Realising the true potential of the Total Market Approach to condom distribution

In many regions around the world, the decline in new HIV infections has stalled, and in some cases infection rates are actually on the rise again. Unwanted pregnancies are declining globally, but in some cases, such as Africa, there are stubbornly high rates of adolescent pregnancy. It is in such areas where the majority of condoms, sometimes as high as 98% of the total market, are totally or partially subsidised.

This can place some significant hurdles in the way of a sustainable HIV prevention and family planning programme. The commercial sector is “crowded out”, whilst public funds are inefficiently used, with wealthier consumers taking advantage of the heavily subsidised products. In addition, if the national economy is growing, donor funding can dry up, further exacerbating the situation.

Furthermore, the market does not develop when it is overly reliant on subsidies. Since the 1980s there has been a dependence on significant donor investments, and whilst this might have been expected to create opportunities for private sector suppliers, few social marketing programmes have led to strong markets for commercial condom manufacturers. People tend to use the highly subsidised brands, because they are cheaper.

Thus many countries are at a crossroads in their HIV prevention and family planning programmes, faced with the challenge of sustaining access to lifesaving condoms through means other than government subsidies. This has prompted an increase of interest in the Total Market Approach (TMA) to help effectively manage the condom supply.

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Such an approach sees all market actors, including the public, social marketing and private sectors, as playing different roles in order to build the market. This is done by following a philosophy whereby the wealthiest should purchase their products, where the poorest should receive free products, and where average earners should benefit from partially-subsidised products. Ultimately, such efforts can increase condom users, reduce subsidies and build sustainable condom markets.

Laying the foundation for a total market approach

Various organisations involved in HIV prevention, family planning and other public health challenges have formulated frameworks to develop a total market approach. Three steps are usually defined: market assessment through data collection; key stakeholders engagement; and the development of the plan itself.

Two case studies from either end of the market spectrum

The application of the total market approach can result in very different strategic recommendations according to the country. To illustrate this, Mali and South Africa will be used as case studies.

Getting to know the market

Quantitative market data should be collected, on both the supply side and demand side, so all stakeholders can understand consumer preferences, demand and access to condoms. Important data encompasses total number of condoms sold, number of outlets, brand diversity and reported stock outs. On the demand side, data on the population’s condom usage, their knowledge of outlets, perceptions on affordability and willingness to pay commercially viable prices for condoms is desirable.

Here is a summary of such metrics in Mali and South Africa, showing just how different markets can be:

Metric Mali South Africa
Universe of need 35 million condoms 850 million condoms
Use (males, 15-49) 36% 67%
Market volume 14 million condoms 500 million condoms
Market value USD870,000 USD22,000,000
Number of brands 22 58
Market subsidy 98% subsidised 83% subsidised
Equity index Equal use across wealth quintiles Overwhelmingly used by top wealth quintile

By building such a comprehensive understanding of the factors influencing the supply and demand side, the market  can then be classified as nascent, developing or mature. This informs subsequent strategies and lays down a foundation from which an effective TMA can be built.

Building a coalition

In the next stage, key actors in government, social marketers, NGOs and the private sector should work together to build a consensus regarding the best market strategy. All actors should decide on the role they will play in the total market approach, give their perspectives on the collected data and propose forecast needs.

Putting together the plan

The subsequent total market plan should reflect the data, analysis and perspectives from all participating actors. It should give each stakeholder all the information and guidelines needed for them to put together their own strategies. So in the case of Mali, for example, UNFPA recommended the following strategies, to enhance the current total market approach:

  • Increasing demand: most of the population does not use condoms. Therefore condom promotion and behavior change communications campaigns would be crucial.
  • Pricing: to increase market sustainability, socially marketed condoms should be increased in price. Government price controls should be eased to aid expansion of the commercial sector.
  • Targeting: As most condom use occurs in the wealthiest segments of society, more effective targeting will encourage a more equitable spread of condom use.
  • Reporting: improved reporting will result in more up-to-date data and will enable timelier and more relevant strategies in the market place.

Whatever the strategies employed by each actor, they will be tailored according to the market conditions. So in the case of Mali, the market is firmly in the nascent category. However, in South Africa, things have moved on and the market is in a developing phase. As a result, the recommended strategies are quite different:

  • Increasing demand: condom use has been decreasing over recent years. So condom promotion and behavior change communications campaigns are necessary, particularly targeted to the youth sectors.
  • Increasing distribution to non-medical outlets: NGOs mostly distribute condoms in medical facilities. By increasing the distribution into other venues such as bars, availability would increase.
  • Improving communication between stakeholders: better coordination between the public sector, social marketers, NGOs and commercial companies would help prevent stock outs and improve distribution efficiency.
  • Partnering for success: stronger relationships between the public sector and commercial companies maximise the efficacy of public funding.

Once a total market plan is in action, the foundation is in place from which markets can move from nascent to developing, and developing to mature.

Theory versus reality

TMA activation is hindered by poor data and a preference for providing free access to condoms over the creation of an environment that will support the long term sustainability of markets. Furthermore, the time needed to build stakeholder cooperation and consumer behaviour change is a hurdle. Few total market strategies have been implemented, yet organisations continue to test this approach in various markets. Time will tell whether a popular theory can translate into actual success.

About Ulinzi Latex

Ulinzi Latex, part of NRS International, is a newly established company that will manufacture and supply high quality, totally reliable and affordable reproductive health products for the institutional market. By 2022, Ulinzi Latex aims to manufacture more than eight billion condoms each year. This will give greater access to family planning and will bring new impetus in the fight against HIV/AIDS, the world’s most significant public health challenge. By working with all stakeholders, we can together make a significant and long-lasting contribution to many of the Sustainable Development Goals, and so make the world a better place for all. For more information, visit

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