In the Caribbean, where HIV prevalence is second only to Sub-Saharan Africa, the question of condom availability can be a matter of life or death. For those already-vulnerable populations, such as the rural poor, out-of-school youth, sex workers and migrants, the barriers to condom access can be unfeasibly high. Since its inception in 2005, CARISMA partner programmes have worked with the Total Market Approach (TMA). This innovative approach – which is increasingly supported by UNFPA and key donors - is believed to have great potential for boosting both the overall size and sustainability not only of condom markets, but of other reproductive health supplies.
The aim of the TMA is to expand condom access and availability for
the poorest and highest-risk groups while simultaneously increasing
condom demand and use across the public, private, NGO and social
marketing sectors. CARISMA partners, by working in collaboration with
all sectors of the condom market, encourage effective use of existing
resources and reduced duplication of effort by market actors. The
ultimate aim is to achieve a sustainable regional market in which
condoms are sold at the right price, through the right mechanisms, to
the right people in all participating countries. Read the CARISMA Statement of Purpose on Promoting a More Sustainable Total Condom Market in the Caribbean
The Total Market Approach in Action
How does the TMA actually work and why do we need it? A common problem in the field of global public health is lack of coordination between key actors in a given health system. For example, a donor may fund a social marketing intervention to increase condom use in urban slums as part of a comprehensive sexual and reproductive health initiative. Simultaneously, a separate donor may fund the free distribution of condoms on a national scale. The commercial sector may then feel under pressure and disinclined to invest in markets where they have to compete with free or subsidised products.
The unintended result is a counterproductive approach to increasing condom use across all socio-economic groups. In some instances, a social marketing brand may draw higher-paying customers from the commercial sector. In other cases, the commercial focus of private sector campaigns may reinforce an existing market, but fail to grow demand among new potential users. Lastly, free condom distribution may create dependency on unstable condom resources that may dry up with the next funding cycle, leaving potential users without protection. The aim of a Total Market Approach is to improve the effectiveness, efficiency and equity of a health system (in this case the condom market) through the coordination of interventions with all key actors.
PSI Caribbean, which works across the islands of the Eastern Caribbean, offers a good working example of the TMA in action. This SMO initially chose not to introduce a socially marketed condom as there was already a thriving commercial condom sector providing a variety of brands and prices. In doing so, they paved the way towards a collaborative relationship with key actors in the commercial condom market, ultimately signing an MOU with regional and local condom distributors. This positive working relationship made it possible for PSI Caribbean to access several companies’ sales data to track the growth of condom sales. PSI Caribbean also collaborated with UNFPA to distribute and promote female condoms which proved to be a popular within the sex worker community. Through trained Condom Promotion Agents and the “Got It Get It” condom promotion and behaviour change campaign, PSI Caribbean helps to identify non-traditional condom outlets for commercial distributors and promote sales. They sensitize sales staff to reduce judgmental attitudes towards condom purchasers. As a result, condom outlets have been substantially expanded in the eastern Caribbean and now include places where condoms have never before been sold, such as barbershops, rum shops, mom and pop shops and nightclubs.