Demand Generation for the 13 Life-saving Commodities: A Synthesis of the Evidence

This literature review analyses demand creation for the 13 under-utilised life-saving commodities for periods during pregnancy, childbirth, and early childhood that have been identified by the United Nations (UN) Commission on Life Saving Commodities for Women and Children. They include: contraceptives for family planning; medications for haemorrhaging and eclampsia during birth; resuscitation devices and medication such as steroids and antibiotics for sepsis and infection treatment and prevention in newborns; and zinc, oral rehydration salts, and antibiotics for childhood pneumonia and diarrhoea treatment.

The Commission also identified key barriers that prevent access to and use of these commodities and developed 10 recommendations to overcome these barriers, including a focus on increasing demand and utilisation. "Demand generation, or the process of creating a need, or belief in the need for, a health product or service among a particular target audience, is a persistent weakness across all priority commodities This report reviews, assesses, and synthesizes the current evidence of social and behavioral drivers of demand generation for the 13 commodities as well as effective practices in implementing demand generation programs. This review aims to provide a foundation for future demand generation activities and help other groups better understand the barriers to utilization and evidence for evidence-based programming to generate demand for these under utilized, life saving commodities.

Using the social ecological framework to guide the evidence synthesis, the review identifies facilitating factors and barriers at the individual, community, and society levels that influence the demand and uptake of life saving commodities. The literature review also examines a wide range of evidence for successful strategies to overcome barriers and generate demand for each commodity."

Recommendations include analysis at the individual, community, and societal levels:

• Individual-level demand creation includes the need to increase knowledge among health care consumers and providers (trained birth attendants, pharmacists, community health workers, and others about the commodities. "For consumers, communication messages should be tailored to different audiences (including fathers and caregivers other than mothers) and should be disseminated via all available channels to reach caregivers everywhere...." Additional research is needed to better understand and address demand for ineffective treatments. Training is needed to address provider biases that affect treatment. Providers need strengthened guidance and protocols on certain commodities and need to be included in establishing new clinical guidelines.
• Community-level barriers and demand creation need additional research on best strategies to: educate caregivers and community health workers in provision of commodities in their work with families, including quality health education; understand patient non-compliance; evaluate social marketing approaches; increase community-based access to health care; and prepare supply chains against stock-outs of the commodities.
• Societal-level facilitators for demand creation include: advocating for a supportive national and international political environment, in-country manufacturing, and respected project leadership; supporting the development and adoption of new products that may increase uptake of essential commodities; and addressing gender norms to impact a broad array of health issues through social norms and expectations of how men and women should behave in terms of prevention, care seeking, and treatment.