Access to Medicines in Low- and Middle-Income Countries…Part 1

A short series offering actionable insights from a Health Affairs article

Part 1 – What did they find?

In April 2017, Health Affairs published an article, “Industry-Led Access-To-Medicines Initiatives in Low- And Middle-Income Countries: Strategies and Evidence,” that evaluated these initiatives. This article marked – according to the authors knowledge – the first comprehensive review of industry-led Access-to-Medicines (AtM) initiatives.

Having experience in global access programs, a common challenge is figuring out what determines success. Another challenge is communicating that success – to audiences that either are concerned or that you think should be concerned.

So, in that light, I “reverse engineered” the article for reporting and gaining recognition for a successful program. Over the next few insights, I will reverse engineer the article to create a roadmap based not just on the article, but other articles and my own experience.

So, let’s start…


Part 1:  Who, What Where, When, Why…..and How?  (the “how” is for next time)



Who did the research?  

All five researchers were from Boston University (or had been) – either in the School of Medicine or School of Public Health


What companies did they review?

The 21 research-based global biopharmaceutical companies. Alphabetically:  Abbot, AbbVie, Astellas, AstraZeneca, Bayer, Boehringer, Bristol-Myers Squibb, Celgene, Daiichi Sankyo, Eisai, Eli Lilly, Gilead, GlaxoSmithKline, Johnson & Johnson, Merck KGAa, Merck MSD, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, Takeda – AND – multiple company partnerships. They reviewed initiatives for two things:

  • To assess their strategies for improving access
  • The quality of evidence on the impact of their initiatives


Where did they get the list of 21 companies?

The companies were listed in the Access to Medicines index.


When was the time frame for the review?

They looked at initiatives between 2000 and 2015


Why did they do this?

Companies report their AtM initiatives and it’s clear the companies’ commitment to improving access to medicines in low- and middle-income countries has increased. However, the authors suggest that there is not enough accountability on measuring and reporting the impact of the initiatives so it’s difficult to really gauge the impact of these programs.

Ultimately, the authors suggest companies do more to generate high-quality evidence on their initiatives, and that the global health community do more to assist them on that.


What were their findings?

  • 500% increase in AtM operating initiatives between 2000 and 2015 (from 17 to 120)
    • Two major kinds of strategies used in these 120 initiatives:
      • Medicine-donation strategy (48%)
      • Price-reduction strategy (44%)
  • Authors found published evaluations for only 7 of those 120 initiatives; of those 62% were of low quality and 32% were of very low quality



Part 2 will focus more on the insights…