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Marketing Mix Strategy 115

M A R KE TI N G M IX STR ATE GY

In Peru, all 4Ps in the marketing mix were needed to “get the job done.”

Product: DOTS, Adequate Drug Supplies, Clinical Services,
Training, and Information Systems

Downstream product strategies focused on DOTS. Mentioned earlier, this service
usually involves a healthcare worker who directly administers, observes, and then
documents the patient’s ingestion or injection of the tuberculosis medication (see
Box 5-1 for Paul Farmer’s DOTS story). Product quality efforts were to ensure that
when citizens arrived for testing, and when patients arrived for drugs, there would
be ample supplies and assistance. It was fully recognized that clinical services would
need to be in place in order to serve the demand communications were anticipated
to create: if patients or potential patients were unable to receive high-quality
services and drugs, as promised, they might not return or complete treatment.
Collaboration with international and national pharmaceutical companies, along
with technical assistance from international agencies, helped ensure a sufficient
drug supply, and a centralized procurement system increased efficiencies and
cost-effectiveness of their distribution. Funding from the government and inter-
national donors increased the number of microscopes and other supplies for lab-
oratories. Serving these populations well would also require the integration of TB
services into the primary healthcare system, as well as upgrading hospitals and
clinics to provide more effective diagnostic services, counseling, and treatment.
Midstream efforts were intended to strengthen interpersonal skills and expand
service capacity, with staff at all levels receiving training in clinical, laboratory, and
counseling skills. Training curricula were developed with technical assistance
from WHO and the Pan American Health Organization, focused on healthcare
workers’ first contact with patients, and included components to counter health-
care providers’ perceptions about TB (as well as about TB patients). Workers were
taught how to avoid TB while still being inviting and welcoming. Computers were
provided and used to upgrade health management information systems, and staff
were trained to record and analyze data using software specifically designed for
the TB program. And for the political leaders and media upstream, informational
seminars were provided with presentations by international experts.

Price: Free Services and Monetary and Nonmonetary Incentives
Downstream, not only did patients receive free testing, treatment, and counsel-
ing, they were also offered incentives. To encourage completing treatment,