Health product access and use maintained as social marketing organization transitions toward sustainability

A survey for the Nepal CRS Company (CRS), a Nepalese social marketing organization and key USAID partner, indicates that they are well positioned to operate independently of donor support, without sacrificing public health goals. The endline knowledge, attitudes, and practices (KAP) survey evaluated the effectiveness of CRS’s provision of family planning and child health products. The findings highlight CRS’s successful transition toward sustainability while maintaining product access and use.

Balancing financial sustainability and impact

CRS leads the USAID-funded Ghar Ghar Maa Swasthya (GGMS) project, which aims to increase access to family planning and child health products through marketing and distribution. Since 2017, SHOPS Plus has supported CRS to implement several financial sustainability measures as they prepare for a withdrawal of USAID funding when the GGMS project ends in April 2021. Specifically, CRS has focused on improving operational efficiencies, and increasing cost recovery, while remaining a leading provider of family planning and child health products. Examples include:

  • Implementing incremental price increases on key health products based on regular price reviews
  • Developing and following a product procurement plan based on evidence-based forecasting of product needs and sales
  • Rationalizing product distribution, including tailoring distribution strategies to specific geographic areas
  • Limiting new outlet openings to areas of greatest need based on identified market gaps; and
  • Focusing promotion efforts on products that have market competition and tailoring materials and messaging to the population segments most likely to use the product.
A SHOPS Plus data collector interviews a woman for the endline KAP survey
A SHOPS Plus data collector interviews a woman for the endline KAP survey


Recognizing the tradeoff between sustainability and ensuring product access, SHOPS Plus and CRS aimed to carefully balance the two objectives. A key aspect of SHOPS Plus’s mandate is to work with CRS to generate, and use, data to inform decision making. To support this mandate, SHOPS Plus collaborated with CRS on a baseline KAP survey in 2018, followed by an endline KAP survey in 2020, to understand if health product access and use changed in GGMS areas.

Endline demonstrated that CRS maintained health product access and use

The endline survey found that access and use were maintained, and in some cases even improved between 2018 and 2020. For instance, the modern contraceptive prevalence rate (mCPR) increased from 40 to 45 percent among married women in GGMS areas. Perceived access to short-acting methods also increased, as well as perceived availability and affordability of zinc for childhood diarrhea. These findings suggest that CRS has adequately balanced its goals of preparing to graduate from donor funding and avoiding negative impacts to the market.

A more detailed summary of KAP endline findings is accessible here. Additional information on how CRS and SHOPS Plus used baseline KAP findings to inform the evidence-based RAI curriculum is available here.




Sustaining Health Outcomes through the Private Sector (SHOPS) Plus is a five-year cooperative agreement (AID-OAA-A-15-00067) funded by the United States Agency for International Development (USAID). This website is made possible by the generous support of the American people through USAID. The information provided on this website is not official U.S. government information and does not represent the views or positions of USAID or the U.S. government.

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