Improving the affordability, availability, and acceptability of health technologies for low- and middle-income countries
In this guest post, Claire Wingfield—product development policy officer at PATH—writes about a new paper she developed for the GHTC that outlines key issues surrounding access to global health products.
In order to achieve impact, a health technology must be more than just safe and effective. It must also be affordable, available, and acceptable to ensure that it is accessible to those who need it most.
The pipeline of products addressing public health needs in low- and middle-income countries (LMICs) has grown substantially over the past two decades. Much of that success can be traced back to the 1990s when a number of nonprofit product development organizations (NPPDs) were established to accelerate the development and accessibility of new health technologies targeting poverty-related diseases and conditions. Since that time, NPPDs and their partners have contributed to the development, evaluation, and/or introduction of 42 new health products.
- The GHTC has launched a new paper that outlines key issues surrounding access to global health products. Photo credit: PATH
Because NPPDs were established to develop—not deliver—health technologies, they negotiate collaborations with partners from the public and private sectors that are designed to ensure access to the resulting products and knowledge. Today, the GHTC is launching a paper that explores how NPPDs approach access and how they manage partnerships and negotiate agreements to improve access – which they define as the affordability, availability, and acceptability of technologies targeting the health needs of LMICs.
Although there is no “one size fits all” model for how NPPDs operate, they do employ some common strategies to ensure that the resulting products benefit those most in need:
- Spreading investment in research and development across a portfolio of technologies, thereby allowing NPPDs to select only the most promising products to advance through the pipeline.
- Prioritizing access to these technologies for poor populations.
- Planning for access from the beginning of the product development process.
- Working closely with manufacturing partners to guarantee that consistent supplies of high-quality, cost-effective products are available to target populations.
- Engaging end users and beneficiaries in the design and the development of the product.
- Negotiating collaborations with partners from the public and private sectors that create a framework for access in LMICs.
NPPDs also shared lessons that they and their partners have learned in trying to improve the affordability, availability, and acceptability of new health technologies for those most in need:
- Defining the value of a technology must be driven by the local communities and countries that will use the product. Product developers must understand and address the needs and wants of those who will ultimately be implementing and benefiting from the product.
- Achieving global access does not guarantee local access. NPPDs and partners may achieve global access targets (such as receiving World Health Organization prequalification) but this does not guarantee that the technology will be accessible at the national or subnational level.
- Relying on national average income status can undermine access for the poorest populations. In many middle-income countries, the burden of disease is among poorer populations who have not benefitted from strengthening economies. Therefore, the poorest populations, often the most at risk, are unable to access new technologies.
- Securing donor recognition that access activities need to be initiated early is critical. In order to ensure there is not a lag between licensing a product and making it available in the health system, NPPDs and partners must start planning for access from the beginning of the development process. Support from donors for these activities is critical.
- Demonstrating a niche in the market for manufacturers is essential to incentivize their investment. Manufacturing partners must understand the value that they bring to a market to enable them to invest time, effort, and expense to developing products for poverty-related and neglected diseases and conditions.
Any delays in planning and implementing an access strategy can result in significant lag time from licensure to actual delivery in country. A product that needs to be retrofitted for affordability, availability, and acceptability will result in a costly and time-consuming development process. Therefore, as the GHTC’s new paper reveals, it is critical that NPPDs and partners address these principles from the beginning of the product development process.