According to the World Health Organisation Universal Health Coverage (UHC), full access to high-quality services for health promotion, prevention, treatment, rehabilitation, palliation and financial risk protection cannot be achieved without the meaningful involvement of the private sector.
In Uganda, the Ministry of Health saw the need and birthed the Public Private Partnership Policy Framework to facilitate the approach. Universal Health Coverage is premised on the collective understanding that all people should have access to quality services that they need without the risk of financial ruin or medical impoverishment now and in the future. According to WHO, overall access to quality universal healthcare in Uganda is improving, and can even get better if all sector work in concert complementing each other.
The Total Market Approach (TMA), also known as, “Whole Market Approach” is a mechanism, which aims at harnessing resources and infrastructure in both public and private sector in order to ensure that all consumer segments are served; the poorest, the poor, middle income, rich and the richest. In our case, it means public, private not for profit, private healthcare practitioners and commercial suppliers like pharmacies.
This needs to happen because there is no “one size fits it all” strategy that can be applied to meet all segments because of consumer preferences and choices which the law cannot regulate entirely.
In Uganda, Total Market Approach has helped deliver health solutions to Ugandans through the public private partnerships. It has notably helped deliver health solutions in HIV/Aids, maternal health and family planning. Implementing the Total Market Approach means acknowledging some general principles that make it possible for various actors to coordinate efforts, while meeting respective goals. The four principles here are; comparative advantage, consumer choice, autonomy of suppliers, and value for money across the board. All these will yield results if government provides oversight of all sector players.
The Total Market Approach has been used by the United States Agency for International Development (USAID) and the United Nations Population Fund (UNFPA) to deliver priority health services and products in the area of HIV/Aids, family planning, maternal and child health, and malaria in countries like Ivory Coast, Honduras, Nicaragua, Vietnam, Paraguay and India.
This means the approach is beyond proof of concept but ready for scale up. In Uganda, the Total Market Approach can deliver if government takes the lead and formulates one-all-inclusive strategy for the priority health areas the country wants to start with, and these could be family planning, HIV/Aids, malaria and maternal and child health. Where the approach is already being applied informally by different players in the sector, there is need to define the health market through formative research to appreciate the stage at which Uganda’s health market is and grow the market to meet the health needs of all Ugandans.
It’s important to note that the Total Market Approach can only work if the key regulators and funders of the different players work with one voice and focus by limiting competition and adopting collaboration as a guiding pillar. Secondly, government needs to organise the different actors in the health sector through registration, licensing, accreditation and progressive zoning of where they can operate through incentives for players who venture in hard-to-reach areas of high unmet need for priority health services. In addition, there must be an enabling policy environment for the approach to work. This may require adding sections of Social Marketing and the Total Market Approach in the Public Private Partnership Policy Framework and conducting issue based advocacy for the approach across the country to ensure buy-in at district level which is the primary locus of all implementation.
Total Market Approach can only work if we as a country harness the comparative advantage of the different actors in the Total Market Approach.
Dr. Okello is a practicing/teaching Public Health and Project Management Specialist at Uganda Management Institute (UMI) and Head of Clinical Services at Uganda Health Marketing Group.
Source: The monitor
