Markets Matter: Translating Policy into Improved Product Access for Women and Children
Health advocates have a long history of increasing access to lifesaving products, especially for women and children, by affecting policy change. But what happens when, once adopted, the national policy doesn’t translate into increased product access throughout the country? Policy change alone is not always sufficient to achieve improved access to health products. However, advocates have an important tool at their disposal to complement policy change: market advocacy.
Health policies and product markets go hand in hand. Once a policy aimed at increasing access to health products is adopted, markets are the mechanism through which that policy is realized. What do we mean by this? Market dynamics describes the range of interactions that determine how a product is produced, procured, distributed and delivered—functions that are carried out by market actors. Policies govern the environment in which market actors operate, and in turn, their interactions—market dynamics—shape the way policies are operationalized. Market advocacy helps determine how market failures impede access, and helps identify entry points for additional advocacy to ensure that policy becomes reality.
Applying a market lens to advocacy works for any category of health products, whether you work on contraceptives, diagnostics, antiretroviral drugs, childhood antibiotics, vaccines, or maternal health supplies, and provides a new way of seeing both the problem and solutions. Health advocates have tried and true tactics they employ: collecting and packaging evidence, fostering collaboration, and mobilizing citizen demand, to name a few. Market advocacy relies on many of those same tactics, but focuses on formulating the advocacy ask after exploring the current situation in light of the 5As that characterize a well-functioning market: availability, affordability, assured quality, appropriate design, and awareness.
Asking yourself and others about each of these criteria, as applied to your health product, can help to identify new advocacy audiences and entry points. How do we know? We tried it.
In 2017, PATH provided grants to two organizations—Generation Initiative for Women and Youth Network (GIWYN) in Nigeria, and the Bangladesh Paediatric Association (BPA)—willing to try this approach in their advocacy around misoprostol for postpartum hemorrhage and chlorhexidine 7.1% for umbilical cord care, respectively. GIWYN and BPA’s advocacy highlights two of the benefits of utilizing a market advocacy approach—the ability to advocate to new audiences, and to engage existing audiences in a new way.
Engaging new audiences to expand access to chlorhexidine for umbilical cord care
As a pediatric association, BPA is committed to improving child health. Evidence has shown that chlorhexidine (CHX) 7.1% applied to the umbilical cord at birth is an important tool in preventing infection and illness that lead to almost 20% of the 62,000 annual neonatal deaths in Bangladesh.
BPA used the 5As framework to conduct a series of interviews with existing stakeholders to investigate barriers to ensuring that CHX 7.1% is available at all births in Bangladesh, whether at home or in a facility (public or private). Through this process, BPA determined that the government’s neonatal strategy—which calls for use of CHX 7.1% for umbilical cord care—had been set in motion, but product access remained low, which required market advocacy on both demand and supply. As an association with both public- and private-sector members, BPA used its convening power to reach new advocacy audiences with the message of needing to expand CHX 7.1% availability at all births.
On the demand side, BPA’s scoping interviews identified private-sector delivery as crucial to realizing increased uptake of CHX 7.1%. BPA engaged the Bangladesh Private Medical Practitioners Association and was able to secure a commitment to introduce CHX 7.1% in its facilities. As the majority of facility-based births occur in private-sector facilities, it was essential that BPA engage beyond the usual public-sector stakeholders to include private-sector practitioners as well.
BPA also held a series of supply-side consultations. By engaging ACI Healthcare Limited—currently the only manufacturer of CHX 7.1% in Bangladesh—BPA was able to understand its current capacity and challenges. BPA then organized a stakeholder consultation with the Directorate General of Drug Administration and other potential manufacturers to ensure that all parties clearly understood the current state of production and projected needs across the country. Using its unique viewpoint as an advocacy organization, BPA was able to forge new connections among these stakeholders, bridging information gaps between the government and manufacturers.
Increasing access to misoprostol—opening new doors with existing stakeholders
Postpartum hemorrhage is Nigeria’s leading cause of maternal death. GIWYN has been working to increase access to misoprostol for its prevention and treatment in three states—Edo, Imo, and Lagos—but found that significant gaps in access remained. Despite having a broad policy foundation to ensure funding for and provision of misoprostol at the primary health care and community levels, the medicine has remained elusive for many expectant mothers in Nigeria.
GIWYN first sought to determine why the combination of policies currently in place was not ensuring consistent access to misoprostol. Interviews with more than 4,000 women and 700 community health extension workers (CHEWs) revealed two underlying causes for misoprostol underutilization: low awareness among CHEWs and community members, and limited or no stock availability due to insufficient or untimely disbursement of purchasing funds.
GIWYN developed an advocacy strategy to address each of these challenges, using a market lens to both identify the problems and communicate the proposed solutions. GIWYN partnered with the National Coalition for Reproductive Justice to educate CHEWs on the current policies and equip them to advocate for misoprostol locally. They also formed a technical working group to monitor the budget for misoprostol and encourage timely and complete fund disbursement.
As part of these efforts, GIWYN used the 5As to produce case studies for each state’s Primary Health Board on current gaps in misoprostol access. This framing helped policy makers better understand the nature of the problems preventing access to misoprostol, and provided a line of argumentation that proved more compelling than those employed in previous misoprostol access advocacy efforts. As described by GIWYN’s Executive Director Sybil Nmezi, using a market framework “opened new doors that were previously closed.”
When policy change isn’t enough: market advocacy to improve access to health products
Market advocacy can help ensure that policies aiming to increase access to health products achieve their intended impact. By providing a systematic approach that allows advocates to understand the root causes contributing to access issues, employing the 5As framework can help identify critical barriers to access, and advocate to ensure that national policy is realized at all levels. To learn more about the objectives and tactics employed by BPA and GIWYN, see these case studies:
- Market Advocacy to Reduce Newborn Infections and Deaths in Bangladesh
- Applying a Market Lens to Advocacy for Increased Misoprostol Access in Nigeria