Financing and Service Options including Total Market Approach

Understanding how governments, donors, providers, and clients interact in the demand and supply of family planning is critical in expanding access to reproductive health services for all. Improving the resource envelope through increased levels of financing, more efficient use of existing resources, and better understanding of clients’ ability and willingness to pay are all important. Investigating innovative and sustainable financing schemes is also crucial to ensuring that all market segments of clients are covered, including the most disadvantaged.

A total market approach (TMA) is defined as a coordinated approach serving all clients in a country—from those requiring free services to those who are willing and able to pay—to maximize access, equity, and sustainability. Central to this approach is that providers in the public and private sectors leverage their comparative advantages to reach different types of clients with appropriate products and services. A TMA to family planning recognizes that suppliers have different capacities and strengths, and that clients have a range of needs and resources (including ability to pay) to obtain family planning methods and services. A TMA also depends on the robust engagement of stakeholders from the public, private commercial, and private nonprofit sectors, with government officials leading the process.

As more countries consider adopting a TMA, more evidence is needed on the effects of this approach in improving the efficiency, sustainability, and reach of family planning and reproductive health programs and on which metrics work best for capturing changes in these outcomes.

The Evidence Project is examining how different financing schemes, such as vouchers, health insurance, and performance-based financing, can expand and diversify contraceptive method use for a larger market while ensuring clients’ rights and choice. Our work will provide critical evidence to policymakers on effective approaches for financing the provision and utilization of services. Simultaneously, the project is helping to build the evidence base on TMA by developing and testing a total market family planning landscape tool. The tool is being piloted in Uganda and can be used to lay the foundation for total market initiatives in other country contexts.