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Increasing Access to Medicines – Taking a multifaceted approach ICIUM 2011

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 need 10m avoidable deaths Health systems issue

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Increasing Access to Medicines – Taking a multifaceted approach ICIUM 2011

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  1. Increasing Access to Medicines – Taking a multifaceted approachICIUM 2011 Saul Walker*, Clare Innes** *Senior Health Advisor, **Private Sector Advisor UK Department for International Development

  2. Why address access to medicines? • High need • 10m avoidable deaths • Health systems issue • Core component • Supports multiple MDG goals (4,5,6 and 8) and NCDs • Improve value for money • 3/9 top inefficiencies (WHR 2010) • 5% savings in total health spend

  3. UK Comparative Advantage

  4. 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

  5. Approve & Register Demand & Use Scale-up & Manufacture Develop & Test Prescribe & Dispense Discover Distribute Procure • Poor demand data • IP challenges • Limited capacity for some products • Regulatory • Weak logistics, infrastructure and information • Poor coverage • Leakage • Mark-ups • Inefficiencies • Affordability/ lack of social financing • Limited access • Social barriers • Poor information • Low health literacy • Poor adherence • 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 • Low & variable financing • Multiple channels • Poor quantification • Poor use of pricing info • Non-transparent • Unclear pathways • Limited harmonisation • Very limited capacity at country level – approval, quality, pharmacovigilence • EMLs/STGs • Limited HR • Informal sector • Limited regulation • Unethical promotion • Poor practice Value chain blockages

  6. Cumulative losses in efficiency Doesn’t include availability of ACTs at int’l level Doesn’t include correct dosing or adherence Community effectiveness of healthcare: A study of malaria treatment in adults and children in Burkino Faso Krause & Sauerborn, Ann Trop Paed 2000

  7. Approve & Register Demand & Use Develop & Test Prescribe & Dispense Distribute Discover Procure UK value chain interventions Scale-up & Manufacture Push Investment – e.g. PDPs Pull Mechanisms e.g. AMC Innovation Regulatory Paths and Capacity e.g AMRH TRIPS Flexibilities/Patent Pools/IP – Global Funds and Market dynamics/engagement - e.g CHAI, GF MDC Enabling Environment Industry Good Practice - e.g. IGFAM Policy Research Affordable Medicines Facility Malaria Southern Africa Regional Programme on Access to Medicines Health Systems Medicines Transparency Alliance Bilateral Country Programmes

  8. Approve & Register Demand & Use Develop & Test Prescribe & Dispense Distribute Discover Procure 92m Coartem D* (15.3m AMFM) Example – Malaria Treatment Scale-up & Manufacture MMV - Coartem D® + pipeline DNDi – ASAQ + ASMQ FDCs Affordable Medicine Facility for Malaria - £40m + funds for M&E GFATM – long-term funding, board & MDC CHAI - Subsidy Proof of Concept, research, ACT 16 bilateral programmes - Rx specific and sector WHO Global Malaria Programme and RBM e.g. normative guidance (ACTs, RDTs), monitoring, mobilisation, best practice learning *Source: Regina Coghlan, MMV

  9. 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?) Challenges

  10. 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)

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

  12. Leading the UK government’s fight against world poverty LONDON 1 Palace Street London SW1E 5HE EAST KILBRIDE Abercrombie House Eaglesham Road East Kilbride Glasgow G75 8EA Tel: +44 (0) 20 7023 0000 Fax: +44 (0) 20 7023 0016 Website: www.dfid.gov.uk E-mail: enquiry@dfid.gov.uk Public Enquiry Point: 0845 300 4100 If calling from abroad: +44 1355 84 3132

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