Access to Medicines in Low- and Middle-Income Countries…Part 3-Final

Part 3:  So…How do We Gain Recognition for our Access Program?

We started this in two parts by providing some background as to how to map out a plan to help gain recognition, based on a Health Affairs April 2017 36:4 article, “Industry-Led Access-To-Medicines Initiatives in Low- And Middle-Income Countries: Strategies and Evidence.” In the series on, we broke down the article as follows:

Part 1:  What did they (the authors) find?

Part 2:  How did they (the authors) review the programs?

Leveraging this information, we now ask:

  • What insights do we gain that help get recognition for the value of a global access program?
  • Where to put our focus/leverage our resources?

We start with how are global access programs considered. Definitely not the same as commercializing medicine – and that makes sense as that is the mainstay of business. As a result, it’s hard to manage the organization and gain resources to drive access programs. Plus, these programs often can be evaluated only after they are up and running for several years – which is quite different from evaluating commercialized medicines on the quarterly investors call. 

Therefore, two key pieces of advice in embarking on this kind of program:

1)  ENSURE that senior leadership (of the organization not just a business unit) is a champion of these kinds of initiatives; and

2)  STRATEGICALLY think about the global access program as if it were a key asset of the organization – how would you bring a new therapeutic to commercialization? You would leverage Discovery, Development and Commercialization, so let’s categorize a global access program that way

Step 1:  Discover the Needs and Potential

This is where you marry the value of the product and/or company to that needs of the patient community. You need to:

a) Understand your product/company’s mission and what value (clinical, societal) is offered by it to patient populations

b) Understand which people are in need of that help. In keeping with the article, we’ll assume it’s patients in low- and middle-income countries. Here is where you really need to truly define where your program can help and understand the challenges in delivering on it in different patients’ communities (e.g., countries, regions). This is where you understand you have an effective drug that is infused; however, Country A and Country B do not have places, training or supplies to offer infusions. Value and need have to “marry.”

To understand the country’s capabilities and commitment to healthcare and to the potential value of the medicine, you should look at various indices. Some examples follow:

  • You can look at how much the company devotes to healthcare as a percentage of GDP and/or healthcare spend per person
  • You also want to look at where these kinds of programs can be sustainable (meaning stable governments, wars, etc.)
  • Further, you may want to see if the country is on a development path
  • You should also look at more than one index as some have greater support than others Some potential places to look include:
  • Talk to your own representatives in these areas – your local people may offer greater insight into issues, concerns, changes and even put you in touch with some local stakeholders

Unsplash / Pixabay

Step 2:  Develop the Program

If this were a medicine, you would have researchers and healthcare professionals using established protocols and working with key external stakeholders for a study. Along these lines, consider the same guidelines for an access program – how do you structure it to evaluate success?  

This is where you should consider working with a key external consultant or expert in public health programs. Key may be working or partnering with knowledgeable academic entities, such as Harvard’s T.H. Chan School of Public Health, Johns Hopkins Bloomberg School of Public Health, or the London School of Hygiene and Tropical Medicine. These are experienced institutions that not only can offer guidance or partnerships in developing these programs but can suggest the best places to present or publish the work.


Consider the value and strategies of the program. In light of the article authors review, don’t consider ONLY price reduction or medicine donation, but consider capturing an aspect of all the strategies to develop a more robust program. If product donation is considered, then look to guidelines by W.H.O. as well as the Partnership of Quality Medical Donations. Following are access strategies evaluated in the study:

Access to Medicines

Strategies aimed at reducing access barriers to medicine directly)

  • Price reduction
  • Medicine donation
  • Licensing agreement
  • Supply chain strengthening

Health Services

Strategies aimed at improving service delivery

  • Service sponsorship
  • Infrastructure investment
  • Provider training
  • Awareness campaign

Indirect Support Strategies

Strategies aimed at improving population health indirectly

  • Financial support
  • Community development
  • Research and development


Map out the program with a clearly defined design. The authors evaluated each program following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system – guidelines developed by an international working group to provide quality and consistency in evaluating health care programs. GRADE is recommended by the Cochrane Collaboration – a not-for-profit organization that produces and disseminates reviews of healthcare interventions. It would be important to understand both GRADE and the Cochrane Collaboration guidelines in developing a program.


Can your program clearly match the strategy and guidelines identified by transparent and well-respected organizations? It’s not that it absolutely has to, but bear in mind if it doesn’t it will be harder for third parties to assess the value of your program. This is about getting the recognition for a program and the suggestion is to follow established criteria.


Cozendo / Pixabay

Step 3:  Commercialize 

Help people understand the program and its value/target communications

  1. Map out a communications plan, which should include the basics of any key asset:

 Publication and Presentation Plan (look for public policy, health policy conferences, public health publications (e.g., Health Affairs, Lancet Global Health, Chronicle of Philanthropy, Journal of Global Health)  

  • Make sure the publication/presentation is ‘searchable” by key search engines. You don’t have to publish or present at ‘many,’ just the “right” specific to your therapeutic area of interest. The authors used PubMed, Google Scholar and Google Web – you should use these sources and also look to the key journals and conferences relevant to the therapeutic area of interest to you. There are a number of other monitoring systems as well to use
  • Also make sure that the program is listed in relevant source materials – such as the International Federation of Pharmaceutical & Manufacturer’s Association (IFPMA) Health Partnerships Directory – Companies’ list of Health Initiatives, your organization’s corporate social responsibility reports and/or company annual report
  • If not done already, double check that your program is included in the materials provided for the Access to Medicine (AtM) index
  • Finally, ensure the listings are linked so they are easy to find and amplify the program strategy and outcomes
  1. Develop language, messaging and spokespersons around the program that is being used to search for these kinds of initiatives and make sure to use it consistently in presentations, publications and abstracts, and articles
  • It is important to consider search engine optimization. Leverage the terminology, categories and characterizations of key indices and guidelines. This makes it easier for people to “find” your program and for anyone reviewing it to understand how it aligns with the needs identified in the public health arena
  1. Develop an appropriate communications plan targeted to your audiences of interest
  • It should include information presented in as transparent a way as possible. Consider public health audiences for sure, but also key healthcare professional stakeholders, government representatives, professional association organizations and targeted media and watchdog groups. And do not forget your employees

This sometimes is where the funding stops but it’s very important to communicate appropriately about your program:

  • People reviewing and judging programs and health systems should understand your program so as to factor it into their assessment
  • It could offer important information to a country about its health care system and needs of some of its patient population
  • The more that the right people understand your program the more they can support it – and potentially in a forum of significant importance to the company
  • Greater support for a program may mean less push back which should improve the environment in which the program is carried out
  • There are some investors that consider programs of these kinds in providing a perspective on the company overall
  1. Finally, ensure you communicate throughout your organization, but particularly to senior leadership, investor relations and media relations as to the impact and outcomes of the program

Underscore the value and outcomes of the program as defined by your strategy. Make sure the timeframe and outcome at specific timeframes is clear and whether additional resources are required

geralt / Pixabay

So, to get the best recognition for a program

  • Discover, Develop, Commercialize it
  • Be consistent and transparent

Most importantly:  Consider it a key asset to the organization and manage it that way