Shaping the Family Planning Market by Strengthening the Public Sector

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Total market approaches (TMA) are critical for achieving universal health coverage, which is the goal of ensuring that all people have access to quality health care, including voluntary family planning, without facing undue financial hardship. The term “TMA” is often associated with efforts to direct clients who can pay for services to the private sector to allow subsidies in the public sector to better reach the clients with the greatest financial need. However, Population Services International’s (PSI) approach to TMA involves solutions that involve both the public and private sector players at the levels of supply, demand and the enabling environment.

This program brief presents cases, supported by several different donors, which take into consideration the total family planning market. The TMA lens helped PSI to prioritize interventions that strengthen service delivery in the public sector. Each case began with consideration of two key TMA questions:

1. Who is the family planning market failing? As a first step to understand the market, PSI analyzes contraceptive use and unmet need for family planning by age, gender, geography, risk behavior and other factors—segmenting the population to inform the rest of the approach.

2. How is the family planning market failing those groups? This step requires consideration of the total health market and incentives for performance from the perspectives of direct players across the value chain as well as indirect players who influence the enabling environments. Examples of direct players are pharmaceutical manufacturers and providers in the public and private sectors who influence supply and demand. Indirect players include regulatory and financial actors, among others.