Total Market Approach

What is the Total Market Approach (TMA)?

Thoughts about social marketing have matured a great deal over the last 50 years. Social marketers and their stakeholders are examining the sustainability of programs and asking whether programs are as effective and efficient as they can be. This has resulted in the development of a total market approach (TMA), also known as the “whole market approach,” which some argue is central to the future of social marketing.

TMA is a system in which all sectors - public, socially marketed, and commercial - work together to deliver health choices for all population segments. The goal is to ensure that those in need are reached with the appropriate products: those in the poorest communities receive free products, those with slightly greater resources benefit from partially subsidized products, and those with a greater ability to pay should purchase their products from the commercial sector. Greater efficiency in the market increases sustainability by better targeting public and social sector subsidies and decreasing “crowding out” of the commercial sector.


Background: Between November 2012 and November 2013, PSI completed six TMA case studies with support from two independent researchers. The countries selected were Botswana, Lesotho, Mali, South Africa, Swaziland, and Uganda – all of which have large condom social marketing programs, are affected by HIV, and have high maternal morbidity and mortality relative to their economic development. UNFPA sponsored the research.

Objective: To inform the development of appropriate, evidence-based decisions aimed at increasing condom use equitably and sustainably through actions undertaken in the public, socially marketed, and commercial sectors.

Methods: Content for the case studies was based on a review of the literature, seven key TMA metrics calculated from national-level data, and interviews with stakeholders. All case studies were subject to review by stakeholders, including Ministries of Health and non-governmental organizations in all six countries, UNFPA’s local and regional offices, UNFPA headquarters in New York City, PSI country and regional offices, and PSI’s headquarters in Washington DC.

Summary: The case studies describe the market for male condoms in each of the six African countries, and the roles of the public, social marketing, and commercial sectors in those markets. They illustrate the universe of need for condoms, levels of use, socioeconomic equity among users, and the market presence of condoms for reproductive health and HIV prevention (dual protection). They also propose a set of recommendations for improving the effectiveness, efficiency, and sustainability of condom markets.

We welcome you to read and comment on the case studies. Download them here: