In order to ensure appropriate use of our products, Merck works closely with our customers to develop and assist in the implementation of a framework for quality service provision and related support.

For family planning programs in the developing world involving Merck's contraceptive implant, IMPLANON (etonogestrel implant), Merck requires that recipient governments and partnering NGOs sign a Cooperation Agreement for the Receipt and Use of Implanon. The cooperation agreement includes:

• Merck's commitment to a comprehensive service approach that provides and/or supports the provision of capacity building in service delivery, including pre- and post-insertion counseling and insertion/removal training
• Distribution requirements that must be met by Merck and local partners to ensure that all clinics/providers meet training and quality assurance requirements, offer sustained provision of services over the duration of the product's life (3 years), and can access referral centers in case more specialized care related to Implanon is required
• Merck's commitment to fully fund all costs related to Training of Trainers and provision of training materials including audiovisual materials, training kits, artificial arm models, placebos, etc. Merck may provide additional technical and financial assistance for direct training activities of healthcare providers on a case-by-case basis
• Procedures to report product complaints and adverse events
• Provisions regarding compliance with U.S. and recipient country applicable laws, and Merck's ethical and business compliance policies

Partnering for Implementation

In the countries where Merck products are included in family planning programs, we work closely with Ministries of Health and local implementing partners who play a pivotal role in supporting training, counseling and other related activities. Some of our local implementing partners have included: JHPIEGO, EngenderHealth, Marie Stopes International, International Planned Parenthood Federation, Population Services International, Pathfinder International, etc. Such collaboration ensures that, in addition to existing Merck staff, countries have the on-the-ground expertise they need to achieve their reproductive health objectives.

In 2010, we worked with over 15 countries in sub-Saharan Africa, Asia and Central America to provide contraceptive products through numerous partnerships with governments, donors and NGOs. Some of the countries where Merck's Institutional Family Planning services had partnerships in 2010 include Madagascar, Ethiopia, Kenya, Uganda, Tanzania, Nigeria, Bangladesh and Cambodia.

As part of our capacity building and training commitment, Merck, governments and/or local implementing partners trained more than 5,000 healthcare providers in sub-Saharan Africa, Asia and Central America in 2010. Merck also trained and/or provided medical education to many healthcare providers around the world.