R4D supported local change agents in 10 low- and middle-income countries to strengthen health markets for voluntary family planning (FP) and other essential health products and services, improving access, equity, and sustainability in the private sector.
The Challenge
In many low- and middle-income countries, health systems do not have enough resources, infrastructure, or workforce to fully meet growing demand for voluntary family planning (FP) and other health products and services (including for MNCH, TB, HIV/AIDS, Malaria and more). Within a mixed health system, the private sector can play a critical role in providing health products and services, but it often underperforms — marked by inefficiencies, siloed data systems, and insufficient incentives for high-quality service delivery at the primary healthcare level.
The Opportunity
Through the Frontier Health Markets (FHM) Engage project (2021-2025), R4D and an expansive consortium of international and local partners worked to build responsive, consumer-driven health markets that expanded access to family planning and other health products in Ghana, India, Kenya, Liberia, Madagascar, Nepal, Nigeria, Sierra Leone, Tanzania and Zambia.
This pioneering project applied a market development approach to identify the root causes of underperforming health markets. FHM Engage worked with local, regional and specialized partners to develop context-specific and locally informed strategies to improve market enabling environments and businesses’ capacity to grow demand for and supply of essential health products and services sustainably.
Specific approaches included:
- Identifying underlying causes for market underperformance
- Collaboratively establishing a shared vision for the market
- Determining and prioritizing necessary changes, including the responsible parties, methods and timelines
- Assisting market actors in implementing interventions to improve market dynamics
- Promoting inclusive processes and integrating mechanisms for accountability
- Enabling market actors to experiment with and refine solutions, continuously evaluate progress and measure systemic changes
- Strengthening health business operations and access to financing
- Supporting learning by identifying challenges and adapting strategies accordingly
- Advocating for policy changes that enabled businesses to function more productively
Our Work
R4D played a role in the global scope of FHM Engage as technical co-lead and supported local implementation in Tanzania — where R4D maintains a team of local experts with close ties to government officials and local partners. The following key achievements illustrate the project’s impact:
- Developed comprehensive market assessments across the FHM Engage countries: The program developed a systematic approach to understanding FP markets in each FHM Engage country, one that involved the aggregation of data from multiple sources to identify the most salient market failures in each country. These comprehensive descriptions of the FP markets then served as a guide for developing context-specific interventions to address the identified areas of market underperformance.
- Facilitated a multi-country community of practice: R4D co-managed and moderated the Healthy Markets Community of Practice (HMCoP) — a monthly forum that convened donors, implementation partners, local private sector actors and other professionals working in family planning and reproductive health markets. Each session featured local speakers and country-specific examples, creating space for participants to share knowledge, test ideas and learn from one another. By facilitating these exchanges, R4D helped build a trusted platform for collaborative learning that surfaced practical insights, addressed market gaps, and informed donor priorities and investments.
Click here to view recorded CoP sessions.
- Expanding access to data in Tanzania: One of the most significant barriers to data-use in Tanzania is siloed information systems that can differ in database structure, formats, granularity, units of measurement, availability, frequency and more. To address this, R4D worked with partner Zenysis Technologies to begin to develop the Tanzania Market Analytics Platform for Health (T-MAP), a web-based analytical tool to harmonize and integrate data from various sources (both private and public) into a single workspace to allow for easier data analysis, visualization, dissemination and use. T-MAP was designed to include two dashboards — however the platform was never finalized or implemented due to abrupt foreign assistance funding cuts:
- Condom Dashboard – Designed to strengthen Tanzania’s condom market by giving stakeholders easy access to high-quality market data to guide investments and programming. The dashboard would allow market actors to visualize trends in condom demand, assess impacts on sourcing and distribution, and make informed decisions.
- Private Sector Health Facilities Map – Designed to use service information and geolocations of pharmacies to support the introduction and scale-up of priority health products. It would link private pharmacies (and potentially ADDOs) with public and private health facilities to support private sector delivery of family planning (FP) and HIV products and services.
- Strengthened market intelligence for contraceptive products in Tanzania: The program created a data-informed methodology to estimate the size and value of Tanzania’s private contraceptive market, helping suppliers forecast demand and reduce stockouts.
- Mobilized domestic resources for FP service delivery in Tanzania: By building financial institutions’ capacity and leveraging a Development Finance Corporation loan guarantee, private lending to health providers increased sevenfold enabling for-profit, non-profit and faith-based facilities to expand access to FP and essential health services.
- Improved financial literacy among young health professionals in Tanzania: R4D collaborated with Tanzania Health Summit — a Tanzanian health advocacy organization — to develop and launch the Kuza Project, a financial literacy training program for young health professionals. The program aimed to equip young healthcare professionals and college students with the knowledge and skills to make informed decisions about investing in private healthcare-related businesses. Training covered topics such as setting financial goals, budgeting, understanding credit and debt, credit scores, and identifying investment opportunities. In addition to improving financial literacy, the program facilitated linkages with financial institutions, venture capital firms, grants, and other funding sources, helping young health professionals access the resources needed to participate in and strengthen Tanzania’s private health market. As of 2023, the program had reached 200 young health professionals — and 124 trainees successfully applied for and received loans.
