Policymakers and managers in reproductive health are increasingly aware that the most effective strategies for meeting the reproductive health needs of consumers must engage all sectors that supply reproductive health products and services: the public sector, the private nonprofit sector, and the private commercial sector. Having the public and nonprofit sectors provide subsidized services for needy consumers while maintaining sustainable commercial provision for consumers who are able to pay is often referred to as a “total market” or “whole market” approach. Many reproductive health organizations have adopted a total market approach for their sourcing of products and provision of services. Adopting such an approach more widely would lead to more rational use of limited resources, ensuring access to reproductive health products and services for all consumers.
Since 2007, the Market Development Approaches Working Group of the Reproductive Health Supplies Coalition has strongly advocated for the total market approach as an alternative to almost exclusive reliance on the public sector. However, even as MDAWG members supported the total market concept, they debated the form that an ideal approach would take, and realized there were no examples of how a country had moved from a single sector approach to a total market approach in its reproductive health planning and programming. To address this gap, the MDAWG members and the organizations they represent began to operationalize the total market theory by designing and implementing total market initiatives (TMI) intended to reorient government health policymakers and reproductive health program managers from a single sector focus to a total market perspective and thus increase access to reproductive health products and services efficiently and equitably.