World Health Assembly 75: Side Event Report
Moving toward equity: Innovative approaches to increase access to affordable NCD medicines and products
Panel urges audience to change approach.
What is needed to strengthen access to NCD treatment and care:
- A coordinated, multi-sectoral approach is needed to make impact. We must move away from siloes.
- To focus on youth and transient populations
- To address the gap in palliative care
- Integrate services to provide easy to access care
- Human-centered design approaches
- Improved diagnostic access for NCDs
NCDs remain a major cause of disability and death across the world but there hasn’t been a significant global commitment to tackle some of the greatest issues facing the NCD response, despite years of progress. At the 75th World Health Assembly (WHA75), NCDs took a greater portion of the agenda than ever before. With new diabetes targets and an omnibus decision on NCDs on the table, PATH, the Leona M. and Harry B. Helmsley Charitable Trust, and the Coalition for Access to NCD Medicines & Products took the opportunity to gather a multi-sectoral panel to highlight a key problem for people living with NCDs – inconsistent availability and affordability of medicines and products.
When access to care, medicines, and health products are frequently unavailable, patients incur higher out-of-pocket costs and are at greater risk of complications. The World Health Organization (WHO) estimates that one-third of the world’s population lacks access to essential medicines and diagnostics, and in the poorest regions, this proportion increases to 50 percent.[i] These struggles have made it challenging for countries to deliver comprehensive care efficiently and effectively. Indeed, improving access to existing essential medicines and vaccines could save 10 million lives per year.[ii]
While several innovative initiatives seek to tackle this urgent problem, including the recent launch of the Presidential Group, and the NCD Compact, we aimed to gain a multisectoral perspective on the various barriers to supply security and initiatives that are having an impact and can be scaled across countries. To facilitate this discussion, we brought together a unique panel representing government, foundations, academia, private sector, and multilateral organizations:
- Gina Agiostratidou, PhD, MBA, Program Director, Helmsley Charitable Trust
- Michael Fredrich, Access Accelerated Steering Committee Chair, Lead Access to Medicine NCDs, Bayer AG
- Bashier Enoos, Technical Officer: Integrated Service Delivery, WHO
- Patrick Kuma-Aboagye, Director-General, Ghana Health Service
- Richard Sullivan, Kings College, London (representing the Lancet Commission on Diagnostics)
Key challenges identified during the discussion include:
Inadequate and siloed financing
- A lack of sustainable NCD funding from donors and governments has stunted progress against these chronic conditions. Additionally, siloed, short-term projects fail to live up to their potential if they were invested in and further scaled.
- As mentioned above, siloed investments and projects have led to uneven progress across disease areas, and this is particularly apparent in NCDs. Investments in integrated, person-centered care can address some of these issues.
Lack of resources
- Almost half of the world’s population has little or no access to diagnostics. The Lancet commission found the diagnostic gap is the single largest gap in the care pathway and is most severe at the primary health care level. As with many issues in global health, low-income, marginalized groups suffer the most.
- Inadequate or low-quality data make it difficult for governments to budget for and provide sufficient resources for medicines and products.
- Lack of local health care capacity to diagnose and treat NCDs, which hides the true need for NCD commodities.
Stockouts and other systemic supply chain issues
- People living with NCDs often struggle to access all the medicines and products they need to manage the condition. These struggles are caused by stockouts, insufficient cold chain capacity for insulin, out-of-pocket costs, and unavailability at the primary health care level.
- Drug pricing and high out-of-pocket costs are a challenge for many countries and people living with NCDs.
Our multisectoral panel identified impactful innovations from local to global levels
In-country innovation and scale
- Patrick Kuma-Aboagye, Director-General of the Ghana Health Service, described several initiatives that are improving supply security for NCD medicines and products in Ghana.
- The NCD Navigator, implemented in partnership with PATH, is providing clarity on NCD projects in the country and how they align with the disease burden and national priorities, improving resource allocation and decision making.
- Twenty-two new NCD indicators were added to the national data system to improve NCD data quality and help the Ghana Health Service understand demand for NCD services and medicines.
Commission reports to country implementation
- Richard Sullivan explained some of the findings of the Lancet commission on diagnostics, which noted where investments in research and innovation capacity showed value, as in the co-creation sprint for cancer diagnostics in Kumasi that brought together teams of diagnostic companies, government, and local innovators with end users to conceptualize and design solutions to address the access gap to cancer diagnostics.
Supporting a coordinated collective action for greatest impact
- Gina Agiostratidou detailed Helmsley’s commitment to improving care for people living with diabetes, especially access to insulin. Helmsley is partnering with PATH, ministries of health, health workers, and people living with diabetes on a human-centered bundling solution for diabetes medicines and products in three countries in sub-Saharan Africa. Investing in person-centered care is critical to ensure sustainability.
- Access Accelerated, represented by Michael Fredrich, is a group of more than 20 biopharmaceutical companies that have come together to address barriers to NCD care. This unique group is changing the way the private sector can support better NCD care. Its collective impact over the past five years is clear – many of its projects are now supported by ministries of health and will remain in place long after Access Accelerated’s initial investments end. Michael emphasized the need for coordinated collective action across all sectors.
- WHO has prioritized improving NCD care in recent years, especially access to medicines. Bashier Enoos noted that one of WHO’s key initiatives is upgrading cold chain equipment and capacity, which includes integrating insulin into immunization cold chains to make use of excess capacity. They are also working to improve accuracy in forecasting leveraging previous work done in this area by stakeholders including CHAI and the Coalition and advocating for extended prescription cycles.
Immediate Calls to Action from Roundtable Discussions
- Strengthen regulatory harmonization for country registration to lessen the administrative burden for companies looking to introduce medicines and products into countries.
- Build health care worker capacity to better screen for and diagnose NCDs at all levels of care.
- Improve transparency of markets and data on availability and affordability across health products.
- Include communities earlier in all discussions and projects for ground reality checks and concrete guidance and actions to be developed and effectively implemented.
- Extend diagnostic tools into primary health care and universal health coverage packages.
- Build multisectoral partnerships to address key challenges in supply chains
- Advocate for donors and governments to invest in integrated health models and move away from siloed programs.