Market assessment of family planning products and services in Poland

OVERVIEW
CARE and Women Refugee Commission, with a local partner, will undertake a landscape assessment to inform stakeholders and develop recommendations on how Cash and Voucher Assistance (CVA) can be used to improve access to and uptake of family planning (FP) among Ukrainian refugees in Poland. The assessment will also contribute to understanding how family planning (FP) goods and services may be considered in the Minimum Expenditure Basket (MEB), which informs the design of Multipurpose Cash Assistance (MPCA), as well as how “top-up” CVA transfers via referrals from sexual and reproductive health (SRH) service providers may be needed to adequately address the critical FP needs of refugee women and girls and host communities.

INTRODUCTION
Women and girls face a greater risk of unintended pregnancy during a humanitarian crisis when access to FP services is limited. Cash and voucher assistance (CVA) in humanitarian settings has demonstrated improvements in accessing healthcare; however, contextual factors need to be considered to guide effective design and implementation of CVA to improve access to FP and strengthen SRH outcomes. This assignment is a part of a larger study and it aims to conduct a market assessment of FP services and supplies including their associated costs, availability, accessibility, and quality in areas serving Ukrainian refugees, using and adapting established assessment tools to measure these factors. In the scope of this study, family planning is understood as contraceptive methods available in Poland, including emergency contraception.

BACKGROUND
SRH services, including FP, are lifesaving and the standard of care in crisis-affected settings. The Minimum Initial Service Package (MISP) for SRH—the global standard for SRH response in acute emergencies—includes the prevention of unintended pregnancies as one of six objectives. People affected by crises want and need access to FP, but FP services in crisis-affected settings remain limited and uneven. To meet the SRH needs and fulfil the rights of displaced women and girls of reproductive age, it is critical to strengthen FP services and pilot innovative approaches to improving FP access and availability.

Since the military conflict began in Ukraine in February 2022, more than 9 million people crossed the border from Ukraine to Poland, and over 1.5 million are currently registered in Poland. An estimated 18 million people will be affected by the crisis. In host countries, refugee women and girls, including adolescents and those with disabilities, are facing critical unmet SRH needs and barriers—including financial barriers to access. Prior to the crisis, birth rates among Ukrainian women were low, averaging 1.2 births, 5 suggesting that the ongoing need for FP services among refugees is likely to be high. The need for FP access is further heightened in Poland, where most FP methods are contingent on prescription, while access to safe abortion care is legally restricted.

While health services are often intended to be available free of cost in humanitarian settings, experiences from past crises show that, in reality, refugees often face many structural issues in their host countries. These include being unable to access services because of proof of ID, language barriers and complications navigating the healthcare system and, perhaps more importantly, financial barriers. Financial barriers to access services can be particularly challenging for refugees to overcome as they are often restricted in how, where, and when they can work. This may include costs related to transportation and child-care, as well as costs related to obtaining services through alternative pathways, like pharmacies and other private sector outlets, while national health systems adjust to rapid increases in demand. Restrictive policy environments for SRH, as found in Poland in particular, can compound the financial barriers to accessing services. For example, a prescription is required to access emergency contraception (EC) and most other FP methods in Poland, which necessitates travel to a doctor to obtain a prescription, to a pharmacy to pick it up, and back home – all within the short timeframe in which EC can be used effectively to prevent unintended pregnancy.

OBJECTIVES OF THE CONSULTANCY
The objective of the consultancy is to conduct a market assessment in the target sites (Warsaw and Przemyśl) of Family Planning services and supplies, including their associated costs (direct and indirect) and their availability, accessibility and quality. The market assessment will focus on the national health care system, the private health care sector (including pharmacies, drug shops, health care service providers) and local and international NGO providing humanitarian medical care. It will also assess their supply capacity to increase services if a CVA-SRH intervention were to increase demand for services.

METHODOLOGY, DELIVERABLES AND TIMELINE:

1. METHODOLOGY
The consultant will hold a kick-off meeting with CARE and WRC, then conduct initial scoping interviews with the main stakeholders. This will be followed by other interviews with the inter-sector coordination group members (health sector coordinators, protection sector coordinators and CWG coordinators) to further collect background information on the family planning markets and barriers faced by vulnerable populations in Poland. The study will comprise several stages as listed below:

• a. Information gathering: The consultant will gather secondary information on FP in Poland by collecting published studies, articles, reports, revising databases available, and through stakeholders interviews. Then they will produce an inception report containing the following elements (i) secondary findings detailing the FP market environment (size, actors, products and services) at the national level and in the focus locations; (ii) a list of FP products and services available in Poland; (iii) a list of key informants of FP providers to participate in the study, for example: manufacturers, distributors, warehouse agents, facility managers, and service providers; and (iv) a plan and timeline for the primary data collection.
• b. Market Assessment tool preparation. The consultant will be responsible for: (i) defining statistically relevant sample size of FP providers to be assessed on both sites, define and validate the scope of the market assessment articulating the methodology and limitations; (ii) defining key indicators that survey should track and analyze including market size, accessibility, market sustainability, quality, and market equity; (iii) prepare the relevant tools (e.g. questionnaires, key informant interviews for quantitative and qualitative interviews) for primary data collection, using/adapting existing assessment tools where feasible; (iv) present the tools to the country team, local partner (FEDERA), CARE USA, and WRC for their review and approval
• c. Lead the market assessment : once tools are finalised, the consultant will be responsible for (i) hiring and training the data collectors (to be approved by the country team); (ii) lead them during the data collection; (iii) collect and organize the data.
• d. Data analysis and report production. The consultant will be responsible for (i) data analysis; (ii) provide a first draft report in English and presentation enabling feedback questions and comments from country team, local partner (FEDERA), CARE USA, and WRC; (iii) review and integrate the comments providing a comprehensive final report using an agreed template.

2. DELIVERABLES
The final timeline of the assessment will be finalized by the research consultant(s) in consultation with CARE. Indicative phases and their duration below. Expected deliverables (TOTAL 40 days):

• Inception report Report is based on the scoping interviews with key stakeholders – CARE, WRC, inter-agency members and collection and review of initial (secondary) documents (5 days)
• Draft survey and KII guides: KII Survey and guides for CARE and WRC feedback and finalisation (7 days)
• Train enumerators: Consultant will train enumerators with oversight from WRC (1 day)
• Conduct study: Administer and coordinate primary data collection, clean /analyse datasets and write KIIs report (15 days)
• Preliminary findings workshop: Present and facilitate workshop to collect feedback for final report (5 days)
• Write and finalize final report: Produce final report (7 days)

● Inception report: This report will outline secondary information collected on the subject and on the consultant’s proposed methodology to gather primary data and a detailed work plan to complete the entire exercise.

● Market assessment survey and KII guides: The consultant will develop the market assessment tools by either contextualising materials from CalP Network and Market in Crises online repository or developing their own within the allocated time frame. The tools will be shared with the project focal points for feedback.

● Preliminary findings and workshop presentation: The consultant will organise an online workshop to present the preliminary findings of primary data collection. The objective of the workshop is for CARE and WRC to review the collected data sets and provide feedback on the finalisation of the study.

● The Final Report: The final report is presented in a 20-30 pages report, before appendices. The main body of the report will contain an executive summary of at most three pages. All data collection tools must be included as annexes. The final report should incorporate specific and feasible recommendations for improving access and supply of Family Planning services to the vulnerable groups as outlined in the TOR. The information should include users and potential users of FP split into sub-groups (market segments) with similar characteristics or product needs. The segmentation can be based on resident status, socio-demographic and economic characteristics. Information about each segment (e.g., their willingness to pay for products and services – including price threshold, preference for specific distribution outlets, and
preference for specific FP products or services) should be clearly outlined.

● Raw data: A copy of raw data (every survey response to every question) should be provided separately with final study in an excel format. A copy/summary of the cleaned data set will be included in the final report following the methodology, as outlined above in the annex section.

3. TIMELINE
The total expected duration to complete the assignment is 40 days. The consultancy is expected to start on April 1st.

MANAGEMENT AND SUPERVISION
The consultant will work and report primarily to CARE’s technical lead at country level and secondary to CARE and WRC technical advisors. The selected consultant(s) will be required to comply with CARE’s processes and in particular to follow CARE’s safeguarding policy or equivalent.

QUALIFICATIONS DESIRABLE
(a) Training and experience:

• Master’s Degree in social sciences, public health, international development or similar.
• Minimum five (5) years of experience in the areas of market assessment and family planning, humanitarian assistance, or international development, and report writing.
• Demonstrated experience in healthcare and pharmaceutical market analysis.

(b) Skills:

• Ability to develop high quality, structured, evidence based reports
• Good interpersonal and communication skills.
• Ability to collect, organise, analyze, distil and document significant amounts of information and process steps.
• Familiarity with the ways of working of humanitarian organisations (INGOs, NGOs and civil society organisations), government actors, UN agencies and the private sector.
• Personal commitment, effectiveness and commitment to results.
• Ability to manage multiple tasks while meeting strict deadlines.
• Ability to work in English.

Preferences :

• Prior experience in conducting market analysis for the design of humanitarian responses
• Proven statistical analytic and econometric skills
• Understanding of the family planning services in Poland