Palladium s Total Market Approach (TMA)

Transcription

1 Palladium s Total Market Approach (TMA) A pathway for delivering health impact

2 Building Momentum for Total Market Growth Palladium is committed to building new pathways to creating greater health equity, sustainable development, and enduring social change. Health markets in emerging and developing countries are often fragmented and inefficient, resulting in wasted resources, supply gaps, poor quality, and inequities. We believe that these market inefficiencies can be better served by leveraging the complementary roles of all sectors to improve health impact through a total market approach (TMA). For more than 45 years, Palladium has been a thought leader in advocating and working toward balanced, sustainable health systems and markets. This work includes developing data analysis tools and models to inform national and global decision makers; improving health policies and the capacity of governments and private and NGO institutions to implement them; and pioneering new models for private sector engagement all building momentum for advancing total market principles. The road to results requires improved coordination understanding who is doing what and where; increasing efficiency in resource utilization among all sectors; better targeting donor and government subsidies for underserved and priority audiences; and better monitoring of total market metrics. Most importantly, however, TMA interventions must be tailored to support countries in achieving their health priorities, whether to increase contraceptive prevalence, address HIV, nutrition, or malaria or achieve universal healthcare coverage. 2 Palladium s Total Market Approach (TMA)

3 Our TMA Framework Palladium s TMA framework (Figure 1) is designed to capture the complex process of market analysis, multi-sectoral engagement, market-shaping interventions, and market monitoring relevant to TMA, while recognizing that not all components would be applied in all situations. As learning around TMA implementation evolves, so does the Palladium framework. TMA is an intensive, iterative process but one that leads to important results. As described below, the six elements are closely linked, often overlapping, and will vary depending on the country context. Palladium s Total Market Approach (TMA) 3

4 1. Analyze market dynamics. Effective engagement of all sectors requires in-depth understanding of total market dynamics. We recognize that health markets are constantly evolving, as are government health priorities, market actors and actions, and consumer behaviors, aspirations, and ability to pay. Palladium pioneered the market segmentation methodology used widely today 1. The methodology has been refined to use residence-specific wealth quintiles to understand how poverty and place of residence influence behaviors, as well as regional- and district-level analysis (where data allow) 2. In India, for example, Palladium s district-level analysis revealed important differences in access to and use of public and private sector services. Though it had been widely assumed that rural health markets were homogenous, the findings helped stakeholders understand the existence of micro-markets, comparative strengths among sectors, and key differences in health-seeking behaviors. We are continuously striving to design more and better ways to use existing data. In Zambia, we are linking retail audit surveys with market data analytics collected by sales representatives to build a robust, continuous picture of market trends. Our use of data models and other evidence tools to understand market inequities is a hallmark of family planning programs in many countries. 2. Understand Comparative Strengths Among Market Players. Based on an in-depth market analysis, TMA seeks to build understanding of the comparative strengths of sectors and 1 Berg, R Initiating public/private partnerships to finance reproductive health: The role of market segmentation analysis. Working Paper Series No. 7. Washington, DC: Futures Group, POLICY Project. 2 Foreit, K., et. al Disentangling the Effects of Poverty and Place of Residence for Strategic Planning. Washington, DC: USAID Health Policy Initiative. stakeholders. Health markets are diverse and dynamic, and sectors have different advantages depending on health goals, target audiences, method mix, and geographic focus. The emergence of social enterprises and increasingly cost-effective and commercially viable models that can reach the poor with information, products, and services is further changing this dynamic landscape. At the same time, we understand that players often have a strong, vested interest in the status quo, which makes for a complex consensus-building process that requires clear and targeted incentives and value propositions to encourage participation in coordination efforts, as well as strong stewardship by governments and donors. In Kenya, Palladium is working to increase awareness of the importance and strategic investment of the commercial sector. We have helped to integrate commercial sector data into the MOH s family planning quantification exercise for the first time. In Zambia, Palladium is advocating for improved market segmentation to allow mid-priced, fully commercial condom brands to better serve middle and upper wealth quintiles in urban markets. 3. Engage Key Stakeholders. Effective TMA engagement includes key stakeholders from public and private sectors in an ongoing, transparent, and resultsoriented platform in which all actors can participate. We believe that effective engagement requires providing decision makers with data and analysis to inform goal-oriented dialogue resulting in concrete action. Examples include securing government commitment to equity and targeting of resources to hard-to-reach and/or under-served populations, achieving removal of regulatory barriers for the private sector, and strengthening mechanisms for public-private partnerships. These are key issues that a range of stakeholders can rally behind in the development and execution of a TMA strategy. In many countries, Palladium s legacy as a trusted policy partner and neutral broker makes us well suited to play this role. In Mali, Palladium is supporting the Directorate of Pharmacy 4 Palladium s Total Market Approach (TMA)

5 and Medicines in implementing its TMA action plan, which was recently updated and validated by key donor, government, and other key stakeholders. In Malawi, we are supporting the Ministry of Health and National Condom Coordination Committee (NCCC) to integrate TMA principles into the national condom strategy, introducing TMA through a series of district-level workshops and strengthening multi-sector coordination at national and district levels. 4. Strengthen Stakeholder Stewardship Capacity. With sustainability and stewardship in mind, Palladium builds the capacity of government and key stakeholders to understand TMA concepts and evidence-based practices, analyze country-level data and priorities, strengthen planning and accountability, and effectively engage NGO and commercial sectors. For the public sector, this often includes strengthening public-private partnership units, regulatory reform, accreditation, and relationships with companies. For the private sector, this includes building capacity and engagement of professional medical associations, advocating for rational regulation, and participating in data sharing to strengthen market monitoring. In Uganda, Palladium is undertaking a TMA assessment model that includes political economy analysis to help stakeholders understand and prioritize policy and regulatory actions that will support market development. In Afghanistan, Palladium supported the MOH unit to strengthen its design, management, and monitoring of large-scale hospital public-private partnerships. 5. Support Total Market Interventions. Palladium ensures that its market interventions are evidence-based and informed by total market principles. These interventions may include partnering with the commercial sector to introduce new products; improving market segmentation for social marketing through targeted distribution and financing; introducing new technologies to strengthen distribution channels; and implementing demand generation activities to stimulate overall market growth. In India, Palladium supported a unique approach to strengthen public and private service delivery channels, which included facilitating accreditation and reimbursement for private providers through government-supported insurance schemes. In Kenya, Palladium has engaged more than 15 commercial sector partners, manufacturers, importers, and distributors to increase their investment in the family planning market. In Zambia, Palladium is working to improve market segmentation of priority health products, introducing a variety of new brands, while increasing engagement with commercial importers and distributors to support total market growth. 6. Total Market Monitoring. Achieving sustained health impact is an ongoing process that requires continuous reengagement of stakeholders and reassessment of market dynamics, entrance of new players, and changes in policies and regulations. To further advance TMA dialogue at country and global levels, we believe that TMA metrics can be strengthened and market shifts monitored more closely. We advocate for Total Market Monitoring to track market-wide shifts across sectors, method mix, products, and services. In India, Palladium monitored multiple data sources to understand short- and medium-term impacts on market dynamics, including government health management information systems service delivery data, sales data from multiple NGO and commercial partners, GIS mapping, and retail audits. In countries where Palladium is implementing social marketing activities, we are creating market data systems to ensure high-quality total market data. Total Market Monitoring is an important part of the road to results ensuring that market interventions are having their intended result and improving efficiency and equity to achieve health impact. Palladium s Total Market Approach (TMA) 5

6