What is market development?
Market development addresses the components of the market – from the manufacturer, to the distributor to the local seller or supplier – to evaluate necessary changes to ensure the system benefits everyone.
PSI’s mission is to make it easier for Sara to be healthy and plan the family she desires. Our mission aligns directly with that of global universal health coverage: to ensure that all people obtain and use the health products and services they need without suffering financial hardship. Universal health coverage results from strong health systems, including healthy and performing markets. A market is broadly defined as the space where consumer need is turned into demand and where the demand is fulfilled through a supply chain that results in product and service provision. PSI’s approach is to develop the total market for health products and services to achieve universal coverage.
This approach keeps tabs on how markets are working or failing. It also addresses the underlying causes of success or failure. Interventions that make markets work for the most vulnerable need to be flexible, highly nuanced and catalytic.
Market development is part of a “total market approach.” In taking a holistic view, we evaluate where we can best add value as a direct implementer of a service or purveyor of goods or by co-opting others. The goal is always to realize sustained and equitable increases in the use of these health products and services. PSI promotes market development by addressing demand and supply simultaneously, converting need into demand and facilitating supply to meet demand. Our action and facilitation of the total market is intended to grow demand and supply to meet the consumer’s need.
How do we develop markets?
We look at the “health” of a market – how well it operates and how sustainable it is . We implement interventions to improve the market long-term so that health solutions last well beyond our project cycles.
For example, we continue to develop markets for sanitation in India. In 2012, with funding from the Bill and Melinda Gates Foundation, we launched 3SI: Supporting Sustainable Sanitation Improvements in Bihar, India. Together with our partners, PSI generates both supply and demand by working with toilet producers, service providers, finance organizations, the public sector, the private sector and the government.
The project has shown that demand for toilets exists in rural India. The availability of high quality, low-cost products, as well as financing, is key to unlocking a sizeable part of this demand. We learned that accessing existing subsidies can significantly increase market penetration. Partners have also identified business models that can meet customer needs and make a profit. They have also identified players in the sanitation ecosystem who could serve as the “market maker,” conducting market-building activities and creating an enabling environment for growth.
UNITAID funded PSI to create markets in the private sector of five malaria endemic countries for malaria rapid diagnostic tests (RDTs) in five malaria endemic countries within the private sector. An RDT is a simple test that can be used in the field outside of laboratory conditions to quickly detect if a patient has malaria. An entrepreneur in a corner store can correctly administer the test once trained. This project aims to increase both access to and demand for quality-assured RDTs, while improving private providers’ fever case management skills.
More than 40 percent of the population in endemic countries seeks care and treatment for fevers in the private sector. Appropriate use of RDTs is critical to ensure proper diagnosis and treatment. Without these private sector purveyors, RDTs are either not available or, where available, are more expensive than the recommended frontline treatment for malaria, artemisinin combination therapy (ACT). This means consumers and providers overtreat fevers for malaria, often misdiagnosing the illness and wasting antimalarial drugs, This contributes to future resistance to malaria drugs and doesn’t correctly treat the fever from which the patient is suffering.
To address this, we are taking a market facilitation approach. We mapped Kenya’s RDT market to see what barriers kept the private sector from adopting and promoting the widespread sale of RDTs. This in-depth analysis has revealed :
- The regulatory environment does not allow certain types of outlets, such as informal drug shops, to stock or sell RDTs;
- Providers have no incentive to stock RDTs when demand is low and supply chains to restock are weak;
- Consumers do not demand a test because they may lack knowledge of the benefits of RDTs or are unable to afford one;
- Providers choose not to adhere to negative RDT results due to lack of confidence in the test results, loss of profit from a foregone ACT sale and/or demand from customers to treat with an ACT anyway.
Working with market development experts from the Springfield Centre, we analyzed the issues the RDT market faces and started by addressing who best performs the functions and who best pays for the functions. Once the natural incentives for this market are clear to the private sector, we aim to leverage them to serve those who need theses services, namely the poorest and most vulnerable citizens. To create and sustain the market, we look for solutions that neither replace the existing market players or distort their incentives. This is how we change a system rather than simply fill a gap.
- Developing Family Planning Markets in Francophone West Africa
In Francophone West Africa, PSI partners with Ministries of Health to achieve the goals set out by the Ouagadougou Partnership to reach at least 2.2 million additional family planning users by 2020. The pillars of our response are access, choice, quality, and equity.
- Towards Subsidized Malaria Rapid Diagnostic Tests. Lessons Learned from Programmes to Subsidise Artemisinin-Based Combination Therapies in the Private Sector: a Review
Private sector subsidy programmes of ACTs have been effective in increasing availability of ACTs in the private sector and driving down average prices but struggled to crowd out antimalarial monotherapies. A subsidy of rapid diagnostic tests (RDTs) in the private sector has been recommended by governments and international donors to cope with over-treatment with ACTs and to delay the emergence of resistance to artemisinin. In order to improve the cost-effectiveness of co-paid RDTs, we should build on the lessons we learned from almost 10 years of private sector subsidy programmes of ACTs in malaria-endemic countries.
- Business Model Development for Fecal Sludge Management: Insights from Bihar, India
In 2014 PSI began implementing Project Prasaadhan to address critical gaps in fecal sludge management in Bihar, India. Read about the project's key highlights on this poster presented at the 4th Global Symposium on Health Systems Research.
- Oral Artemisinin Monotherapy Market Still Maintains a Foothold in Myanmar, 2015
A 2015 outlet survey was conducted in the private sector within 4 domains: intervention and comparison areas in eastern/central Myanmar for the Artemisinin Monotherapy Replacement Project (AMTR) in operation since 2012; western border areas with India; and the Bangladesh border / Rakhine region. Availability and distribution of oral AMT is a serious problem throughout Myanmar, with particularly urgent need to address this problem in India border areas. It’s distribution, especially at sub-optimal dosing is likely to further exacerbate the spread of artemisinin resistance in Myanmar. There is urgent need for rapid national scale-up and strengthening of strategies, including those used by the private sector AMTR program, to rid oral AMT from the market, and increase access to QA ACT. Policy changes that ban the full import, distribution, and sale of oral AMT would create a far more conducive environment for the support of these activities.
- Private Sector Readiness and Performance for Malaria Case Management in Uganda
In a nationally-representative 2015 outlet survey, 1 in 4 private sector outlets had both confirmatory testing and QA ACT treatment available. Among outlets with testing and treatment available, study results suggest positive private sector performance with respect to testing all fever patients, particularly in health facilities and drug stores, however testing was very low in pharmacies. However, not all patients seeking treatment in the private sector can or will be tested for malaria. There is need to further promote confirmatory testing and first-line ACT treatment among patients and private sector providers, as well as discourage the use of non-artemisinin therapies and inappropriate use of injectable artemisinin monotherapies for uncomplicated cases.
- What Happened to the Malaria Market in Tanzania after the AMFm?
Key strategies have been implemented in Tanzania to ensure access to confirmatory testing and appropriate treatment for malaria cases. To extend quality case management services to the community level, a drug store accreditation program was recently taken to scale across much of the country.
- What Happened to the Malaria Market in Nigeria after the AMFm?
AMFm continuation under the private sector co-payment mechanism (CPM) has been successful in further improving access to quality assured ACTs in the private sector, where the majority of antimalarials are distributed in Nigeria. High QA ACT price relative to nonartemisinin therapies including SP and chloroquine is likely still a barrier to uptake. Furthermore, the very low availability of confirmatory testing in the private sector suggests that presumptive treatment remains common.
- What Happened to the Malaria Market in Kenya after the AMFm?
The AMFm continuation under the private sector copayment mechanism has maintained strong QA ACT availability in the private sector, where nearly 90% of antimalarials are distributed. However, QA ACTs accounted for only half of antimalarial distribution, and 1 in 5 antimalarials distributed were non-QA ACTs. Furthermore, QA ACT price increased following the AMFm pilot to more than double that of SP. Availability of confirmatory testing has improved in the public and private sectors, however availability remains low in the private sector and only 1 in 4 antimalarial-stocking outlets were equipped to test. This result suggests that presumptive treatment remains common.
- ACT Availability, Price and Market Share in Kinshasa & Katanga, DRC, 2013-2015
QA ACT availability improved in the public and private sectors of Kinshasa and Katanga between 2013-2015, however, substantial gaps in availability remain in both sectors. In addition to sub- optimal availability, QA ACT high price relative to cheaper antimalarial alternatives is likely a barrier to uptake. Distribution of QA ACT relative to SP and non-QA ACTs remains low. Ensuring that malaria is managed appropriately in DRC with quality-assured ACT requires working with the private sector to address current gaps in availability, affordability and distribution of QA ACTs.
- Malaria Testing and Treatment Markets on the Thai-Myanmar and Thai-Cambodia Borders
A 2016 outlet survey was conducted in Thailand with 2 study domains: Thai-Myanmar and Thai-Cambodia border areas. Availability of malaria blood testing was high in the public sector, but antimalarial availability was variable. Overall, over half of malaria clinics/posts and hospitals had ASMQ or DHA PPQ, CQ, PQ and malaria blood testing available, indicating moderate readiness to test for and treat both P. falciparum and P. vivax malaria. The gap in readiness in the public sector suggests that patients may need to be referred to a different facility to receive appropriate care.