Landscaping: Implementing the First Step of a Total Market Approach in Uganda

Total Market Approach to Family Planning

Jerry Parks

PATH | Program Associate

When it comes to doing family planning work in low- and middle-income countries, where there is so much (and so many different types of) work to be done, where do you start? How do you decide where to focus your efforts, or how to make sure you aren’t repeating the same research or offering the same services as another group?

At PATH, we are strong advocates for the total market approach (TMA) to family planning (FP) to help address these challenges. We see a TMA as a collection of principles to help providers of contraceptives reach the largest possible proportion of the population and make the most of existing supplies of product in a country or region. While every organization working in this space has a slightly different interpretation of a TMA, at its heart are three consistent ideas:

  1. The government is the steward of the family planning market and should lead coordination activities
  2. Representatives from all sectors of the FP market—free providers (government and nongovernmental organizations), social marketers, and full price (formal and informal pharmacies and drug shops) —should collaborate on where they operate and what types of clients they serve
  3. FP users with the ability to pay some, or all, of the cost of a product should be “shifted” away from using free providers towards social marketing or full-cost clinics, thus making more free contraceptives available for the poorest segments of the population

Before you get started on any of this, however, you need to know what you’re getting into in a given context. This first step of a TMA is called a landscape assessment. Under the USAID-funded Evidence Project, PATH was able to conduct an assessment in Uganda. Landscaping is meant to reveal the underlying attitudes and levels of knowledge related to a TMA—coordination, sharing data, the idea of the government as a leader of the market—as well as the policies, information gaps, and practices of greatest interest to local actors.

Preferred reasons for implementing TMA principles given by Ugandan stakeholders

Preferred reasons for implementing TMA principles given by Ugandan stakeholders

In Uganda, PATH first compiled a desk study of existing data on the country’s contraceptive market, including major product sources, relevant health policies, the supply chain, and estimates of overall cost and volumes of product. Following this, we interviewed 19 key informants from all three sectors of the FP market. The majority of respondents in all sectors were receptive and interested in the ideas of a TMA, specifically the fact that it complements existing policies that encourage public-private partnerships, reduces duplication, and could help meet the country’s FP2020 commitments. As the image at right shows, the stakeholders we interviewed showed high levels of interest in a variety of principles, all of which a TMA could help address. Overall, there appeared to be genuine interest in what a TMA could bring to the table in terms of strengthening the Ministry of Health’s ability to lead and fostering greater collaboration between FP organizations.

Using our landscaping experience in Uganda (and other countries) as a foundation, PATH then worked with the Evidence Project to produce a Planning Guide for a Total Market Approach to Increase Access to Family Planning. In this document, we included practical information and specific tools to help organizations and other in-country actors conduct a landscape assessment, with the goal of providing an informational platform that users can augment and modify to suit the different contexts in which they are working. It also contains a variety of tools and directions that other actors can use to start pursuing their own TMA efforts:

  • A description of each step in the landscape assessment process, information on why the step is necessary, what TMA planners should know, and a brief discussion of other key considerations 
  • Key activities to achieve the goals of each step, along with recommended approaches, and potential opportunities and challenges
  • A set of seven foundational tools used in the completion of a thorough landscape assessment

As we all know, there is no “quick fix” to reducing unmet need, or to assuring that both women and men have access to a full range of reproductive choices and options. There are other factors, like increasing demand for contraceptives and increasing the overall supply of family planning products in a country, that are outside of a scope of a TMA. But at PATH, we firmly believe in the utility of a TMA, as both a way of maximizing the existing product supply in a country and of fostering the kind of long-term collaboration among FP providers needed to ensure that every type of user has equitable access to contraceptives.