Health innovations do not miraculously reach people in need
The Access and Delivery Partnership (ADP) is a Government of Japan-supported collaboration between UNDP, WHO/TDR and PATH. It supports low- and middle-income countries (LMICs) to strengthen their capacity to improve access to, and delivery of, new health technologies for TB, malaria and neglected tropical diseases (NTDs).
A recent meeting brought together ADP country partners and stakeholders from Ghana, Indonesia, Tanzania and Thailand; ADP Advisory Group members; and the ADP project team for the first time. The meeting was an opportunity for exchange between countries and to assess similarities and differences in ADP implementation. The following is a summary of the discussions.
Can we keep half of humanity deprived of knowledge developed over thousands of years of thought, science and civilization? Or can we make health a right for all? Universal health coverage (UHC) aims to ensure all people obtain the health services they need, and without suffering financial hardship when paying for them. With many pieces to the UHC puzzle, access to the health technologies and tools that promote health – medicines, diagnostic tests, vaccines and prevention options – is clearly a critical element. We need to bring accessible and affordable technologies to all people, wherever they need them.
But innovation does not miraculously reach people. Product development partnerships (PDPs) have been created to fill the innovation gap for many diseases. But PDPs often hit a wall once new products are developed. Ensuring access and delivery of health technologies must be an integral piece of the product development value offer.
“Some of the exciting strengths around the access and delivery partnership are that it is ensuring that some of the world scientific breakthroughs, the new innovations that potentially enable us to achieve some of the big goals of the world, are actually becoming available for use. That’s what ADP is all about.”
No one step in the access and delivery process trumps others. The most critical and pressing needs are determined by each country and local context, which includes a range of strengths and also areas where building of capacity may be needed. The Access and Delivery Partnership (ADP) is founded on the central principle that countries can best see what they have and what they need, and what’s the learning or smart tools they can share among countries to help each move forward in its own unique way to promote access and delivery of new health technologies.
The rapid growth of low- and middle-income economies may be making this all the more urgent. As they grow, many countries are ‘graduating’ from traditional aid assistance models, and both public and private domestic resources will be increasingly allocated to address health needs. The result is that many of the innovations that in the past have been driven by donors – who decided which were the important innovations, what related programmes they would finance, and which ones they would support for introduction in countries – will now be the decision of governments themselves. That switch, from supply-side driven innovation to demand-driven innovation is one of the main reasons the ADP initiative is moving as fast as possible to help countries build their capacities to make optimal, timely decisions that meet priority national health needs.
ADP takes a comprehensive approach to strengthening national capacities across the full access and delivery value chain. The partnership works with countries to help identify key strategic interventions across an entire range of decisions they need to make, including: enabling legal and regulatory policy and regulatory frameworks; looking at strategic information and evidence; asking how to strengthen the procurement and supply chains to get the drugs from the central level down into districts and to patients; supporting countries to allocate resources for optimal access and delivery; and helping to ensure that medicines and technologies are monitored for safety; and unpacking local contexts and barriers though implementation research. This helps prime countries to determine what their priority needs are, identify impediments slowing down progress to target communities, and then address bottlenecks.
“I think what’s really exciting in terms of what the partnership is doing is building health technology assessment capacity, so long after the partnership is gone there will be the capacity in-country, in the system, for them to assess technologies and be able to make decisions for what’s needed in their particular context.”
The partnership compliments the capacity-building approach by encouraging South-South learning and exchange. Low- and middle-income countries, while diverse, also share certain common problems, approaches and experiences that they can valuably share with one another. ADP partners have made a very deliberate choice to work in the first instance with a few focus countries, with a view to supporting countries with communicating their lessons and solutions globally, so all countries with similar challenges can benefit.
The main strength of ADP is the way it brings together different partners, stakeholders and sectors, each working at different levels towards the same objectives.
“Sometimes you take it for granted that this is the way things should be done, but they’re not done quite that way. And so I think the partnership has done a really great job in bringing the relevant partners to the table.”
The leadership of the government of Japan in supporting this initiative needs to be commended. It is visionary to not just invest in research and development areas, but to have the foresight to also invest in getting the products to the people who need them.
The partnership has a synergistic relationship with the Global Health Innovative Technology (GHIT) Fund, a public–private partnership between the Japanese Government, companies and the civil sector to facilitate and finance global health technology discovery and development. ADP works in parallel to help build countries’ preparedness for selecting, accessing and introducing the most important new health technologies on an effective, sustainable basis.
Among many other targets, the Sustainable Development Goals (SDGs) focus on the elimination of diseases like HIV, TB, malaria and NTDs, which together have a huge impact on human development. Defeating them will require countries to move new innovations and technologies along the entire value chain from selection, to regulation, and ultimately into the hands of the patients who need them.
“We have the opportunity to raise our national capacity and local production especially for dealing with the shifting from infectious diseases to the noncommunicable diseases and mental disease – it needs new technologies.”
Dr. Tim France is Managing Director at Inis Communication.
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