Total Market Approach Compendium

A total market approach (TMA) is a lens or process for developing strategies that increase access to priority health products and services. The TMA takes into account free, subsidized, and commercial delivery methods for a more sustainable approach that seeks to increase access for all segments of a population. This compendium brings together tools and resources that can be used to help understand new ways of engaging country counterparts to support TMA efforts.

Targeted Marketing Strategies

Cases in Public Health Communication and Marketing Journal. Volume 8 – "The Total Market Approach"
This issue of the journal focuses entirely on case studies related to the total market approach internationally. 

Condom Social Marketing in Sub-Saharan Africa and the Total Market Approach
Social marketing interventions are important in developing nations. Both increasing use and shifting users from receiving subsidized condoms need to be pursued using a total market approach. This paper reviews the performance of social marketing through a cross-country comparison of condom use, equity, and market share, plus a case study illustrating how TMA can be applied.

Social Marketing: Leveraging the Private Sector to Improve Contraceptive Access, Choice, and Use
This family planning high impact practices brief overviews how social marketing supports distribution of a wide range of contraceptive methods and the promotion of healthy family planning behaviors. The brief explains what social marketing is and why it is important with short examples from Myanmar and India to highlight two of the three models discussed.

Social Marketing Models for Product-Based Reproductive Health Programs: A Comparative Analysis
This document provides a comparative analysis of product-based social marketing approaches, specifically, the so-called non-governmental organization and manufacturer’s models and increasingly common variations of these models. The analysis is followed by context-specific design guidelines for donors and implementing organizations.

A Total Market Approach for Condoms in Myanmar: the Need for the Private, Public and Socially Marketed Sectors to Work Together for a Sustainable Condom Market for HIV Prevention 
This article presents data on the size and composition of the Myanmar condom market, identifies inefficiencies and recommends methods for better targeting public safety.   

Tools

Healthy Markets for Global Health: A Market Shaping Primer
This market shaping primer presents the state of the practice by identifying noteworthy achievements across products and markets. The primer is intended as a starting point for ideas that can be further developed and applied.

Market Segmentation Primer
The Reproductive Health Supplies Coalition Market Development Approaches Working Group conceived of this market segmentation primer to endorse the importance of market segmentation to overall market growth. The primer serves the following purposes: (1) introduce the purpose, theory, process, and approaches for segmenting markets to increase family planning (FP) market efficiency and equity, (2) make the case for using market segmentation to expand access to and affordability of modern contraception, (3) provide all stakeholders—policymakers, public and for-profit providers, manufacturers, distributors, donors, program implementers and contractors, and NGOs—with a common set definitions and sources, (4) collect in a single place reference materials, websites, and data to facilitate use of market segmentation approaches in diverse country settings.

Total Market Approach eLearning Course
The course guides USAID missions and other entities seeking to assist governments on how to use the total market approach concept to maximize resource use, increase access to priority health goods, and improve sustainability. Although this course focuses exclusively on health products, it is important to note that stakeholders can apply the total market approach beyond products to health information and service delivery.  

A Total Market Approach to Family Planning Services
This elearning course complements a Total Market Approach by applying the basic total market concept to  family planning services.

Stewardship and Policy Process

Developing Total Market Strategies for Family Planning in Nicaragua: Enhancing Public-Private Coordination for Equity and Sustainability 
In 2009, PATH worked in Nicaragua to expand civil society engagement in the government-led contraceptive security group; secured a public commitment from the Ministry of Health in 2010 to increase coordination with all sectors; and assembled evidence to help promote changes and facilitate a collaborative planning process with the private sector to support family planning. This case study highlights lessons learned and recommendations for those considering similar initiatives in other settings.

Market Development Approaches Scoping Report
This paper provides the Reproductive Health Supplies Coalition with an overview of market development approaches and an analysis of lessons learned with key gaps and priorities identified. More broadly, the document is a tool for donors, governments, and implementers to learn about market development approaches and begin thinking of options and issues to encourage, design, implement, manage, and evaluate them. Complementing the document is a web-based guide, which provides overview text and links to key documents, examples, tools and other resources. 
 
Policy Advocacy for Total Market Approaches for Family Planning
In May 2014, the United Nations Population Fund, the Eastern Europe and Central Asia Regional Office (EECARO), and PATH organized a second regional workshop in Antalya, Turkey. The workshop supported participants in the development of advocacy strategies and brought together resources to aid in the introduction, support, and scale-up of total market approaches to address inequities in access to sexual and reproductive health in the region. This report summarizes and highlights key takeaways from the workshop. 

Road-Mapping a Total Market Approach
The United Nations Population Fund, EECARO and the International Planned Parenthood Federation European Network regional office conducted a meeting in June 2012 to bring attention to gaps, priorities, and measures for client-oriented RHCS strategy in middle income countries. The workshop jump started a "road-mapping" implementation of a total market approach in the region with 19 country teams developing action plans in the course of the workshop. The workshop enabled countries with previous experience with components of a total market approach to examine gaps and move forward quickly to develop an integrated plan.

Road-Mapping a Total Market Approach for Family Planning and Reproductive Health Commodity Security
In order to introduce sustainable financing mechanisms, such as total market approaches, and to mobilize government prioritization of funding for vulnerable populations, the United Nations Population fund and EECARO initiated activities for road-mapping implementation of total market approaches in the region. After several consultations during 2012 and analysis of 2013 online survey findings, EECARO and PATH developed materials for regional workshops. These activities and workshops were funded by the United Nations Population Fund Global Program to Enhance Reproductive Health Commodity Security.

Stakeholder Perceptions of a Total Market Approach to Family Planning in Nicaragua
This paper assesses private-sector stakeholders' and donors' perceptions of a total market approach to family planning in Nicaragua in the context of decreased funding. It builds evidence for potential strategies and mechanisms for a total market approach implementation (including public-private partnerships) and identifies information gaps and future priorities for related research and advocacy. 

Assessments

Bangladesh Contraceptive Market Segmentation Analysis: Final Report
Segmentation of the contraceptive market in Bangladesh already exists with the public and private sectors playing crucial roles. Using the Demographic Health Survey data to highlight each sector’s efforts to reach contraceptive users, this report will help guide policymakers and other stakeholders in resource allocation decisions. Analysis of the users by income, region, and other characteristics has helped determine which methods are being used, by whom, and from which source. Opportunities have been identified that will help both the public and private sectors focus their attention on potential and existing clients. This report is the first step in the consultative process. The second step, a workshop in Bangladesh for donors and stakeholders, will be to develop policy to maintain market segmentation.

Benin Private Health Sector Census
The SHOPS private sector census was the first attempt to comprehensively capture the size and geographic distribution of the private health sector in the entire country. The maps created by this exercise and the information obtained from private facility owners and providers can be used by key stakeholders, including the Ministry of Health, USAID, and private provider associations, to inform key policy and programmatic decisions. The resulting maps showing geographic distribution of private facilities enable stakeholders to see where private facilities are located in relation to the population, and identify potential gaps in coverage. Additional district level maps and analyses can further pinpoint service delivery gaps and identify areas where increased efforts to engage the private sector may be warranted.

Census of Private Health Facilities in Nigeria
This census of six Nigerian states assesses the private health sector’s capacity, geographic distribution, and services offered. It reveals that private facilities are overwhelmingly concentrated in Lagos and that existing lists of private facilities are inaccurate. The findings indicate that private facilities may have excess capacity to deliver family planning services.

Census of Private Health Facilities and Providers in Malawi
This is a poster overviewing the census of private health facilities and providers conducted in Malawi. Objectives of the census are to determine the total number of private health facilities, the services and products they offer, and their geographic distribution; and, identify the key characteristics of private health providers, the main barriers to expanding private health, businesses, and top clinical and supporting trainings desired by providers.

Developing a Total Market Plan for Family Planning in Vietnam: An Innovative Public and Private Collaboration to Enhance Equity and Sustainability
In 2012, PATH helped the Vietnam government plan a pilot program to compare different mechanisms to protect vulnerable populations within the context of new fees, and to advocate for the eventual inclusion of family planning in the national health insurance program. This case study highlights lessons learned and recommendations for those considering similar initiatives in other settings.

Malawi Private Health Sector Mapping Report
The SHOPS project undertook a private provider mapping exercise to describe the size, scope, and geographic distribution of private health providers in Malawi. As part of the mapping, SHOPS collected data on provider characteristics and services offered, and asked providers to identify obstacles to expanding their businesses. This report is based on information collected from 763 facilities (including 94 pharmacies) and 2,492 providers and includes maps conveying information about different types of private facilities.

Total Market Approach in Six African Countries: Case Studies
Between November 2012 and November 2013, Population Services International completed six total market approach case studies with support from two independent researchers. The countries selected were Botswana, Lesotho, Mali, South Africa, Swaziland, and Uganda--all of which have large condom social marketing programs, are affected by HIV, and have high maternal morbidity and mortality relative to their economic development. The United Nations Population Fund sponsored the research. The case studies describe the market for male condoms in each of the six African countries, and the roles of the public, social marketing, and commercial sectors in those markets. They illustrate the universal need for condoms, levels of use, socioeconomic equity among users, and the market presence of condoms for reproductive health and HIV prevention (dual protection). They also propose a set of recommendations for improving the effectiveness, efficiency, and sustainability of condom markets. 

Metrics

Measuring the Total Condom Market in Caribbean: Insights and Findings from the CARISMA Programme
This report is a synthesis study of key findings from the Total Condom component of the CARISMA (CARISMA) programme over two phases, cumulatively from 2005-2012. The aim of the programme was to use social marketing techniques to create demand, widen access and promote HIV prevention behavior, including condom use, through growing the total condom market. In its second phase, CARISMA expanded to social marketing for family planning, addressing stigma and discrimination, increasing access to sexual and reproductive health services with a focus on sexual and reproductive health rights. 

Health Financing Strategies

Contracting Reproductive Health Services in Rural Tanzania
This health financing case study describes the contracting model that operated between Marie Stopes Tanzania and 13 local government authorities from 2005-2011. The program was envisioned with dual objectives: first, to increase access to comprehensive maternal, newborn, child, and HIV and AIDS services in remote areas; and second, to design and implement a public-private partnership model of cooperation between a non-state health provider and decentralized local government authorities. This contracting experience provides an interesting example of how donors can support national governments and non-state actors like MSI to pilot new partnerships for the benefit of the population.

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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.