Scaling Up Access and Rational Drug Use

Anthony D. So, MD, MPAProgram on Global Health and Technology Access

Sanford School of Public PolicyDuke University

ICIUMNovember 2011

Hurdles to Drug Access

Therapeutic

Financial

Structural

Source: Health Action International-Peru

R&D Pipeline

Marketplace

Delivery System

Where in the value chain to intervene?

Pharmaceutical Manufacturer

—SupplierLocal Buyer

Provider

Pharmacy Consumer

Community management

Global Drug FacilityGreen Light Committee

Gupta et al. “Responding to Market Failures in Tuberculosis Control.” Science (2011) 293 (5532): 1049-1051.

Affordable Medicines Facility for Malaria

Pharmaceutical Manufacturer

—SupplierLocal Buyer

Provider

Pharmacy Consumer

AMFm Co-Payment Fund US$216 million Financed by UNITAID, Gates Foundation, DFID

Supporting Interventions Up to US$ 126.7 million Financed by Global Fund

AMFm: Issues of Supply and Demand

11%

22%

16%

20%

6%

25%

Sanofi-Aventis NovartisAjanta CiplaGuilin Ipca

Source: AMFm, 2001.*These figures do not count co-payments through AMFm's Voluntary Pooled Procurement mechanism or ACTs purchased through the President's Malaria Initiative.

Multinational corporations supply roughly one-third of

co-pay approved treatments*

Supply Demand

36%

63%

1%

Approved ACT orders,

by sector

PublicPrivate, for-profitPrivate, not-for-profit

Source: Olusoji Adeyi, Affordable Medicines Facility-malaria (AMFm): Achievements to date, UNITAID Consultative Forum, October 4, 2011, Geneva.

No. of treatments approved for co-payment

Source: Rutta, Edmund, et al. Increasing Access to Subsidized Artemisinin-based Combination Therapy through Accredited Drug Dispensing Outlets in Tanzania. Health Research Policy and Systems 2011; 9:22