfectant
or both Government distribution systems can usually distribute large volumes of
supplies rapidly and into distant areas that are underserved. However, they require
functioning vehicles and staff. Some governments may not have financial and management
resources to maintain them. Using a government system for distribution of Safe
Water System products may divert resources from other health service activities
and may not be as sustainable as private sector distribution.
In
Ecuador, a project was initiated by PAHO in response to flooding from El Nino
with funding from the Embassy of the Netherlands. Sodium hypochlorite production
sites were located in clinics run by the Ministry of Public Health.5
The disinfectant solution was distributed to local neighborhoods by Ministry of
Public Health personnel. Additional funding was provided by USAID. This project
was later incorporated into the Ministry of Public Health as a funded program.
Now street vendors are receiving training in the use of this method and are preparing
food and drinks with safe water, which enables them to be accredited by the Ministry
of Health. This method was also used to provide safe water to victims of recent
volcano eruptions.
B.
Non-government Organization (NGO) Systems
Non-government
organization (NGO) systems may approach distribution in one of two ways:
•
NGOs implementing a Safe Water System project may organize their own distribution
system.
•
NGOs that focus on distribution activities, for example supply of essential drugs,
may distribute Safe Water System products.
A
distribution system organized by an NGO for its own project may work well but
may be expensive and unsustainable when donor support is discontinued. If the
NGO is small, it may be limited to a small geographical area.
Relying
on a larger NGO, such as CARE or PSI, has the advantage of using existing distribution
structures and may be more credible and sustainable. This approach requires obtaining
permission from the appropriate authorities to distribute Safe Water System products
and finding a way to cover distribution costs. Sustainability of the project depends
on the sustainability of the NGO. In Western Kenya, CARE used this approach.
CARE distributed water disinfection products to villages in its Water and Sanitation
for Health Project, using community volunteers as distribution agents. CARE also
incorporated an element of social marketing into this project (see below).
Distribution through
a combination of government and NGO systems is a common traditional approach
for distribution of health products. Products are given away or sold through NGO
clinics, government health centers and health posts, private or public pharmacies,
etc.
The
advantage of a traditional distribution system is that it may reach some individuals
who may not be served by commercial channels. It also ensures lower initial costs
than private sector approaches.
In
Peru, the Panamerican Center for Sanitary Engineering and Environmental Sciences
(CEPIS—an office of PAHO), ADRA (a 7th Day Adventist-supported
NGO), and the Ministry of Health joined together in a GTZ - funded project to
provide their unique version of the Safe Water System to communities in 5 regions
of the country.7 Distribution was organized by committees elected by
community members.
C.
Commercial Sector
Commercial
sector distribution involves distributing vessels and disinfectant through existing
commercial distribution systems and retail outlets. In most areas there are large
or small established companies that can capably manufacture a product. They can
also distribute the product through commercial channels that are appropriate for
a locality. When the private sector makes a product widely available and prominent,
people use it. This approach requires a market of consumers with sufficient demand
for the products or a demand-creation campaign. Product prices must be low enough
to be affordable and high enough to include sufficient profit margin to motivate
distributors. Use of a commercial sector arrangement is generally sustainable.
If a project
chooses to work with the private sector for distribution, it is important to arrange
an agreement from the outset so that private companies do not price the product
above the reach of the target population.
In
Zambia and Madagascar, the commercial sector was used by PSI who sold the
products to commercial wholesalers for distribution through retail outlets.11,12
PSI also used social-marketing methods (see below) to increase demand for and
promote correct use of the Safe Water System products.
D.
Social Marketing
Social
marketing is a particular approach to distribution and promotion. It uses commercial
marketing methods including the concepts of market segmentation, consumer research,
and communication to create demand for a product or service. The main differences
are:
•
Social marketing aims to increase the acceptability of a product or idea to meet
a social need, whereas commercial marketing aims to sell a product to maximize
profit.
•
Social marketing usually involves subsidy in pricing a product, or of its distribution
or promotion, whereas commercial marketing involves no subsidy.
Social marketing
is based on research into what potential users know, want and do, and makes use
of the best mix of existing channels of communication to give simple, repeated
and attractive messages. It means finding out about potential users, and considering
"positioning", in other words, what will motivate these potential users
to buy a product or use a service. Developmental testing ensures that brand name,
product images and educational messages are appropriate, understood and effective.
Social marketing
may include aspects of commercial distribution combined with incentives, subsidies,
management or advertising inputs from the public sector or an NGO. The aim is
to support distribution systems in the short term while demand is created and
until a market is well established. Subsidizing distribution costs and/or introducing
price controls may ensure the price is kept as low as possible while providing
distributors a reasonable profit. These approaches seek to enable shops or other
outlets to sell to the community before a commercial system is established. Once
people learn about and use the products successfully, the hope is that they will
continue to want the products so significant demand will be created.
Social marketing,
like traditional marketing, involves deciding on the best mix of four factors,
sometimes called the four "P"s:
•
Product - includes decisions about brand development, quality, packaging,
logo, size and market positioning to interest the target population so they will
use the products.
•
Place - includes decisions about distribution channels and outlets for
vessels and disinfectant, and coverage.
•
Price - includes decisions about affordable prices, subsidies, credit terms
and cost recovery goals.
•
Promotion - includes decisions about communication channels, advertising,
personal selling and sales promotion, promotional materials and events.
The
four "P"s are interdependent. For example, distribution and outlets
("Place") will be linked to advertising and sales promotion ("Promotion").
Demand is affected by "Price," as well as by branding and advertising
("Product"), and by education on use and benefits ("Promotion").
"Product"
issues are discussed in sections 5.0 and 7.0,
"Place" is discussed in this section, "Price" in section 8.0,
and "Promotion" in section 7.0.
Social
marketing:
•
is expensive as it requires start-up funding, marketing expertise, and training
for outlet managers and sales agents.
•
may focus on urban and periurban populations and may miss rural or marginalized
populations.
•
can be very effective, combining the advantages of private sector marketing with
knowledge and experience of traditional health care delivery.
•
generates enthusiasm about a product.
•
includes a system of distribution that ensures the product is accessible and sells
at a low price (not free) so the product will be valued and used.
An important balance
to achieve in social marketing projects is that between coverage (health impact)
and cost recovery (financial sustainability).
Alternatively,
if financial support is more limited, elements of the social marketing approach
could be used in other types of distribution systems. For example, a project could
use consumer research to develop a product brand and advertising for disinfectant
that could be distributed and promoted through a government or NGO system of outlets.
In
Homa Bay, Kenya, CARE hired a social marketing consultant to help market disinfectant
and safe storage practices to populations in rural Western Kenya (social marketing).
The products were distributed by community health workers (government system)
and sold in local stores (commercial sector) as well as in clinics and hospitals
run by the Ministry of Health.
As
the examples in this section show, existing Safe Water System projects use more
than one distribution system. Any project would be wise to explore all potential
distribution options. Different options offer unique advantages, and the likelihood
of project sustainability and success is enhanced by having many different types
of distribution outlets.
6.2
Assess alternate distribution methods for the project
Consider
the possible distribution systems (government, NGO, commercial and social marketing)
and focus on those which seem most appropriate. Investigate community structures
that could be involved in implementation. Then list some possible methods in each
system. For example, in the government system, specific methods could include
distribution by health centers and health posts. In the NGO system, specific methods
could include sale of products to consumers at the clinics of a particular NGO,
or distribution of the products by an NGO that distributes food and agricultural
goods to villages. In the commercial sector, the products could be distributed
through an existing network of pharmacies, or a bleach manufacturer could market
them in small retail shops. Another option would be for a commercial company or
an NGO to establish a network of door-to-door sales persons who are paid a small
incentive for sales of the product.
In
reality, no one model will be used exclusively. A mix is typical, as exemplified
in Madagascar, where the project used social marketing, government certification
of the products, NGO-sponsored community mobilization, and commercial sector distribution.
In both Ecuador and Peru, a combination of NGO and government distribution
systems was used.
To
assess possible distribution methods for the project, use a worksheet such as
the one on the next page to help you make a systematic comparison of the options.
There is a blank copy of this worksheet in Annex D.
Possible criteria for assessing and comparing options are written across the top
of the table.
In
the left column, list possible distribution methods. Then assess each according
to these criteria and any additional criteria that you want to add. The example
on the next page shows how the worksheet was completed by some planners considering
four particular options in their area.
Figure
7: Example Worksheet to Assess Possible Distribution Methods
| Possible
Distribution Methods | Project
cost | Demand
creation | Product
recognition | Effectiveness
of distribution | Accessibility
of product for consumers | Product
price | Control
over product price | Potential
for sustainability |
| Government
& NGO combination - adding onto existing distribution system for NGO
clinics, government health centers, health posts |
Lower |
Low |
Low |
Good - may reach underserved areas |
High where government and NGOs work |
Lowest |
High |
Moderate
to low |
|
NGO - establishing new NGO-sponsored
network of outlets for distribution of vessels and disinfectant |
High |
Moderate |
Moderate |
Depends on number and placement of outlets |
Depends on number and placement of outlets |
Medium to high
may be low if NGO subsidizes price |
High |
Low |
|
Commercial Sector - using network of established
pharmacies, shops for household items |
High to moderate |
High |
High |
Good but may not reach underserved |
Low |
High |
Low |
Moderate
to high |
|
Social Marketing -- health
centers and shops provided with marketing materials; door-to-door sales |
High |
High |
High |
Good, but may not reach
some underserved populations, especially in rural areas |
Will require special targeting
to ensure that at-risk populations have access |
Low |
High |
Moderate
to High |
Though
the final choice will probably be a mix of systems, the worksheet will help make
apparent the strengths and weaknesses of each method. An important consideration
will be whether a method will use an established infrastructure (such as government
health centers) or the system will need to be developed (such as door-to-door
sales persons). Development of any new system requires considerable planning,
resources and effort.
6.3
Select methods of distribution and plan them in more detail
Select a method
or combination of methods that will be able to best achieve project objectives
within the budget. Then plan the methods in more detail, that is, plan for actual
distribution sites and persons who will sell vessels and disinfectant. For example,
specify names of health centers, pharmacies and shops, and plan how to identify
and train door-to-door sales people.
Lack
of community support and poor communication between a project management committee
and the community are common reasons for project failure. Careful planning with
community representatives can help. Identify common goals and address issues where
there are differences in views as early as possible. Identify key people who could
be involved in the project and develop their roles with them.
It
may be helpful for project planners to interview prospective distributors about
characteristics of their system, such as:
•
distribution area
•
site of population covered
•
type of outlets
•
number of outlets
•
other products distributed
•
distribution costs
•
frequency of distribution
•
distribution capacity (i.e., number of vehicles, number of units of product they
can carry in a given period of time)
•
do they have issues with product exclusivity
Caution:
The project must pay close attention to distribution. Insufficient follow-up
after initial distribution in one project led to failures in some regions. Also,
the project grew too large for the capacity of the implementing agency to fill
demand. Households obtained initial supplies but when the disinfectant was used
up, they were unable to replace it. The education campaign was too short to persuade
the target population of the relationship between the consumption of contaminated
water and diarrhea.
