Applying a Total Market Approach to DMPA-SC

TMA is an evidence-based process that identifies market players and understands how they can contribute to improved access to information, products, and services for family planning. The goal of TMA is to create greater equity, increase health impact, and improve sustainability of family planning markets through investments made by all sectors. The TMA process involves analyzing market dynamics, engaging key stakeholders, understanding comparative strengths among market players, strengthening local stakeholders, and supporting market interventions. The process also involves reassessing and reengaging with the market to evaluate and adjust market actions. TMA has gained global traction as a process to improve coordination, implementation, and scale-up of family planning programs. The introduction and scale-up of DMPA-SC can benefit from a TMA approach to improve coordination, implementation, and scale-up. TMA can help DMPA-SC achieve balanced and sustainable growth by examining cross-cutting trends in use, sourcing, and economic/geographic access to understand how markets are evolving and to capitalize on and build momentum. Strategic coordination will help ensure that both public and private sectors are maximizing their comparative advantage and contributing to sustainable access. In considering the introduction and scale-up of DMPA-SC, it is essential to understand the existing market and how it can benefit from the introduction of DMPA-SC. This includes analyzing the market trends, inequities, and opportunities, engaging key stakeholders, and understanding the comparative strengths among market players. It is also crucial to ensure that coordination for DMPA-SC includes all sectors, including the public, private, and social marketing sectors. The private sector's potential role for DMPA-SC is significant, with its comparative strengths including increased access/convenience, establishment of private sector markets, and increased cost-recovery/sustainability. However, coordination of public and private sectors should address questions such as branding and marketing differentiation, potential overlap in distribution channels, policy issues affecting private sector introduction or roll-out, and cost-recovery, pricing, and procurement affecting sustainability. Country examples of TMA consideration and potential actions include Senegal, Nigeria, Uganda, and Kenya. In Senegal, injectables represent the largest share of modern contraceptive prevalence, and sourcing is dominated by the public sector. In Nigeria, Sayana Press (Pfizer's DMPA-SC) was launched in 2014 by DKT International with distribution through hospitals, clinics, pharmacies, and community health extension workers. In Uganda, injectables represent more than half of modern contraceptive prevalence, and private sector sourcing is increasing. In Kenya, the commercial sector's participation in family planning was previously underestimated, and the size of the commercial market was estimated at 6% rather than the previously estimated 1%.