How the Access to Medicine Index inspires stronger action by pharma companies

Access to Medicine Index

An Independent Impact Evaluation concludes that the Access to Medicine Index is a catalyst and inspiration for pharma companies to do more for the two billion people who lack access to medicine.

“We have been stimulating and measuring pharmaceutical companies for 10 years now. It was of key importance for our team, our funders and the wide range of stakeholders we work with, to assess the effectiveness of the Access to Medicine Index. I am pleased that the findings of the study recognise the impact of our activities,” says Jayasree K. Iyer, Executive Director of the Access to Medicine Foundation.

Findings show that the Access to Medicine Index has contributed to change

The evaluation found that the Access to Medicine Foundation has succeeded to a remarkable degree in building consensus between stakeholders in a highly politicised field, advancing the engagement of the pharmaceutical industry with the issue of access to medicine.

Pharma companies confirmed that they use the Access to Medicine Index internally as a tool for learning and strategy formulation, whilst welcoming greater use of the Index by external stakeholders. Together, these findings speak to the importance many companies attribute to the Index and the role of the Index as a valuable agent for change in a complex environment of competing influences.

Tool for learning and discussion

The clearest way in which the Access to Medicine Index has affected corporate access-to-medicine policies and practices is by providing the industry with a tool for learning and discussion. The Index has given companies a greater understanding of their own scope of activities, and enabled them to draw inspiration from each other. In particular, by developing a framework of clear, yet wide-ranging, actions for improving access to medicine, the Foundation has helped companies to broaden their perspective on the issue, in some cases even directly contributing to the formulation of more holistic corporate access-to-medicine strategies.

A race to be the best

The competitive aspect of the Access to Medicine Index has long been considered one of its most powerful potential pathways of influence. Indeed, many companies acknowledge that a high ranking is valued. In several companies, there are indications that senior management seek to improve their rankings (or to maintain an already high one) and that unexpectedly low rankings have acted in the past as a “wake-up call”. However, companies emphasise that their access-to-medicine activities are motivated by a desire to do better in absolute rather than relative terms.

Bringing external pressure to bear

The evaluation also assessed the significance of external pressures linked to the Access to Medicine Index, for instance social pressure from civil society actors, financial pressure from investors and regulatory pressure from governments. Social pressure appears to be the most viable pathway of influence. The positive recognition that the Access to Medicine Index offers for good practices is felt as a welcome encouragement and a source of pride, whilst negative attention is felt as something to be avoided.  Validation of good performance from the Index has also been credited for enabling stronger relationships between companies and non-governmental organisations.

Measuring impact to enhance impact

“The Dutch Ministry of Foreign Affairs has a strong commitment to assess the impact and value-for-money of the projects it supports. This is why I was pleased when the Access to Medicine Foundation embarked in the process of evaluating its influence on what pharmaceutical companies do to facilitate access to medicine. The positive results of the study confirm that our decision to support the Access to Medicine Index has contributed to real action,” says Lander van Ommen, MD MPH, Health Adviser, Social Development Department, Dutch Ministry of Foreign Affairs.

The evaluation provides a retrospective assessment of the effectiveness of the Access to Medicine Index, with the authors offering a number of useful, forward-looking reflections. These suggestions focused on consolidating the achievements of the Access to Medicine Foundation (by, for example, maintaining the Index methodology in line with global health and development targets) and increasing the impacts from existing activities (such as strengthening engagement with external stakeholders working at regional and local levels). The evaluation also recommended expanding the portfolio of activities of the Access to Medicine Foundation. For example, Technopolis Group suggested benchmarking the performance of generics companies too.

How do you measure impact on corporate behaviour?

The evaluation was commissioned by an independent Reference Group, which selected Technopolis Group to design and conduct the study. Technopolis Group has long-lasting experience in impact assessments for global health donors, including for the Dutch Ministry of Foreign Affairs, the European Commission and the UK Department for International Development. The Reference Group was chaired by Paul Engel, Senior Fellow and former Director at ECDPM. It oversaw the study at each step, and validated the methodology.

“The behaviour of pharmaceutical companies in the field of access to medicine is determined by numerous factors. The evaluation has critically looked at those that were evaluable within the framework of this exercise. As was to be expected, isolating the impact of the Index on any of these factors proved particularly challenging. However, by developing and applying a comprehensive Theory of Change, with specific hypotheses and research questions, Technopolis Group was able to provide clear answers where possible. As a result, the final report offers a plausible indication of the various ways in which the Access to Medicine Index triggers corporate change and of the opportunities for improvement that exist,” says Paul Engel, Senior Fellow, ECDPM.

The evaluation was primarily based on interviews with representatives of pharmaceutical companies (both Indexed and non-indexed companies) as well as other external stakeholder groups. Technopolis conducted in-depth case studies for five indexed companies. Purposive selection on several key characteristics was done to ensure sufficient heterogeneity in the sample. The two most important of these were a company’s relative position in the Index (and the evaluation therein over time), and its geographic representation. Additional company characteristics that were considered were the number of diseases and markets covered that are in scope for the Index, or the presence of company characteristics such as particularly strong performance in one of the Technical Areas of the Index.

To provide a theoretical underpinning for the evaluation, Technopolis developed a Theory of Change for the Access to Medicine Index. The Theory of Change included several pathways of influence, covering pressures from both within and outside the companies. The evaluation first assessed whether the Index fulfils basic conditions of relevance, feasibility, acceptability and credibility, which are necessary to activate its potential pathways of influence (such as competition through the ranking, learning through diffusion of good practices, and financial pressure from investors). The study then evaluated the absolute and relative effectiveness of each of these pathways.

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About the Access to Medicine Index

The Access to Medicine Index analyses the top 20 research-based pharmaceutical companies with products for high-burden diseases in low- and middle-income countries. The Index ranks these companies according to their efforts to improve access to medicine in seven areas of corporate behaviour, including pricing, patents, ethical behaviour and donations. It covers 107 low- and middle-income countries and 50 high-burden diseases, and examines eight types of products, from medicines to vaccines to diagnostics. The Index identifies best practices, highlights where progress is being made, and uncovers where critical action is still required. In this way, the Index provides both an incentive and a guide for pharmaceutical companies to do more to improve access to medicine. It is published every two years by the Access to Medicine Foundation, an independent non-profit organisation.

About the Access to Medicine Foundation

The Access to Medicine Foundation is a non-profit organisation based in the Netherlands. It aims to advance access to medicine in low- and middle-income countries by stimulating and guiding the pharmaceutical industry to play a greater role in improving access to medicine. The Foundation is funded by the Bill & Melinda Gates Foundation, the Dutch Ministry of Foreign Affairs and the UK Department for International Development. For ten years, the Foundation has been building consensus on the role for the pharmaceutical industry in improving access to medicine and vaccines. It published its first benchmark of industry activity in this area in 2008, in the first Access to Medicine Index. The fifth Access to Medicine Index will be published in 2016.