Pharma Access Initiatives in Africa Should Routinely Address Impact Bottlenecks Part 1

Lenias Hwenda of Medicines for Africa examines the true impact of access to medicine initiatives in Africa, noting that many of the measures takes are often cosmetic and leave a swathe of “impact bottlenecks” unaddressed. Hwenda calls for a more holistic approach, moving beyond simply bringing medicines to African countries at a price that patients can afford to also including screening, diagnosis, and treatment initiation measures, concluding that treatment is not just medicine, but the total management of an illness.

More than a decade of working on access to treatment and care issues have taught me that it is nearly impossible to improve healthcare without addressing the challenges affecting the availability of healthcare services, the ability of patients to afford those services, and the quality of care. These challenges are greatest for African patients the majority of whom pay for healthcare out of pocket amidst widespread income disparities. Medicines needed to treat a large proportion of societal burden of disease in most African countries are often not available or accessible to patients consistently. When they are available, they are often too costly to be accessible at the point of care and their quality is often questionable. Such absence of quality affordable medical products undermines the performance and quality of national disease responses, interventions, and programmes.

The aid industry and pharma initiatives, like the recently launched Sanofi impact brand which aims to bring 30 high-impact medicines including insulin to 40 low-income countries on a non-profit basis, have long sought to address access to medicines issues. Impact initiatives invest millions of dollars to make affordable treatments available to patients. They are an important additional resource towards tackling access to medicines in African countries, but their impact is typically not lasting, partly because the measures taken are often cosmetic that leave numerous, what I term “impact bottlenecks”, unaddressed.

The only purpose vanity metrics serve is to perpetuate a status quo beneficial for a few elite players in the system whilst little lasting effect is being made on the intended beneficiaries of impact initiatives, the African patients

Impact bottlenecks are factors that, if left unaddressed, reduce the true positive impact of healthcare initiatives. Impact as reported in press releases and brochures often focus on vanity metrics such as companies having an access to medicines policy regardless of whether it is implemented or the number of medicines packs shipped regardless of whether they actually reached the patient at a cost they could afford. The only purpose vanity metrics serve is to perpetuate a status quo beneficial for a few elite players in the system whilst little lasting effect is being made on the intended beneficiaries of impact initiatives, the African patients.

The severe shortage of health workforce in African countries is probably the most important impact bottleneck for access to medicines initiatives. After all, prevention, the appropriate initiation of treatment, and management of disease is only possible if you have adequately-trained health care professionals and appropriate diagnosis services. Only then can patients receive medication that is appropriate to their clinical needs in doses that meet their individual requirements for an adequate length of time. Without proper diagnosis, effective treatment is impossible. Availability of diagnostic equipment can also be a bottleneck, but it is of secondary importance to the availability of healthcare professionals needed to operate the equipment. The treatment also needs to happen at a cost accessible to patients, otherwise, again there is no impact. Let’s also remember that the cost to patient is not only the out-of-pocket diagnostic and treatment cost, but those costs plus the cost of transport to healthcare facilities, cost of time taken off work, and the cost of possibly having to tour multiple pharmacies in search of the medicine that is out of stock in most places. Hence, bringing medicines and diagnostic services close to the patient addresses another major impact bottleneck.