Understanding access to medicines

Proposal for a new global research network: Consultation note

One third of the world’s population lacks access to essential medicines (WHO Medicines Strategy 2004-2007) . The factors that contribute to a lack of affordable, quality assured essential medicines in developing countries are well documented. A growing evidence base exists on medicine availability, pricing and affordability (although time series data is limited). A number of studies have been conducted across different countries to assess the efficiency of procurement and supply chain management systems and document stock outs, although these often focus primarily on the public sector. There is rather less information about medicine quality or utilisation, though several country-level studies have been conducted.

Most importantly, however, the extent of research and analysis that can inform appropriate policy and regulatory responses to these challenges is limited. For instance, very few universities incorporate pharmaceutical modules into their MPH courses. Similarly, Schools of Pharmacy focus on technical rather than policy issues. The range of research providers (academic, non-profit and for-profit) with specific expertise in medicines research and policy analysis in developing country settings is relatively limited, with a few main players dominating the field. Finally, there is a dearth of studies on access to medicines in developing countries that meet the standards for systematic review, for example as defined by the Cochrane Collaboration.

With this in mind, the UK Department for International Development (DFID) is considering the establishment of a global Access to Medicines Research Network (ATM RN). Although the ATM RN is at an early stage of development, it is anticipated that it will bring together research institutions (research institutions could include academia, think tanks, civil society bodies or consultancies, or any other organisation that has dedicated research capacity) from developed and developing countries, through a co-ordinated virtual network, to enhance the available evidence on how to make medicines, especially essential medicines, affordable and accessible to the poorest populations. It is hoped that the network would provide an opportunity to attract more institutions into the pharmaceuticals policy field and boost capacity for research. Over time, it is intended that the network infrastructure would provide a mechanism through which multiple funders can commission high-quality, policy relevant research on access to medicines.

Currently, the ATM RN is expected to be designed to address topics across the access to medicines agenda – including in areas such as pricing policies, supply chain mapping, pharmaceutical market structure and medicines utilisation. It is also expected to support ongoing efforts by DFID and its development partners to roll out the new global Medicines Transparency Alliance (MeTA). Phase One of MeTA was launched globally on 15th May 2008. It will pilot a new multi-stakeholder approach towards increasing transparency and accountability around the selection, regulation, procurement, sale and distribution of medicines in up to seven countries (Ghana, Jordan, Kyrgyz Republic, Peru, the Philippines, Uganda and Zambia). It is anticipated that MeTA will have a close relationship with the ATM RN, and that MeTA pilot countries will be able to draw on the ATM RN for support in the collection, collation, analysis and dissemination of information about medicines, and in defining appropriate policies and/or regulations in light of this growing local evidence base.

The proposed purpose of the ATM RN is to provide a flexible and responsive mechanism to generate policy-oriented research on issues affecting poor people’s access to medicines. Its proposed goal is to build an evidence base to support the achievement of MDG 8 Target 17 to provide access to affordable essential medicines in developing countries, with the ultimate aim of improving health outcomes for poor people in developing countries.

We anticipate the network being managed by an independent Managing Organisation (MO), overseen by an Advisory Committee. Research institutions would be invited to apply to join the network, from the outset or as the work programme evolves. The MO would contract with network members to deliver pieces of research or analysis, using ATM RN core funds (or in the longer term, those of a third party buyer). It is not anticipated that the research network will fund unsolicited research proposals. It is also proposed that the MO manage a global medicines data repository, drawing on a wide range of sources – including MeTA countries – to compile a searchable reference tool on medicine affordability, availability and quality.

It is envisaged that this model will deliver a number of outputs, including:

• Increased access to and dissemination of data on price, availability and quality of medicines;
• A stronger evidence base on policies and regulatory actions that can increase access to medicines in developing countries, including the generation of research that meets the standards for systematic review;
• Development and validation of diagnostic tools to identify challenges in pharmaceutical systems;
• Improved translation of developing country needs and priorities into the access to medicines research agenda – i.e. a demand-led research effort;
• Improved mechanisms for the dissemination and uptake of research findings to inform policy development and implementation;
• Increased capacity for high-quality pharmaceuticals systems and policy research, including in developing countries.

To inform the design of the ATM RN DFID is planning an open consultation with interested parties. An online survey will be available from 1 June for a month. Please take the time to send us your views and comments by accessing the survey through this link: www.atmresearchnetworksurvey.co.uk .

If, after completing the survey, you have additional queries regarding the development of the ATM RN, please address these to Claire Hughes at DFID (c-hughes@dfid.gov.uk ).