Increasing Access to Medicines – Taking a multifaceted approach

ICIUM 2011

Saul Walker*, Clare Innes**

*Senior Health Advisor, **Private Sector Advisor

UK Department for International Development

Why address access to medicines?

High need10m avoidable deaths

Health systems issueCore component

Supports multiple MDG goals (4,5,6 and 8) and NCDs

Improve value for money3/9 top inefficiencies (WHR 2010)

5% savings in total health spend

UK Comparative Advantage

In-house

expertise &

ext. partners

Recognised

leadership (e.g

Financing)

Rising R&D

budget

Disease

& system

approaches

Strong global

& country

presence

Established

Analytical

Framework

Established

Govt

Working

DFID

Access challenges

Financing – insufficient and inequitable

Complex state/non-state mix

Weak infrastructure and HR

Weak regulatory environment

Very high information asymmetries

Weak management information systems

Strong external players

Portable, high value goods

Discover Develop & Test

Approve & Register

Scale-up & Manufacture

Procure Prescribe & Dispense

Distribute Demand & Use

• Low commercial incentives• Limited product development

expertise in public sector• Limited R&D/trial capacity in

developing countries• Limited ID and Dev Country

expertise in private sector

• Unclear pathways • Limited harmonisation• Very limited capacity at country

level – approval, quality, pharmacovigilence

• Affordability/ lack of social financing

• Limited access• Social barriers• Poor information• Low health

literacy• Poor adherence

• Weak logistics, infrastructure and information

• Poor coverage• Leakage• Mark-ups• Inefficiencies

• Poor demand data

• IP challenges• Limited capacity

for some products• Regulatory

• Low & variable financing

• Multiple channels• Poor quantification• Poor use of pricing

info• Non-transparent

• EMLs/STGs• Limited HR• Informal sector• Limited regulation• Unethical

promotion• Poor practice

Value chain blockages

Cumulative losses in efficiency

Community effectiveness of healthcare: A study of malaria treatment in adults and children in Burkino FasoKrause & Sauerborn, Ann Trop Paed 2000

Doesn’t include availability of ACTs at int’l level

Doesn’t include correct dosing or adherence

Innovation

Enabling Environment

Health Systems

Polic

y R

ese

arc

h

Discover Develop & Test

Approve & Register

Scale-up & Manufacture Procure Prescribe &

DispenseDistribute Demand

& Use

Push Investment – e.g. PDPs

Pull Mechanisms e.g. AMC

Regulatory Paths and Capacity e.g AMRH

TRIPS Flexibilities/Patent Pools/IP –

Industry Good Practice - e.g. IGFAM

Affordable Medicines Facility Malaria

Medicines Transparency Alliance

Bilateral Country Programmes

Global Funds and Market dynamics/engagement - e.g CHAI, GF MDC

Southern Africa Regional Programme on Access to Medicines

UK value chain interventions

Example – Malaria Treatment

Discover Develop & Test

Approve & Register

Scale-up & Manufacture Procure Prescribe &

DispenseDistribute Demand

& Use

MMV - Coartem D® + pipeline DNDi – ASAQ + ASMQ FDCs

Affordable Medicine Facility for Malaria- £40m + funds for M&E

CHAI - Subsidy Proof of Concept, research, ACT

WHO Global Malaria Programme and RBMe.g. normative guidance (ACTs, RDTs), monitoring, mobilisation, best practice learning

16 bilateral programmes- Rx specific and sector

GFATM – long-term funding, board & MDC

92

m C

oa

rtem

D*

(15

.3m

AM

FM

)

*Source: Regina Coghlan, MMV

Challenges

• Measuring results– Long and complex results chain

– Measuring the impact of influence

• Plausibility of top to bottom interventions

– Aligning policy, multilateral and bilateral programmes

– Few clear lines of sight

• Spread too thin?

• Contribution and attribution

• Strengthen evidence base (AHPSR)

• International engagement• Normative frameworks, multilateral

practice (e.g. IHP), bilateral partners

• DFID strategies (malaria, RMNH)• e.g malaria and RMNH

• Partnerships• Cluster interventions (overlap?)

Final thoughts

• Value chain only effective if all links work– International, national, provincial and last-mile

• Value chain useful analytical tool but processes aren’t linear–Highly-reflexive system (linked to other systems)–Not self-correcting

• Multi-disciplinary approaches needed to put technical solutions in context

–Political, organisational change, anthropological, economic, philosophical (values)

Acknowledgments

• Emma Back• Danny Graymore• Jane Haycock• Dr Michael Borowitz• Dr Charles Clift• Clare Innes

Leading the UK government’s fight against world poverty

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