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Making Markets Work

The future of global health care will require ecosystems that serve both the poor and rich. How do we create more equitable global health solutions?

Devex and its partners — The Abraaj Group, Philips and Population Services International (PSI) — will explore investments in health infrastructure that make markets work for global health and development. Over 10 weeks, #MakingMarketsWork will amplify the discussion around effective health financing, analyze key challenges blocking universal market access in the health care supply chain and explore the key strategies to make markets more effective.

Drive the conversation forward by following #MakingMarketsWork and tagging @Devex.

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Seeking new health options

Achieving the Sustainable Development Goal of healthy lives and well-being will require fully functional health markets, in which health solutions — whether provided by public or private actors — are affordable and accessible to everyone.

It also requires that stakeholders are able to quickly diagnose and correct where and why health markets break down.

Health market failures are complex — from breaks in the supply chain of medicines or medical products, to a dearth of trained health personnel, to poor policy outcomes, to name only a few. To correct the problems, rather than simply treat the symptoms, close and comprehensive analysis of all market actors is required.

In this interactive feature, Devex outlines one example of how the health market can break down, and how comprehensive analysis can correct it. Join Satya, a recently married 19-year old woman, as she explores family planning options in rural Bihar.

Satya, a recently married 19-year old woman, lives in a rural area in the northern Indian state of Bihar and is looking for family planning methods. Although she married young, she doesn’t want to have children until she’s older.

What are Satya’s options? Explore where health market obstacles occur, and how global development stakeholders can make a difference.

Click here to begin

Last week, Satya married a 22-year old farmer named Bilal, and moved into his family’s house. Someday, she knows they will want to have children. Right now, however, she believes that they are too young, and prefers to wait a few years before starting a family.


Globally, 76 percent of married women have access to modern methods of family planning, according to 2015 data from the World Health Organization.

In India, that number drops to 48.5 percent — the bulk of which live in urban centers. However, in the states of Bihar and Uttar Pradesh — two of the poorest — less than half of married women who do not want to have any children in the next two years have access to any form of birth control.


If Satya were living in a metropolis, like India’s capital New Delhi, she would have many options available. In big cities, women like Satya are more likely to receive information about birth control choices and access directly from nongovernmental organizations.

She could go to a pharmacy to get oral contraceptives, or to a public or private hospital to get IUD’s or injectable birth control.

However, Satya lives in a rural area in the state of Bihar, one of the poorest in India. Of all the 10.5 million married women of child-bearing age living in Bihar who don’t currently want to have a child, only half have access to modern methods of birth control.

Satya is one of the “lucky” ones: She lives in an area with access to some family planning options. Even so, these options are extremely limited. Pick from Satya’s available options:
a. Go to the local ASHA worker, Radha (a local woman trained as a health activist) for advice b. Go to the nearest pharmacy c. Go to a government clinic

a. Satya goes to the local ASHA WORKER

As an Accredited Health Activist, Radha has received training from the Indian government on key health issues — such as how to motivate women to give birth in hospitals, bring children to immunization clinics, and treat basic illness and injury with first aid.

However, her family planning training is limited, and only prepares her to encourage women to opt for sterilization. The women she works with also get a financial incentive in the form of wage loss compensation to do so. But because Satya is very young, newly married and wants children one day, neither women think this option is the best for Satya. She gives Satya some condoms, explains how to use them, and recommends she go to the government clinic for more options.


Satya goes to the nearest pharmacy. Sometimes they have oral contraceptives, but they stocked out months ago, and don’t know when they will receive the new stock.

They give her condoms. She decides to go to the government clinic to explore additional options.
Goverment Clinic


Satya goes to the government clinic. Unfortunately, they stocked out of short-term methods like condoms and birth control pills. They offer to perform a sterilization, but Satya wants to have children one day, so she refuses. They give her some condoms.

A. Supply of all forms of modern birth control options (oral and injectable contraceptives, IUD, etc.) is insufficient.



In fact, India is a major producer of modern family planning methods of all kinds. However, nearly 90 percent of family planning products are destined for export, and only a fraction end up supplying the Indian marketplace.

Identifying the root cause:

Various analyses identify government policies that capped the prices companies are allowed to charge for modern family planning methods. While the intention behind this policy was to make modern birth control methods more affordable, it had the unintended consequence of making it difficult for companies to make any money by selling family planning methods in India. Unable to make much profit domestically, companies focused instead on exporting to international markets.

B. Health care providers don’t have enough training on all available family planning methods.



In rural areas, healthcare providers include ASHA workers, alternative medicine providers, people who work at pharmacies, and trained doctors that work in private and government clinics and hospitals.

The training of ASHA workers focuses on improving health outcomes rather than family planning methods. ASHA workers know about sterilization, but are not as educated on other modern family planning methods.
Rural pharmacies might have oral contraceptives, but frequently stock out.
And private health care providers are unlikely to offer them to women they consider “uneducated,” because of prevalent bias that “uneducated” women won’t be able to remember to take oral pills on a regular basis.

They tend to avoid prescribing injectable contraceptives because they believe the side effects are difficult to manage. Convincing patients to adopt IUD (the most hassle-free family planning methods) is difficult, and requires significant counseling.

C. Government policies that create financial incentives for sterilization are distorting access to other modern birth control methods.



Sterilization remains India’s most prevalent family planning method. The government provides women who undergo sterilization with financial compensation.

However, this can create unintended consequences: For example, in some cases women have been forced to undergo sterilization because they (or their husbands) felt they needed the money. Also, financial incentives for ASHA workers are only for sterilization, leading to overwhelming demand for sterilization, and shrinking the market for other methods.

How do we address these market failures, so young women like Satya have access to a greater variety of modern family planning options?

Addressing the root causes of these market failure requires a multi-pronged intervention, with each stakeholder (private companies, governments, non-governmental organizations and health care providers) doing their part.
Private Companies
Health Care Providers


The government could reform domestic family planning policies, for example removing financial incentives for health care workers that favor sterilization over other forms of birth control, and creating more balanced family planning policies that uses consumer segmentation. Sterilization might be an appropriate solution for an older married woman who already has children, and doesn’t want more. However, younger women like Satya should have more appropriate options.
The government can also remove red tape limiting the private sector, for example, by not regulating the prices companies can charge for birth control methods so much that it becomes a disincentive for the private sector, and when appropriate, subsidize them so the price point works for both suppliers and consumers.
Even so, the government can’t fix this challenge by itself.

Private sector

The private sector also has an important role to play. Private companies are responsible for marketing, manufacturing, and distributing modern family planning methods. Now the government has changed their family planning policies and started subsidizing other family planning methods, there’s an enabling environment for private manufacturers to produce more family planning options for the domestic market. The private sector will also have to invest in advertising and marketing, to help boost awareness of their products. This will boost demand, and help develop the market for a variety of modern family planning options.
Even so, government and private sector intervention alone isn’t sufficient. We still need the cooperation of other actors.

Nongovernmental organizations

Nongovernmental organizations can contribute to the solution, by training existing rural health care providers on+ all of the available family planning methods, and (in the case of injectable and IUD’s) how to safely provide them.
They can also train providers on the counseling techniques appropriate for women at different stages of life.

Health care providers

Once health care providers have the training on how to counsel and offer modern family planning services, they can provide all of the available options to women like Satya. Problem solved!

Through innovative partnerships and the cooperation of all stakeholders, no market failure is insurmountable. The solutions are there — we just need to make them happen

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