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In its strategy document for 2014-2020, USAID’s Office of Population and Reproductive Health identified total market approach, or TMA, as a key focus area for their work. Advocates argue that a TMA can increase access, improve equity, and make health systems more sustainable. While we can all agree that these are laudable outcomes, many people have been left wondering just what a TMA is. The term itself is jargon and not very clear. For a long time, different people would mean different things when they used the term, adding to the confusion. In recent years, though, a general consensus has begun to emerge.
As we defined in our Global Health eLearning Center courses Total Market Approach and A Total Market Approach to Family Planning Services, TMA is a lens that donors, implementing partners, governments, and other stakeholders can use to view their health systems and design programs that take into account the full range of resources available in a health system. It recognizes that the public sector, private commercial actors, nonprofit organizations, and donors each have their own comparative advantages when it comes to supplying health products and services. For example, the public sector can offer free access. Nonprofits—including donor-funded social marketing organizations—can deliver subsidized goods and services. And the private commercial market can operate at a wide range of price points.
A TMA recognizes that each of these actors has a role to play and informs the creation of programs and strategies to ensure that they are all given the space to operate without prohibitive barriers. Policy restrictions, financial limitations, supply chain bottlenecks, and other obstacles are identified and removed. And as a result, the full range of health care suppliers is able to reach the full range of current and potential users.
The Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project, USAID’s flagship initiative in private sector health, uses the TMA lens to guide its strategies and activities. For example, in Senegal, we are currently conducting a review of the supply of and demand for family planning, malaria, and maternal and child health products to determine market gaps for each of these commodities. Our analysis uses market data to identify bottlenecks that prevent current suppliers from reaching their targeted consumers with their desired products. When this analysis is completed, we will use the results to design program activities that will work with partners in the government of Senegal and the private sector to address and eliminate the blockages. By using a TMA, we will ensure that our work is not limited by a partial view of the health system. We will have an accurate picture of all the resources at our disposal. Knowing the full range of options available will give our activities a better chance of achieving maximum impact.