What do markets have to do with girls’ and women’s health? The simple response is everything. From sexual and reproductive health to sanitation, we are increasingly aware that the most effective strategies for meeting countries’ health needs must include an understanding and engagement of all actors that supply, enable or regulate health products and services. In other words, access to and use of life-saving products and services relies upon a strong, healthy market. However, many markets are not working effectively to address the health needs of all people across all economic and social strata in a society.
At PSI, we use the total market approach (TMA) process to better understand health markets and consumer needs. Our aim is to improve market performance with a vision towards universal health coverage (UHC), which means ensuring that every person, everywhere, has access to the quality health care they need without causing undue financial hardship. For PSI, taking a total market approach involves identifying market failures and determining the most appropriate interventions needed to improve demand and supply for accessible and affordable health products and services, particularly for women and girls.
GROWING THE TOTAL MARKET FOR FAMILY PLANNING
To reach its FP2020 goal, India will have to add 48 million additional new users of contraception. This constitutes 40 percent of the total FP2020 target worldwide. With support from the Bill and Melinda Gates Foundation, PSI is using the TMA process to better understand current and potential consumers for the family planning market in India’s most populous states, Uttar Pradesh and Bihar. Initial analysis in both states confirms that the current market is failing rural, young and poor women.
PSI, in partnership with FSG Consulting, collected market data across all players in the value chain (i.e., manufacturers, wholesalers, distributors and different levels of providers) to understand their capacities and incentives to perform in the FP market. Literature reviews and primary research was also conducted among indirect market players (i.e. government partners, other FP implementing organizations, donors and regulatory bodies) to understand the enabling environment that supports or inhibits market performance.
In Uttar Pradesh and Bihar, female sterilization has been the major family planning option for most, therefore many girls and younger women who need family planning are not using any modern method. Using the TMA lens allowed PSI to understand the market failures and their root causes. This information informs the interventions that we are rapidly innovating to reach the women we hope to serve, while offering a full range of family planning methods. With our findings, we are adjusting our own social enterprise strategy for PSI’s portfolio of family planning products, while also being in a position to make recommendations for donors and governments on areas in the market needing further investment.
Funder: Bill and Melinda Gates Foundation | Partners: FSG Consulting
IMPROVING MALARIA CASE MANAGEMENT
Malaria remains one of the most dangerous infectious diseases in the world, particularly for pregnant women and young children. In many endemic areas, the private sector is often the primary source of treatment for patients at the onset of fever. Patients are frequently sold antimalarials without confirming malarial infection using a rapid diagnostic test (RDT) as recommended by the World Health Organization (WHO). In addition to leaving other illnesses untreated, overuse of the most effective and first-line treatment for malaria, artemisinin-based therapies (ACTs), has significantly contributed to the spread of drug-resistant malaria.
To address this situation, PSI and partners implemented a project to provide much-needed evidence on how to safely introduce RDTs to the private sector in five malaria endemic countries: Kenya, Madagascar, Nigeria, Tanzania and Uganda. The UNITAID-funded project focused on increasing both access to and demand for quality-assured RDTs. Applying the findings also helped improve private providers’ ability to properly diagnose and treat febrile illnesses. PSI’s learnings will contribute to a WHO roadmap for public-private engagement that will inform other countries in taking a total market approach for correct febrile case management going forward.
Funder: UNITAID | Partners: Malaria Consortium, FIND and World Health Organization (WHO)
BUILDING THE GLOBAL EVIDENCE BASE FOR HIV SELF-TESTING
Less than half of all people living with HIV globally (48 percent) know that they have the disease. HIV self-testing (HIVST), which provides a simple and discreet way to determine one’s status, could dramatically contribute to the UN 90-90-90 target that aims to first ensure 90 percent of all people living with HIV know their status by 2020, and increase the number of people who go on to access support and further testing, prevention, treatment and care. For women, in particular young women and adolescent girls who are at a greater risk of HIV infection, self-testing offers an effective way to reduce the social and economic costs of facility-based testing.
Despite initial indications that HIVST may increase testing among first-time and repeat testers, HIV self-tests are not widely available in most low-resource countries — particularly in sub-Saharan Africa, where the health impact from making this product available on the market may be greatest.
With funding support from the Bill and Melinda Gates Foundation, PSI will improve understanding of the global market for HIVST, including the potential demand in nine priority countries, supply barriers and incentives, as well as the capacities among manufacturers and other enabling environment factors critical to the success of HIV self-testing.
These various components will feed final recommendations to donors regarding appropriate investment needs for market interventions to establish a secure supply of a quality-assured, appropriately-priced HIV self-test kits that meet global demand.
Funder: Bill and Melinda Gates Foundation | Partners: Accenture Development Partners and UNITAID-PSI STAR Project