Total Market Approach to Family Planning
A total market approach to family planning aims to efficiently use all available public, nonprofit, and private commercial sector resources and infrastructure to improve access to family planning products and services for all clients. Ultimately, a total market approach to family planning will grow the market in a sustainable manner, ensuring that those in need of family planning can access it through varied and optimal channels: low-income clients receive free products and services, those with slightly more financial means can access partially subsidized products and services, and those with the most robust ability to pay can purchase products and services from the commercial sector.
Continue reading to learn strategies for a total market approach:
A Total Market Approach Requires Cross-Sector Knowledge-Sharing
Each country’s application of a total market approach to family planning will vary depending on the local context. In order to develop and implement a total market approach to family planning, stakeholders must effectively share data and information with each other across sectors to understand the following:
- What the market looks like from both supply and demand perspectives
- Who is currently providing products and services (and who could with the right support), where, and at what prices
- Who is currently accessing services (and who could if the right barriers were removed)
Strategies for a Total Market Approach to Family Planning
With this information, a country can apply a total market approach to ensure that the full range of financial resources—both public and private—are used to access family planning services from the full range of providers. Ideally, governments take a stewardship role of the family planning market, using data for decision making, enabling private sector participation in the family planning market, coordinating market actors, and engaging a range of stakeholders in solutions. Strategies used within a total market approach can include the following:
- Targeting subsidies so that only those who truly need them can use them.
- Contracting out family planning services to private providers to expand access to clients who live in areas underserved by public providers.
- Distributing vouchers to increase access to private facilities by subsidizing the price of health services and products for target populations.
- Increasing health insurance coverage to include family planning products and services for more people.
- Social franchising to network quality assured private clinics who can offer contraceptive products and services so that governments can more easily engage in strategic purchasing with private providers instead of contracting with each provider separately. These networks offer private providers and pharmacies training opportunities, access to commodities and advertising, and membership in an organization whose brand signals quality and affordability.
- Task sharing responsibilities, including delivery of voluntary long-acting and reversible contraceptives and permanent methods, with trained, competent lower-level cadres in order to expand access to contraceptive services.
- Public-private partnership activities, including joint public-private sector in-service trainings; referral systems so that providers in one sector can send their patients to facilities in another for services that they cannot provide; and collaboration with pharmacists and drug shop owners to increase access through non-facility-based points of care.
- Demand-creation activities, including public health campaigns to raise awareness about new, effective modern contraceptives and provide information about where they can be accessed, and public, nonprofit, and commercial advertisement of the availability of specific branded services at their facilities.
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A total market approach to family planning harnesses the resources of the entire range of health care providers—public, private (nonprofit and for-profit commercial), and donor—to ensure that all people who want family planning products and services can access them, regardless of their ability to pay.
- The total market approach uses a combination of free, subsidized, and commercial delivery methods to ensure access to the full range of high-quality contraceptive methods and services for all segments of a population.
- Greater efficiency in the market increases sustainability of family planning programs by lessening the burden on donor and government resources and enabling private-sector participation.
- Equitably meeting the diverse needs of different population segments requires coordination and knowledge-sharing across all market sectors.
- Healthy family planning markets exist when contraceptive products and services are readily available, affordable, appropriate, quality assured, and in secure supply for all segments of the population, including poor and hard-to-reach segments.
- Family planning market: Clients; providers and outlets of contraceptive products and services; contraceptive manufacturers and distributors; and contraceptive products
- Private sector: Both not-for-profit and for-profit commercial providers of contraceptives
- Market segmentation: Division of diverse populations into subgroups with similar characteristics, needs, and likely responses to family planning marketing or service delivery to shed light on the current and potential market
- Social franchise: Network of private health providers that contractually agree to provide socially beneficial services under a common brand
- Health vouchers: Tokens distributed by accredited health facilities that entitle clients to services at any contracted facility of their choice, public or private. The provider who accepts the voucher is reimbursed for the cost of services provided, plus a reasonable profit.
The Global Health eLearning Center offers two courses focused on the total market approach:
Total Market Approach: This course introduces learners to the total market approach and how to use it to maximize resource use, increase access to priority health goods, and improve sustainability. Although this course focuses exclusively on health products, the approach is applicable to health information and service delivery as well.
A Total Market Approach to Family Planning Services: This course encourages learners to focus the total market approach lens on nurturing a healthy market for family planning services and understanding the roles of different sectors within that market. Particular attention will be paid to metrics for defining and measuring the family planning total market, health financing strategies, and total market activities that can help increase access and overcome staffing obstacles to quality family planning services.
Several other courses offer additional opportunities to learn about related concepts:
Bajracharya A, Veasnakiry L, Rathavy T, Bellows B. Increasing Uptake of Long-acting Reversible Contraceptives in Cambodia Through a Voucher Program: Evidence From a Difference-in-Differences Analysis. Glob Health Sci Pract. 2016;4 Suppl 2:S109-S121. By reducing financial and information barriers, a family planning voucher program in Cambodia significantly increased contraceptive choice and uptake of more effective long-acting reversible contraceptives among poor women and women with the least education. Without vouchers, many of these women would not have used contraception or would not have chosen their preferred method.
Boddam-Whetham L, Gul X, Al-Kobati E, Gorter AC. Vouchers in Fragile States: Reducing Barriers to Long-Acting Reversible Contraception in Yemen and Pakistan. Glob Health Sci Pract. 2016;4 Suppl 2:S94-S108. Vouchers for family planning in Yemen and Pakistan reduced barriers, such as cost and availability, and encouraged public and private providers to improve skills, leading to an increase in uptake of long-acting reversible contraceptives and permanent methods.
Menotti EP, Farrell M. Vouchers: A Hot Ticket for Reaching the Poor and Other Special Groups With Voluntary Family Planning Services. Glob Health Sci Pract. 2016;4(3):384-393. Vouchers can be a highly effective tool to increase access to and use of family planning and reproductive health services, especially for special populations including the poor, youth, and postpartum women. Voucher programs need to include social and behavior change communication with clients and quality assurance for providers, whether in the private or public sector. In the longer term, voucher programs can strengthen health systems capacity and provide a pathway to strategic purchasing such as insurance or contracting.
White JN, Corker J. Applying a Total Market Lens: Increased IUD Service Delivery Through Complementary Public- and Private-Sector Interventions in 4 Countries. Glob Health Sci Pract. 2016;4 Suppl 2:S21-S32. Between 2013 and 2014, IUD services provided to women increased more than threefold–from 22,893 to 79,162–in 417 public facilities in Guatemala, Laos, Mali, and Uganda through a Population Services International pilot that engaged the public sector alongside existing private-sector interventions within an informed choice context. Based on family planning market analyses, the country-specific interventions focused on strengthening policy, service delivery, supply chain management, and demand promotion.
Munroe E, Hayes B, Taft J. Private-Sector Social Franchising to Accelerate Family Planning Access, Choice, and Quality: Results From Marie Stopes International. Glob Health Sci Pract. 2015;3(2):195–208. In just 7 years, Marie Stopes International (MSI) has scaled-up social franchising across Africa and Asia, from 7 countries to 17, cumulatively reaching an estimated 3.75 million clients including young adults and the poor. In 2014, 68% of clients chose long-acting reversible contraceptives, and many clients had not been using modern contraception in the past 3 months. Service quality and efficiency (couple-years of protection delivered per outlet) also improved significantly.
Thurston S, Chakraborty NM, Hayes B, Mackay A, Moon P. Establishing and Scaling-Up Clinical Social Franchise Networks: Lessons Learned From Marie Stopes International and Population Services International. Glob Health Sci Pract. 2015;3(2):180–194. Family planning social franchising has succeeded in countries with an active private sector serving low- and middle-income clients, with services provided mostly by mid-level providers, such as nurses and midwives. Key support for social franchising includes: clinical training and supportive supervision, help building sustainable businesses, marketing and demand creation, and mechanisms to make services affordable for clients. The forward agenda includes selectively introducing other priority health services, improving cost-effectiveness of the model, and promoting sustainability and health systems integration.
Social Franchising: A Blockbuster to Address Unmet Need for Family Planning and to Advance Toward the FP2020 Goal. Glob Health Sci Pract. 2015;3(2):147–148. Social franchising has scaled-up provision of voluntary family planning, especially long-acting reversible contraceptives, across Africa and Asia at a rapid and remarkable pace. The approach should be pursued vigorously, especially in countries with a significant private-sector presence, to advance the FP2020 goal of providing access to modern contraception to 120 million additional clients by 2020.
Social Franchising: Improving quality and expanding contraceptive choice in the private sector (2018; PDF, 659KB) describes the potential impact of social franchising on key family planning outcomes. This type of network can be particularly important for expanding availability and improving the quality of family planning services in the private sector, particularly for provider-dependent methods such as intramuscular injectable contraceptives, contraceptive implants, and intrauterine devices (IUDs). It also provides useful guidance on how social franchising can be used to increase access to high-quality family planning products and services.
The brief Social Marketing: Leveraging the private sector to improve contraceptive access, choice, and use (2013; PDF, 845KB) outlines how social marketing in family planning programs makes contraceptive products accessible and affordable through private-sector outlets, such as pharmacies and shops, while using commercial marketing techniques to achieve specific behavioral goals. Additionally, it describes the three main social marketing models (NGO model, manufacturer’s model, and hybrid models) and outlines key considerations that social marketing programs should take into account to ensure success.