Implementation Resourcing

Recommended Approach To Launching

V LITE RECOMMENDATIONS

Every intervention in the V Experience was designed to supplement and build off each other, we recognize that in situations, one can not move forward with all interventions. We do not recommend ignoring a strategic pillar entirely but rather choosing at least one one element from each pillar to implement. We have highlighted our recommended focus areas throughout this guide.

CENTRALIZED COORDINATION AND MANUFACTURING OF STARTER KITS

The most efficient, cost effective way to produce and distribute the V Starter Kits is to pool funding and create a centralized regional hub/coordinator. This takes the work off the already overloaded clinics—ideally, they could simply order kits and printed materials through this hub. Partner with an entity (or create one) that is willing be the single coordinator for manufacturing and other partnerships (e.g. local pharmacy networks, Department of Health and clinic relationships, insurance companies, loyalty program partners and health and beauty brands).

Consider partnering with a pharmaceutical company already producing PrEP or large consumer-goods company with a corporate social responsibility budget. They can leverage their own supply and logistics capabilities and use their existing distribution channels. They may also be able to achieve greater economies of scale through volume savings, and more easily scale up manufacturing of materials, kits and marketing collateral.

EXPLORE INNOVATIVE FORMS OF FUNDNG LIKE PRIVATE SECTOR PARTNERSHIPS OR SOCIAL ENTREPRENEURSHIP MODELS

Private-sector organizations, such as retail pharmacies and popular health and beauty brands, are already well set-up to execute these recommendations. And they almost universally want to help. But these organizations have typically invested many years and many millions of dollars into building brand equity that they can’t afford to risk just for the opportunity to be charitable. This is where design of the brand of the PrEP products becomes a critical upfront investment prior to launch. Avoid typical medical messaging, packaging and aesthetics, and take design cues from the types of organizations that would be helpful partners attracting young women, such as makeup and skincare companies. Flip the negative conversation about avoiding sickness into a positive one about feeling good about yourself as a young woman. Design something that coveted private sector brands actually want to be associated with, instead of just something they “should” support.

A particularly promising way of offsetting higher costs is to leverage popular business models from social entrepreneurship. At their most general, these models all charge premium prices to higher-income influencer populations and use the revenues to fund free or reduced-cost distribution to economically disadvantaged populations.

Examples of popular models include:

BUY ONE GET ONE

Most famously used by TOMS, this model sets the price of the commercial product such that each purchase funds the free distribution of the exact same product.

MATCHING FUNDS

If the price of the goods being produced is too high for a pure one-to-one model, another strategy is to use matching funds. Warby Parker, for example, donates a portion of the sale of each pair of eyeglasses to local partners that source and distribute eyewear on their behalf. Our Design Research showed that South African women find these models very appealing, and were willing to pay up to 20% more to fund PrEP products for less advantaged women in their communities.

ETHICAL CONSUMERISM

The designs for the bags and pill cases in the Starter Kit were so popular, women said they would buy them in a store. This means you could make extra and sell them commercially to subsidize the cost of setting up VPro. This would both offset the cost of the implementation and keep the bags from getting an overly medical association. You could also approach private sector lifestyle and beauty brands about creating co-branded products (like a V lipstick), where proceeds from the sale contribute to funding VPro. This is the model used by The Global Fund with PRODUCT(RED), a licensed brand that engages the private sector in raising awareness and funds to help eliminate HIV/AIDS. In exchange for the right to use the (RED) logo, companies donate 50% of the proceeds of the profits to The Global Fund. Co-branded products released by brands like Nike, Apple, Coca-Cola and MAC have raised hundreds of millions of dollars for The Global Fund using this model. When the brand looks this good, people are excited to get involved!

Financial Estimates

The costs of implementing V PRO and V LITE generally fall into three categories: things you have to make or buy (like the starter kits), services you have to buy (like advertising or paid Ambassadors), and time you have to spend (training staff, assembling kits, etc.). Since the cost of services and staff varies significantly between countries, and you know those costs better than we do, we’ve focused the financial estimates on what you need to make or buy. We suggest you go through the estimates and pick the items you are going to invest in to make your budget. Then layer in highly localized service costs like Ambassador compensation and/or stipends and advertising, or labor costs for resources you don’t have in house, to get a complete financial picture.

If you have the financial and organizational resources to take on a centralized model at scale, are looking for a robust financial and operational model for launching every part of the system from scratch, we’ve included a detailed cost model to download. It includes everything from paying clinics for additional staff time to setting up manufacturing, warehousing and third party logistics. You can adjust the assumptions tabs to your local contexts and costs, and the model will update itself accordingly. If you take on this approach, we recommend launching it in the private sector as well, and using one of the social entrepreneurship business models to offset the higher costs.

Starter Kits

All of these price estimates, with the exception of the pill case, were obtained from potential suppliers in South Africa in Rand (including VAT), and were converted to U.S. Dollars at the October 5, 2018 exchange rate of $1 USD = 14.78 Rand. We also rounded the unit numbers to the nearest five cents. The pill case estimates are from a US-based contract manufacturer that produced the first limited-scale prototype runs. Significant economies of scale can be achieved at 10,000 units and above. For the pill case, which is custom manufactured, the majority of the cost is setting up the initial tooling, so unit pricing declines dramatically with larger production runs. Depending on the manufacturing capabilities of the partner you select to produce the bags and pill carrying case, you may have to modify the designs accordingly. For some of the other items below, such as the loyalty cards, batch ordering is also an option. This would be a mid-range per unit price, but this setup allows flexibility on ordering just when you need it (for example, batches of 50,000 cost ~$0.12 per unit for a total of $6,000).

Swag

It’s easiest to order swag like t-shirts, pens, stickers and popsockets off the internet from mass customization suppliers. As such, per unit costs don’t vary quite as much with scale. You don’t have to purchase every kind of swag, just make the things that you think women in your community will like!

If you are ordering large quantities, start by requesting a quote online, by email, or phone, and speak with their sales team for different quality options on t-shirts, pens, or types of stickers. Provide a copy of visual files online or by email attachment (files are in the implementers guide in Create Demand and Initiation), and specify the requirements suppliers need to provide an accurate quote. For example, suppliers will want to know the volume to be printed or produced, the number of colors in the graphic to be printed on each piece of swag (e.g. the V logo is 2 colors), the color of the swag (e.g. black or white shirts), sizes where needed (e.g. how many small, medium, and large shirts), and the graphic print size where needed (e.g. graphic printing area on a shirt could be A4, 116” X 20” or full). Typically, supplier websites will specify what details you need to provide and sales representative can help you work out what they need for pricing. Make sure to ask for a preview of the item to be produced before confirming!

Based on how you build and motivate your Ambassador team, or need to create awareness and demand in a community, order swag quarterly, bi-annually or annually. You can save more money with larger volumes in one order, or produce just-in-time for events with one-time orders. Produce swag when you bring in new Ambassadors (e.g. give them each a shirt, popsocket, a set of stickers to provide women, and a few sets of nailwraps to use or share with women) or host events for your Ambassadors or community. You can also reward them monthly with the stickers, sockets and nailwraps based on on how many women they’re reaching out to.

Estimates below were quoted from South African suppliers in USD, and again rounded to the nearest five cents for unit costs. For the PopSockets, the current costs in South Africa are higher than average. Cheaper unit costs could likely be obtained by ordered from abroad, but shipping costs would need to be factored in.

Printed Materials

There are a number of different printed elements across different touch points of the user journey, from small printed certificates that you could make on an office printer, to saddle-binded pamphlets, to full-scale billboards. For economies of scale, we would recommend finding a local printer that could make all the elements poster-size or smaller. Ideally they could also produce the printed elements of the Starter Kit (FAQ insert and potentially the structural packaging).

Work with them to print tests of each element to check for color consistency, and adjust the print settings as needed before full production. Note that cost will vary significantly based on the quality of paper (we’ve made middle of the road estimates). Figure out how many units of each you plan to give to clinics and Ambassadors based on both local populations and the frequency with which you want to distribute (for example, visiting clinics monthly). If you work with a local advertising agency, they may be able to handle some of the printing, especially of posters and billboards.

Estimates below were quoted by South Africa/American suppliers in Rand/USD, and again rounded to the nearest five cents. Note that the unit costs do not vary with scale because they are based on batch volumes of 1000. You will likely order in smaller batches of 100-500 printed booklets, certificates etc weekly, monthly or based on just-in-time need. Posters are more expensive when printed digitally (i.e. on a large format machine versus lithograph).

Text Messaging Automation Services

For managing text reminders to V users, you have two options. If your technical capabilities and/or scale are limited, you can work with a service provider similar to Simple Texting or Textedly that offer an off-the-shelf service to manage SMS text automation. Alternatively, you could hire a local software developer to build a simple custom platform that leverages the Twilio API for either global SMS or WhatsApp. The latter allows more freedom, customization and privacy control, and takes advantage of the popularity and low cost of WhatsApp, but does requires technical knowledge and/or a software developer to help implement.

Costs for off-the-shelf services will depend on the amount of texts you plan to send monthly. Services provider often offer both a monthly plan and annual plan for some savings. For services like Twilio, it would include a per text cost in addition to the potential costs of a software developer. Software development can add another $10,000 - 20,000 (based on average rates for app development) to your costs based on local rates.

For budgeting purposes, consider the number of woman you want to get on the system, and assume daily or weekly texts for the first six months they are on the regimen. If you are putting pill carrying cases in the starter kits, you may be able to get away with a weekly reminder to refill the seven-pill case. In reality, have HCPs ask women their preferences for messaging frequency and timing, and adjust your budget when you start to see local trends. Note that with whatsapp custom API products, you realize greater economies of scale due to spreading out the upfront, one-time development cost.