SOCIAL MARKETING IN HEALTH

Presenter- Dr. Manju

 Contents
• Definition of Marketing
• Social Marketing – Definition
History
Need
• Difference b/w social and commercial marketing
• Objectives & eight essential component
• Six phases of social marketing
• Social marketing in India
• National Strategy for Social Marketing (NSSP), 2001
• Global Social Marketing Challenges
• Implications of Social Marketing for Health Care Practice
 Marketing

Marketing is the activity, set of institutions, and processes for

creating, communicating, delivering, and exchanging
offerings that have value for customers, clients, partners, and
society at large.
American Marketing Association
 Social Marketing

In 1971, Kotler and Zaltman

"the design, implementation and control of programs
calculated to influence the acceptability of social ideas and
involving considerations of product planning, pricing,
communication, distribution and marketing research."

Andreasen, 1995
"the application of commercial marketing technologies to the
analysis, planning, execution, and evaluation of programs
designed to influence voluntary behavior of target audiences
in order to improve their personal welfare and that of society.”
 History

• Field of social marketing began from an article published by

G.D. Wiebe in the Winter 1951-1952 edition of Public
Opinion Quarterly. He saw challenges of attempting to sell
a social good as if it were a commodity, thus identifying
social marketing (though he did not label it as such) as a
discipline unique from commodity marketing.

• The term “Social marketing” was first coined by Kotler and

Zaltman in 1971.
SOCIAL MARKETING IS: SOCIAL MARKETING IS NOT:

A social or behavior change Just advertising

strategy

Most effective when it activates A clever slogan or messaging

people strategy
Targeted to those who have a Reaching everyone through a
reason to care and who are media blitz
ready for change
Strategic, and requires efficient An image campaign
use of resources

Integrated, and works on the A quick process

“installment plan”
SOCIAL MARKETING ADVERTISING

Targets complex, Target simpler, feel-good

psychological processes behaviors (e.g. purchasing)

Tries to change deeply held Fit into existing social norms

beliefs

Requires sophisticated Research can be more

research informal

Needs emotional “hook” Simple slogans

Why is social marketing needed?

• Methods traditionally used to deliver health products and

services in developing countries often do not reach a large
portion of the population, especially those at the low end of
the cash economy.
• Commercial entities sell products at high prices affordable
only to a small portion of the population, usually with little or
no promotion.
• Over-burdened public health systems generally do not
have enough outlets, and provide a free, generic product or
service that often is not valued by the consumer.
• Government ministries are limited in the type and nature of
motivational campaigns they can undertake.
 Why sell products rather than give them
away?

• When products are given away free, the recipient often

does not value them or even use them.
• Accordingly, the quantity supplied under the Free Supply
Scheme is prone to wastage. (not only at the consumer
level but also along the disbursement line).
• Selling products can tap the resources of the local
commercial infrastructure, which is financially motivated to
stock and sell the products. The products become
available, not just in a small number of public health clinics,
but also at pharmacies and other retail and NGO outlets.
• Those outside the cash economy will continue to use the
free products given away by public health clinics.
 Objective Of Social Marketing Program

• To promote the acceptability and adoption of socially

beneficial, voluntary health behaviour.
• To improve access to, and availability of a wide range of
quality health information, affordable products and services
for the rural, under-served, low-income and vulnerable
populations.
• To adequately research the segmented market for
contraceptives and other products and services for basic
and essential health care, as well as consumer preferences
in respect of product attributes.
 Objective Of Social Marketing Program

• To decentralise the social marketing programme.

• To mainstream the coalition envisaged for private–NGO-
public partnership.
• To ensure the strengthening of logistics at state levels to
enable an uninterrupted flow of products and services.
 Eight Essential Components

In 1988, Craig Lefebvre and June Flora

1. A Consumer orientation to realize organizational (social) goals
2. An emphasis on the voluntary exchanges of goods and services
between providers and consumers
3. Research in audience analysis and segmentation strategies
4. The use of formative research in product and message design and the
pretesting of these materials
5. An analysis of distribution (or communication) channels
6. Use of the marketing mix in intervention planning and implementation
7. A process tracking system with both integrative and control functions
8. A management process that involves problem analysis, planning,
implementation and feedback functions
SIX PHASES OF SOCIAL MARKETING

Problem description

Formative research

Strategy development

Intervention design

Evaluation

Implementation
 Problem Description

• A full, clear problem description and analysis will help to

decide whether to undertake a social marketing effort.
• will help you keep your main goal in mind.

In this Phase, you will…

• state your health or safety problem and the groups it affects
• Identify factors that contribute to the problem.
• List of broad potential target audiences, secondary
audiences, and behavior changes.
 Problem Description.

• Summary of any existing data about the problem, audience,

and behavior.
• Models of behavior change that may apply.
• previous efforts to address the problem
• Best practices or lessons learned from other programs that
may be similar.
• List of your strategy team members and summary of how
decisions will be made.
• SWOT (strengths, weaknesses, opportunities, and threats)
analysis.
 Formative research

• Also called formative assessment, market research,

consumer research, or audience research.
• Research conducted during the development of program to
• choose and describe a target audience,
• understand the factors which influence their
behavior, and
• determine best ways to reach them.
 Audience

Primary target audience: Also called target audiences,

• a group of individuals whose behavior needs to change to
positively impact the problem.
• They could be directly affected by the problem themselves,
or those who can make policy or environmental changes
(i.e., voting behavior, approval of policies).

Secondary audience: A group of individuals who exert

influence on the primary target audience's behavior.
 Audience Orientation

• what the target audience currently knows, believes, and

does?
• The program is designed to fulfill the audience's needs and
wants.
Example-
• Program planners created an intervention for young women to increase
physical activity and healthy eating habits.
• They originally thought that their target audience would find
personalized phone calls motivating, and planned to incorporate them
into the intervention.
• However, the target audience did not respond to that idea at all when
asked about it in focus groups.
 Audience Segmentation

• Audience segmentation is the process of dividing a broad

target audience into more homogeneous subgroups, called
audience segments.
Importance:
• to do more with limited resources
• can use the programming, communication channels, and
messages that are most relevant to your segment.
done on basis of
• Demography
• Behavior
 Audience Segmentation

• For example, completely different programs would be

designed for these two segments:
• Overweight adults who do not enjoy physical activity and
are not motivated to participate in it. (The program for this
segment would need to address the target audience's
motivation before behavior change can be expected.)
• Overweight adults who like physical activity and are
motivated to do it, but can't find the time during the day to
participate in it. (The program for this segment would need
to address the target audience's perception of the barrier of
lack of time.)
 Behavior

• Program's goals should be designed to influence behavior

instead of only increasing knowledge or awareness of a
problem
Should know
• Current behaviors of your audience.
• Ideal behaviors.
• Reasonable steps to move the audience from the current
behavior towards the ideal behavior.
• What determines their behavior.
 Behavior

Example-
Current behavior of the target audience: Watches
approximately 5 hours of television per day
Recommended behavior: Watching two or fewer hours of
television per day
Possible behavior change: Reduce television viewing by
one hour-long TV show per day (an intermediate behavior
change that will move the audience towards the ideal
behavior).
Broad Behavior Specific Behaviors

Eat more fruits and 1. Choose fruit or 2. Eat a piece of 3. Purchase fruits
vegetables vegetable options in fruit or some and vegetables
the vending vegetables as a from a local
machine over candy mid-day snack. farmer's market.
or other high-fat
snacks.

Do more physical 1. Join a sports 2. Use lunch hour to 3. Take the stairs
activity team. walk on trail near instead of the
office. elevator.

Watch less TV 1. Turn off the TV 2. Remove TV from 3. Establish and

during mealtimes. bedrooms. enforce rules
limiting TV time.
 Strategy development

• Be creative.
• Consider policy and
environment-level changes
when appropriate.
• Keep your audience's
perspective
 4 P’s of Market Mix

PRODUCT

PROMOTION
MARKET PRICE
ING MIX

PLACE
 Product

Product: What the audience gets or what you offer; can be

tangible items, intangible benefits, or the behavior itself.

Core product - or innermost level is made up of the benefits

of the desired behavior,

Actual product - is the behavior itself,

Augmented product - contains any objects or services

created to support behavior change.
 Product

For example,
• behavior of eating fruits and vegetables - actual product
• fruits and vegetables themselves and a new farmer's
market that sells fruits and vegetables - augmented
products.
• Decrease in obesity- core product
 Price

Price:
• What the audience gives up to get a tangible product;
• also the costs or barriers to making the desired behavior
change.
barriers such as loss of time,
decrease in pleasure,
loss of self-esteem,
loss of respect from peers,
lack of access, or
embarrassment
 Price

Example-
• Psychological and social costs of physical activity for teens
include
• embarrassment
• fear of being teased.
• Other costs include
• loss of time that could be spent doing something
else (i.e., playing video games or talking on the
phone) or
• financial costs, such as those associated with
sports teams or organized classes
 Place

Place:
includes both where and when the audience
• Performs the desired behavior.
• Is located or gathers.
• Accesses products or services.
• Thinks or hears about the health issue or behavior.
 Promotion

Promotion :
• Promotion includes communication or education that
describes the program's benefits, product, price, and place.
• It includes
• Messages.
• Materials.
• Channels.
• Incentives.
• Activities.
 Promotion

• Promotion included consistent, persistent and targeted

communications using a variety of channels
• paid advertising,
• public relations,
• printed materials,
• promotional items,
• signage,
• special events,
• video showings,
• local celebrity involvement, and
• Web sites
 Competition

• "behaviors and related benefits that the target audience is

accustomed to—or may prefer—to the behavior you are
promoting.“
• The target audience is doing something instead of the
behavior you want them to do.
e.g. Possible competing activities for physical activity in teens–
» Watching TV
» Playing on the computer
» Talking on the phone
» Going to the mall/shopping
» Spending time with friends
» Doing homework
 Exchange

• give one thing up in return for something else.

• The target audience will compare the costs and benefits of
performing a behavior before choosing to adopt it.
• The exchange should increase the perceived benefits of
the target behavior and minimize its costs. Or
• it could increase the perceived costs of the competing
behaviors and minimize their benefits.
• It can be
• Tangible (paying a higher price for a healthier vending
machine option),
• Intangible (giving up a TV show to go for a walk to improve
one's health).
 Exchange

You Give Me You Get

Rs. 2.00 /- • A Condom
Embarrassment • protection against
pregnancy
Loss of Pleasure
• protection against
STDs
• peace of mind
 Additional P’s

PRODUCT

POLICY PARTNERSHIP

PROMOTION MARKETING MIX PRICE

PUBLIC POLITICS

PLACE
 Policy

• POLICY refers to the laws and regulations that influence

the desired behavior.
• Policy or environmental level changes can support
individual behavior change
• Make strategies to influence the "upstream" behavior of
policymakers and those responsible for the environment
• Example –
• requiring sidewalks to make communities more walkable,
or
• prohibiting smoking in shared public spaces.
 Partnership

• The social marketing organization can enhance its program

effectiveness by teaming up with other organization
pursuing similar goals.
• The educational and economic levels of the beneficiaries
are some of the factors determining the effectiveness of
program pertaining to health and ecological conservation.
• Avoid duplication of efforts, expanding resources,
minimizing costs and enhancing program effectiveness.
 Politics

• Religious leaders and organizations, village heads or

community leaders
• Permission granting groups
• Trigger social change faster
 SIVA MODEL

• This system is basically the four Ps renamed and reworded

to provide a customer focus.

The SIVA Model provides a demand/customer-centric

alternative to the well-known 4Ps

• Product → Solution
• Price → Value
• Place → Access
• Promotion → Information
 Intervention Design

In this phase, you will:

• Assemble your planning team and assign roles
• plan your interventions in detail
• test and revise your interventions
Know the details about
• Partnerships or agreements with organizations or people.
• New or modified services that will be offered (including staff,
training).
• Lesson plans or curricula for training, skill-building, or courses.
• Messages or materials needed to communicate with the
audience.
• Incentives for the target audience to participate.
 Evaluation

Evaluate to know whether you are doing:

• the right things
• the right things right
• enough of the right things to make a difference in outcomes
In this phase you will:
• determine which program components should be monitored
and/or evaluated
• decide how to gather the information
• decide how to analyze and report the data
 Evaluation

Evaluation activities should be:

• useful (i.e., responsive to stakeholder information needs)
• feasible given time, resources, and available expertise
• accurate enough to inform the kinds of decisions to be
made
• proper/ethical
 Implementation

In this phase, you will implement both your intervention plan

and your monitoring and evaluation plan

In Phase 6, you will:

• Execute intervention plans

• Initiate monitoring and evaluation activities
• Modify program components based on feedback
• Share evaluation findings and lessons learned
MARKET STRUCTURE IN INDIA

TOTAL MARKET

FREE SOCIAL COMMERCIAL

SUPPLY MARKETING MARKET

GoI SMO DOMESTIC IMPORTED

BRANDS BRANDS BRANDS BRANDS
 MILESTONES

1968: Social Marketing was launched with 6 leading

consumer goods/oil companies with 3 lakh outlets, with area
allotted to each.
1983: Introduction of promotional incentive on sale of
condoms to social marketing organizations (SMOs)
1987: Oral Pills – the social marketing programme was
extended to include Oral Contraceptive Pills with the brand
name- Mala-D.
1995: Introduction of Centchroman, ‘Saheli’, through HLL
under social marketing, with Product & Promotional Subsidy
1999: Working Group with all SMOs constituted for evolving
the social marketing programme strategy
 NSSM, 2001

"National Strategy for Social Marketing", [NSSM], 2001

develops a strategy for the social marketing of products and
services for reproductive and child health (RCH) in India.

• Free supply was intended to address the unmet need of

40% of the Indian population below poverty line (BPL)
• Social marketing focuses at the lower (20%), lower-middle
(15%), and middle-middle (12%) income brackets, for a
47% share of the Indian population
• Commercial marketing targets an estimated 8% upper
middle class and 5% upper class, total of 13% share
 STRATEGIES OF SMP IN INDIA

1. Expand Demand among Priority Target Groups

2. Expanding the Basket of Products in the SMP
3. A Public – Private / NGO Partnership
4. Expand the market to reach rural areas and urban slums
5. Social Franchising of Health Care Services
6. Align Government Subsidy to Programme Objectives
7. Diversify sources of funding
8. Institutional Mechanism for Running the Social Marketing
Programme
9. Improving Programme Management
10. Allocation of Public Funds towards Area Projects
11. Social Marketing Ethics
 Expand Demand Among Priority
Target Groups

Promotion of behaviour change among potential users, and

especially among priority target groups
• Generic Campaigns
• Brand Advertising
Behaviour change communication (BCC) may be designed to:
• increase overall demand for products with public health
benefits
• encourage adoption of healthy lifestyles
To bring a health benefit, communication to increase demand
must be combined with measures to ensure access and
supply of the desired product or service in the public and/or
private sectors.
Expanding The Basket Of Products In
The SMP

Operational Strategies
• Provide multiple choices through multiple products and
services at multiple delivery points
• Social marketing organization (SMOs) must diversify and
introduce newer products for basic and essential health
care.
• SMOs must ensure that appropriate training and refresher
courses for their retailers/vendors.
• Ensure regular supplies.
• SMOs must ensure that all prior clearances from the office
of the Drug Controller of India have been duly obtained with
current validity for products not subsidised by government
A Public – Private / NGO Partnership

• Operational Strategies:
• MoHFW will furnish district profiles to the District
Magistrates and District Medical Officers updated once
every year
• District Magistrates and Chief Medical Officers must
facilitate a dialogue with and between potential partners
• SMOs play a catalytic role in sustaining the partnerships
• Non–overlapping concession areas awarded for the
marketing of public sector brands
 Expand The Market to Reach Rural
Areas And Urban Slums

Operational Strategies:
• through the existing and widespread public health infra-
structure
• Additional channels such as the ICDS program could
similarly be utilised
• Promotional programmes like folk theatre, video vans, and
sales booths could become a regular feature of these
partnerships.
 Social Franchising of Health Care
Services

• Social franchising consists of developing networks of

private sector and NGO run clinics, contracted to offer
health information and counselling, health products, and
health care services
• Social franchisee would be a private-NGO-public
partnership
• Contract out a Package for Essential Health Care
• Finance private sector / NGO providers through pre
payment scheme
 THE "JANANI MODEL" IN INDIA

• In Bihar and Madhya Pradesh

• Janani provides family planning and comprehensive
abortion care services by strengthening and expanding the
capacity of the private sector.
• incorporated clinical services, and served rural areas, using
private sector channels that already exist.
• “Butterfly centres" & "Surya clinics"
 Government Subsidy To Programme
Objectives
Product subsidy: the difference between procurement cost
of the product and the issue price to the SMOs.

Promotional subsidy: to pursue promotional activities,

pegged upon the sales achieved.

Packaging subsidy: for those SMOs who market their own

brands, since they supply the packaging materials to the
manufacturer.
 Government Subsidy To Programme
Objectives
Illustrative cost chain for OCPs marketed through SMOs:
• The DOFW buys OCPs from manufacturers at Rs 3.55/
cycle
• An SMO buy OCPs from DOFW at 1.60/ cycle

• The SMO receives a promotional subsidy from the GOI of

Rs. 0.25/ cycle sold

• The SMO buys its own packaging with a government

subsidy of up to Rs 0.35/ cycle
 Government Subsidy To Programme
Objectives
• A promotional incentive provided to the SMOs
• 10 paise per condom sold for Deluxe and Super Deluxe
varieties, and
• 3 paise per condom sold for New Lubricated variety
• Deluxe Nirodh is also sold by State AIDS Control Societies
through their NGOs network.
The names of manufacturers:
• Hindustan Latex Ltd
• TTK LIG
• Polar Latex Ltd.
• J.K. Ansell
 Diversify Sources Of Funding

• GoI will continue to provide financial support to SMPs

Additional resources mobilised from:

• Multilateral development banks,
• Bilateral and other development organisations
• Global foundations
• The private corporate sector
• Other related programs and organisations, such as
National AIDS Control Organisation (NACO)
 Institutional Mechanism For Running
SMP
• Secretariat coordinated by UNFPA within the Consortium.
• Consortium on Social Marketing: A mechanism for
stakeholder involvement in decision-making and for
transparency.
• A dedicated Social Marketing Unit within MoHFW for
performing the role of facilitator.
• Technical Support Group: A TSG contracted by Social
Marketing Unit, within the MoHFW, for providing needed
technical inputs in programme management, and advising
the Secretariat and the Consortium
 Improving Programme Management

Participation in the Social Marketing Programme:

based on pre-defined criteria, carefully documented, and
reviewed each year
Programme Management:
• memorandum of understanding (MOU) with details like
price range
• SMOs to furnish reports at regular and pre-determined
intervals
• External assessment twice a year
 Improving Programme Management

• Product Management:
• Branding: promotes market segmentation and image
building, which enhances demand
• Quality assurance: an inter-laboratory calibration
mechanism set up at the Nodal GOI laboratory for testing
• Product pricing: an appropriate structure of margins in the
MRP, to cover the cost of distribution and some minimal
incentive. Flexibility to the SMOs to set their MRP within a
stipulated price range
 Allocation of Public Funds Towards
Area Projects
• The Secretariat for the administration of the SMP: identifies
areas of need in all parts of the country, and invites plans
from the stakeholders for addressing the need through the
special projects.

• Funding support for this component is over and above the

funds earmarked for normal social marketing operations.
 Allocation of Public Funds Towards
Area Projects
• Swastha Gram Pariyojana:
• In 1998-99, the Department of Family Welfare sanctioned a
pilot project to M/s. Hindustan Latex Family Planning
Promotion Trust, Thiruvananthapuram HLFPPT) of HLL, for
strengthening Social Marketing of Contraceptives
programme.
• The project has been implemented in three districts of
Madhya Pradesh viz., Gwalior, Bhind and Morena.
• This has been extended up to 31.3.2001 with inclusion of
two more adjacent districts namely; Shivpuri and Datia.
 Social Marketing Of MCH Products

• Social Marketing of condoms under the brand name Masti,

being supported by behaviour change communication
through television in UP, Uttarakhand and hoardings in
Jharkhand.

• Social marketing of OCPs under the brand name Pearl

promoted through generic behaviour change
communication campaigns on television; bolstered via the
distribution of flyers addressing common myths regarding
side effects of OCP consumption.
 Social Marketing Of MCH Products

• Social marketing of ORS under the brand name Neotral

supported by intensive meetings among groups of 18-20
private health providers, called “Saadhan Baithaks”.

• Social marketing of IFA tablets under the brand name

Vitalet-preg promoted through “Saadhan Baithaks”..
•
• Newborn brand Clean Delivery Kits (CDK) were being sold
in selected district of Uttar Pradesh and Jharkhand.
 Social Marketing Ethics

• Be truthful, fair and balanced

• Protect privacy
• Don’t model inappropriate behavior
• Don’t be offensive
• Do more good than harm
• Favour free choice
• Evaluate marketing within a broader context of behavior
management
 Social Marketing Ethics

• Select marketing tactics that fit marketing philosophy.

• Evaluate ethicality if policy before agreeing to develop
strategy
• Seek permission to enter and address targeted social
issues.
• Be certain to understand culture, values and norms.
• Ensure there will be responsible participation who can be
held accountable for changes.
 Barriers in Social Marketing

• Potential of social marketing unappreciated.

• The consumer base is very heterogeneous, customization
of products for so many segments and mini segments is
virtually impossible
• Media is privately owned; airtime is expensive
• Social marketing is often done poorly
• Policy decisions at local, national and international levels
often guide the product strategy and hence the product
cannot be easily changed
 Global Social Marketing Challenges

• Increase in health issues competing for public attention

(tobacco, obesity, drug abuse, HIV/AIDS)
• Busy lifestyles, people’s time limitations, technology.
• Cluttered media environment for health information.
• Increase in the number and type of communication
channels, including the Internet.
• Consumers & practitioners: Demands on time, multiple
education/information sources, changing practice
guidelines.
 Implications of Social Marketing for
Health Care Practice
• Social marketing can be useful in health care practice.
• Evidence on social marketing suggests underlying
principles can influence health care consumer decision
making through multiple strategies.
• Health care setting provides a unique opportunity to
reinforce messages aimed to consumers through brief
counseling.
• As a trusted source, practitioners’ reinforcement of social
marketing messages adds value beyond the effects of
mass communication.
 References

• Basics of social marketing. Centre for diseases control and

prevention. Atlanta, United States.
• Training: Social marketing planning process. CDC.
www.cdc.gov/nccdphp/dnpa/socialmarketing/.../planning_pr
ocess.htm
• National Strategy For Social Marketing: DRAFT (November
2001).
• ADM Ganju, Prasad R.Marketing for Public Health
Programmes.The Journal of family Welfare 50; 2004.
• The Basics of Social Marketing. Social Marketing National
Excellence Collaborative. Turning Point National Program
Office. University of Washington