Total Market Approach to Family Planning
Review the Evidence
40 years of evidence; one comprehensive database
POPLINE is the world’s largest free database of family planning and reproductive health literature. An international resource, POPLINE helps program managers, policy makers, and service providers in low- and middle-income countries and in development-supportive agencies and organizations gain access to scientific articles, reports, books, and unpublished documents.
POPLINE has a wealth of evidence on the total market approach.
Collaborate and adapt
Sustainable Growth of Uganda’s Family Planning Market through Improved Private Sector Engagement: A Political Economy Analysis (Health Policy Plus, 2018; PDF, 627KB) investigates why the Ugandan government and family planning stakeholders have not been able to fully engage the commercial health sector, and how the government can better work with the private sector to increase access to family planning and make the market more sustainable. This brief provides findings and recommendations to help the Ministry of Health reach its goal of doubling the size of the commercial sector by 2020.
Total Market Approach to Family Planning: Key Indicators (MEASURE Evaluation, 2018; PDF, 121KB) outlines nine key indicators that USAID implementing partners can use to inform the M&E of FP programs supporting activities in the TMA priority area. Each indicator featured in this resource contains a definition as well as any calculations, suggested disaggregations, or reference periods.
Public-Private Partnerships for Family Planning: Case Studies on Local Participation (SHOPS Plus, 2017; PDF, 2.10MB) illustrates the value of local participation through five case studies on public-private partnerships (PPP) for family planning: Marie Stopes Papua New Guinea, Sehat Sahulat Card in Pakistan, Sayana Press implementation in Senegal, Wazazi Nipendeni in Tanzania, and accredited drug dispensing outlets in Tanzania. The publication begins by discussing partnership mechanisms and the types of partners. The authors consider the experience of PPP unit representatives that worked on health issues, including family planning. The primer closes with a discussion about ongoing challenges and opportunities for these partnerships.
A Participatory Approach: Using Evidence to Support a Total Market Approach to Family Planning (USAID | DELIVER PROJECT, 2014; PDF, 1.77MB) documents the USAID | DELIVER PROJECT’s participatory market analysis approach to expanding contraceptive access. This approach, which is used to analyze the FP market and identify concrete steps to improve contraceptive availability, combines demographic analysis with provider supply data and commercial-sector product and customer data, when available; it is used to learn more about the total contraceptive market and to find opportunities to strengthen, expand, and sustain the market, over time. These strategies are defined through an interactive, consensus-building process based on each partner’s comparative advantage to serve various market segments. This guide provides background and material to help family planning stakeholders in other countries adapt and apply this approach to their own setting.
Evidence summaries: the HIPs briefs
The High Impact Practices in Family Planning (HIPs) team at USAID has developed briefs that synthesize the evidence and provide recommendations on how to implement selected HIPs.
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.
Open access, peer-reviewed journal
The Global Health: Science and Practice Journal contains many peer-reviewed articles on total market approach and related topics.
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.