Launched in 2015, the Novartis Access is a prime example of how the private, public and civic sectors can complement each other. The company is partnering with governments and NGOs to distribute medicines on the ground and to raise awareness and strengthen healthcare system capabilities.
Michael Fuerst, Senior Manager Corporate Responsibility Strategy & Innovation at Novartis International AG spoke to Frances Buckingham about the access programme.
Can you tell me how Novartis Access became part of the business?
Novartis has a long history in access to medicines. Until now, the focus has been on infectious diseases but if one looks at the disease landscape and the global disease burden, we see that the patterns are shifting toward non-communicable diseases (NCDs). Low-income or access-constrained regions are hit hard by NCDs and continuous access to affordable, high-quality medicines is often very limited.
As a large proportion of our company’s portfolio is focused on NCD medicines, it was natural for Novartis to become more active in this space. We decided to build on our existing expertise and launch a new access programme to help lower-income countries address the double disease burden they are now facing.
And how is Novartis Access different from previous initiatives?
Most of the access programmes that Novartis (and other companies) have developed over the years are either philanthropic or not-for-profit. There will always be a need for philanthropic programmes. However, in recent years, we have also been trying to develop programmes that can be sustainable without relying on grants or donations. We expect this will allow us to scale up and replicate the activities. Novartis Access is a prime example: you can’t reasonably build an access programme to help fight chronic diseases that require life-long treatment (in most cases) and reach more than 20 million patients if you do not aim to make it sustainable in the mid- to long-term.
Low-income or access-constrained regions are hit hard by NCDs and continuous access to affordable, high-quality medicines is often very limited.
It covers the four main NCD disease areas – cardiovascular, respiratory, cancer, particularly breast cancer, and diabetes. The treatments provided through Novartis Access have been selected from the Group portfolio based on three criteria: significant health need, medical relevance, and lack of local access programmes in these disease areas. Our approach is to provide a portfolio of on- and off-patent medicines to governments, NGOs and other public-sector healthcare providers at a price of USD1 per treatment per month. In collaboration with our partners, we also aim to keep mark-ups low along the distribution chain in order to keep the price affordable for patients. In Kenya, for example, patients should pay no more than USD1.50 per treatment per month.
What role do partnerships play?
Typically, in the countries where we want to launch, the health systems need to be strengthened. It is not effective to provide NCD medicines to a country without also considering the parts of the healthcare system that are needed for positive outcomes. To give an example, it is ineffective to provide cancer medicines to countries that do not have the facilities to actually diagnose cancer. This is why we are partnering with organisations that can contribute their skills and capabilities to the programme and help strengthen healthcare systems.
It is not effective to provide NCD medicines to a country without also considering the parts of the healthcare system that are needed for positive outcomes.
Areas of potential collaboration include programmes to raise awareness about chronic diseases, train healthcare personnel to diagnose and treat chronic illnesses and strengthen medicine distribution systems.
For example, we work with MSH, an organisation with expertise in the pharmaceutical supply chain area. With them, we are testing and validating a replicable surveillance system for supply chain integrity in Kenya. We also work with other NGOs: the Kenyan Red Cross for drug distribution and capacity building, the faith-based sector, notably the Kenya Conference of Catholic Bishops (KCCB) and the Christian Health Association of Kenya (CHAK) to raise awareness on NCDs and train healthcare personnel, and MEDS for drug distribution as they have excellent warehousing and distribution capabilities.
What work are you doing to strengthen healthcare systems?
We are committed to providing a reliable supply and delivery of high-quality and affordable medicines, which is already a big step in strengthening the system.
Supply chain efficiency and integrity need to be addressed, as well as mark-ups in a highly fragmented distribution system as they can be detrimental from an access and affordability perspective. There are many issues that have to be addressed but above all, progress requires the different parties to share a similar view on the analysis of the situation and the problems, and to reach common conclusions about what needs to be done.
We are also currently exploring partnerships on innovative financing models. We are still at the very early stages of our thinking but bringing capital markets into the equation and the solution mix to help, for instance, to strengthen diagnostic capabilities in hospitals, service delivery, stability and efficiency in the distribution system, etc. could be an interesting route.
What have been the challenges?
Aligning such an innovative programme with our commercial operations and sometimes avoiding conflicts requires a lot of thinking and proper execution. This goes from staffing, to allocating manufacturing capacities to produce the medicines, setting up structures in the countries that are closely aligned with local operations, or dedicating enough resources to conduct the required activities such as regulatory work – since a roll-out in many countries requires filing a huge number of dossiers to register Novartis Access products.
As mentioned earlier, external challenges relate to areas such as distribution, supply chain integrity, lack of disease awareness and health-seeking behavior as well as gaps in the health systems. Another challenge is the lack of national and international funding for treating NCDs, as most of the donor money is still focused on infectious diseases.
One particular external challenge is that countries typically procure on the basis of an itemised tendering process whereas we are offering a portfolio.
How are you measuring the impact of Novartis Access?
As Novartis Access is a novel business approach, we need to ensure we thoroughly measure and evaluate the programme’s outcomes. This should be done in collaboration with highly qualified partners in an independent way so that it brings benefits to us, and others as well.
We want to be as transparent as possible since transparency will support credibility of the results and the programme overall.
Against this background, we have set up a measurement and evaluation programme with Boston University (BU), which is looking at certain outcome indicators at the system level, e.g. availability and price of Novartis Access products and comparator products at the facility level. We are using a method based on randomised control trial design, which is very innovative for access programmes. We have just started with the baseline study in Kenya. BU has academic independence in publishing the results of the study.
The information we will collect and evaluate will be crucial to manage, adapt and improve the programme along the way. We want to be as transparent as possible since transparency will support credibility of the results and the programme overall. We also hope this work will help to develop a standard way of measuring and evaluating access programmes in the future.
This article originally appeared in Radar Issue 11: Blurring the Boundaries.