I was delighted to have Richard Pollard accept an invitation to join our conversations on social marketing this past week. I had met him in the past few months and quickly found not only a fount of colorful stories from the earliest days of social marketing, but one of the most innovative thinkers in focusing on the role of social marketing in the health marketplace.

Today, Richard may be best known for his contributions to the development of the Total Market Approach (TMA; pdf file) which has spawned some corollary movements including Making Markets Work for the Poor [pdf file]. TMA isn't something you'll find in any of the social marketing texts, and indeed, it seems to be known and discussed by only a few in the international development field, including at Global Health Policy and private sector development staff at The World Bank. However, he clearly showed its evolutionary arc from the first social marketing projects of the 1970s, and their even earlier progenitors - social responsibility campaigns in India in the 1960s. Part history lesson, and part glimpse into the future, Richard provided an impressive and thorough introduction to some ideas you will be hearing more about in the years to come.

The presentation began with the recognition that behavior change programs that require a product or service to ensure compliance must ensure these services are available, accessible and affordable. BUT... there are often inadequate public sector resources to achieve equitable coverage and sustain it; donor fatigue at continuing to put funds into the same programs for years if not decades; and the unmet needs of substantial segments of the population even after implementation occurs that are often related to access issues and existing realities.

One of the more important slides Richard showed was a chart depicting the relative share of pocketbook that people spend in countries such as Kenya, Cambodia, Egypt, India and China. In all instances, more than 50% of people's health expenditures are in the private sector and in no case did health expenditures in the public sector reach 40%. His point is that there is already a fragmented marketplace for health products and services that is by it's very nature inequitable (it favors people who can afford to pay for products and services even in societies that are, in theory and by design, suppose to provide public services to everyone). The development of the TMA approach is, in part, an attempt to correct some of these marketplace inequities and develop more sustainable long-term solutions to health problems.

Richard defined TMA as one in which all sectors (public, private and NGO or donor-financed social marketing) are integrated within one market that is segmented by willingness to pay. The objective is to open up the market to the commercial sector through better targeting of public and NGO/social marketing subsidies to the poorest of the poor and allowing the commercial sector to develop products and services to other groups more able and willing to pay [Ed Note: see for example The Next 4 Billion]. The overriding issue confronting TMA approaches is to ensure total market growth and rural/ low-income access that gains more users and, therefore, increased volume through rural wholesalers and community-based distribution. A TMA approach must also insure that commercial interests are not squeezed out of the market (whether it be for condoms, oral contraceptives or LLINs) by free or very low cost public or subsidized social marketing supply to those who can afford mass market prices and are willing to pay. Finally, there must be in place a fair regulatory and policy playing field.

He identified the roles of social marketing organizations (SMOs) in TMA as:

  • Assisting all sectors to move to a TMA over time.
  • Selling commodities to achieve a behavioral result
  • Helping the public sector achieve better targeting of subsidies, and implementing cost recovery as appropriate.
  • Regarding their own brands as a strategy to open up markets for future commercial sector.
  • Supporting national, integrated demand generation activities across all sectors.
  • Motivating the commercial sector to re-price brands and modulating product price subsidies where required (LLINs or ACT).
  • Developing community-based initiatives linking communciations with the provision of commodities.
  • Pursuing public-sector and NGO-sector outreach.
  • Exploring and implementing micro-credit and other BOTP approaches.
  • Creating adequate demand on rural kiosks/ shops.

TMA will only work well when driven by consumer demand and choice. He pointed out that consumers are more than willing to pay whatever they can afford. A payment adds value! There are also no quick fixes for a market. One low cost brand cannot make a market; it requires multiple brands and pricing coupled with strong demand. Finally, an equitable market is one where all sectors of  society have access to a range of brands they can afford and market subsidies/ distortions are carefully targeted. To my way of thinking, all the types of activities social marketers who understand the role of markets in health behavior change may be among the best to plan and undertake.

With his closing slide, Richard made the following points:

  • Most markets are unique and are at different levels of maturity.
  • Notably, public sector policies/ capacities are different; existing demand levels are different.
  • The role of an SMO is to (1) identify strategies to move towards a TMA over a realistic time-frame and establish its own strategies and (2) establish market positioning of their own brands and policies within that framework for each country.
  • The role of donors is to work within long-term market development scenarios.

The next time you hear someone talk about upstream approaches to public health, ask yourself if they have reached the core and identified the strength of the social marketing approach: competing in and harmonizing the marketplace of behaviors, ideas, products and services.

About the Author:

R. Craig Lefebvre, PhD is an architect and designer of public health and social change programs. He is an Adjunct Professor of Prevention and Community Health at The George Washington University School of Public Health and Health Services. Most recently he was the Chief Maven at Population Services International (PSI) where he led PSI's technical teams in capacity-building, HIV, malaria, child survival and clean water programs, reproductive health, and social marketing as well as its research and metrics functions.