How do companies overcome gaps in local health systems?
While health systems are the primary responsibility of governments, companies can provide local governments and healthcare organisations with support in product delivery as they often have the know-how, resources and strategic incentives to help fill gaps.
Some of the biggest challenges to access to medicine in low- and middle-income countries are gaps in local pharmaceutical and health systems. Poor infrastructure and patchy healthcare services cause inaccurate or late diagnosis, inappropriate treatment and a loss in follow-up, in addition to too few healthcare facilities to meet demand.
To help fill such gaps, companies can build capacity outside the pharmaceutical value chain of R&D, manufacturing, pharmacovigilance and the supply chain, with a focus on prevention, education, diagnosis and/or treatment. When health systems are solid, healthcare professionals can more appropriately detect and treat conditions, which can ultimately lead to an increase in product demand. Health system strengthening initiatives can, therefore, be a potential win-win investment in the longer term – though, this commercial interest is also precisely the reason why conflicts of interest need to be managed appropriately.
Company-led initiatives aiming to strengthen local health systems need to be held to high standards to ensure company activities are both responsible and impactful. To assess the quality of company initiatives, the Index assessed a sample of initiatives against the following criteria:
- Takes places in a country in scope and during the period of analysis;
- Addresses local needs priorities and/or skill gaps;
- Is carried out in partnership with relevant stakeholders
- Has processes in place to mitigate or prevent conflict of interest;
- Is guided by clear, measurable goals or objectives;
- Measures or plans to measure outcomes;
- Has good governance structures in place;
- Has long-term aims/achieves integration within the system.
How many health system strengthening initiatives did the Index assess?
The Index examined 82 initiatives from 20 companies that meet the inclusion criteria for this analysis. Companies mostly develop solutions that are sustainable by working with local authorities.
A total of 18 companies report working with the respective national/regional health authorities to align the project with the government’s priorities and/or to integrate the programme or the project deliverables (e.g. guidelines, training curricula) into local health services. In general, companies are performing well in this area, with all companies engaging in health system strengthening. Six companies stand out: AstraZeneca, GSK, Johnson & Johnson, Novo Nordisk, Sanofi and Takeda all have five initiatives which were included for evaluation and met all Good Practice Standards.
What do the health system strengthening initiatives look like?
17 of the 82 initiatives assessed in 2021 are being carried out in partnership with another pharmaceutical company. 25 countries in scope are not covered by companies' health system strengthening initiatives, including small nations islands and countries in Latin America, Asia and sub Saharan Africa that are home to a total of over 55 million people. What’s more, initiatives are often limited to cities, provinces or counties. Once proved e˙ ective, companies should consider scaling up their initiatives both within and outside the country of activity.
Most initiatives take a disease-specific approach, focusing their activities on a predetermined set of diseases in which the company has products and expertise. Initiatives on communicable diseases predominantly target HIV (8 of 12). The majority of non-communicable diseases (NCD) initiatives address diabetes care (16 of 43) and cancer (15 of 43) prevention and diagnosis.
Training of healthcare workers is the most reported activity
Initiatives include online courses, such as Sanofi’s e-diabete and e-pediatrie programmes, reaching approximately 100,000 healthcare professionals annually, as well as in-person training like GSK’s Frontline Health Worker initiative, which has trained a total of 100,000 community health workers. Notably, in early 2020, Last Mile Health, Living Goods, The Audacious Project and the Bill and Melinda Gates Foundation partnered with the companies Eli Lilly, GSK, Johnson & Johnson, Novartis and Pfizer in the Health Worker Training Initiative. Importantly, companies involved in healthcare training activities, should proactively mitigate conflicts of interest.
Case studies: Examples of patient and healthcare reach
NCDs
Sanofi and My Child Matter
Since 2006, Sanofi’s My Child Matter programme is active in 42 countries across Africa, Asia and Latin America. It aims to address the barriers that prevent the improvement of paediatric cancer survival outcomes, including insufficient diagnosis and care and lack of surgeons and radiotherapy. Sanofi is supporting the African School of Paediatric Oncology Initiative, which aims to increase the pool of paediatric oncology professionals in French-speaking countries of Africa.
Reach: More than 25,000 professionals have been trained and more than 85,000 children have been taken into care.
Maternal health conditions
Astellas and the fistula foundation
The UNFPA estimates 3,000 new cases of obstetric fistula occur annually in Kenya, of which the majority go untreated.1 Since 2014, Astellas supported the ACTION ON FISTULATM programme led by the Fistula Foundation in Kenya. The programme centres around four areas: (1) community outreach through radio; (2) surgeons and community health worker training; (3) building collaborative network of fistula hospitals by sharing resources and referrals; and (4) provision of screening, surgery and post-operative care.
Reach: Since 2014, the programme has reached over 330,000 people and resulted in more than 6,000 women receiving treatment.
Monitoring outcomes: commitments vs action
In 2021, all 20 companies take steps to measure outcomes Stand-out efforts for measuring outcomes include working with third-party organisations and universities to measure outcomes. For example, various companies work with the London School of Hygiene and Tropical Medicine to that end. The reported outcomes show an increase in awareness, diagnosis and treatment uptake as well as healthcare worker knowledge and the quality of healthcare facilities.
Initiatives that share the outcomes are disclosed either on the company/partner websites, through academic articles, at conferences and/or on platforms such as Access Observatory, a public platform for reporting on access to medicine programmes. None of the companies publicly discloses the outcomes of all their evaluated initiatives. Companies are encouraged to partner with organisations that measure outcomes, expand their outcomes measurement activities to initiatives for which they do not yet do so. Furthermore, they should accelerate their commitment to publicly disclosing the outcomes of their health system strengthening initiatives, sharing data on people reached, public health outcomes and best practices.
Companies can perform better in the area of impact evaluation.
Higher uptake of impact evaluations needed
While companies have demonstrated increased efforts to go beyond measuring output by measuring the outcomes of their health system strengthening initiatives, they can perform better in the area of impact evaluation. 22 initiatives by ten companies (AbbVie, AstraZeneca, GSK, Johnson & Johnson, MSD, Novo Nordisk, Roche, Sanofi, Takeda) show that the company, their partner or external evaluators measured or plan to measure the impact of their activities. GSK leads in this area, demonstrating efforts to measure impact for all five initiatives included for evaluation.
