The new Access to Medicine Index notes increasing interest from multinational pharmaceutical companies in doing business in Africa that benefits people on lower incomes. However, the 2018 Index also finds important gaps in where pharmaceutical companies are registering new products on the African continent.

The Access to Medicine Index ranks 20 of the world’s largest research-based pharmaceutical companies on how they are improving access to medicine in low- and middle-income countries. In 2018, the Index reports that four of these companies are implementing or expanding commercial models in Africa that serve people on very low incomes. Several of these models focus on products for heart disease, diabetes and other non-communicable diseases, which are on the rise globally.

• In Ghana, Novartis is working with local private medicinal shops to make blood pressure screening more convenient and to dispense medicines from within the community. High blood pressure (hypertension) is a major risk factor for heart disease and affects up to 36 per cent of adults in Ghana, where long and costly journeys often prevent people seeking the healthcare they need.
• In Kenya, Merck KGaA is expanding its initiative to set up local healthcare centres. It is now running in the counties of Kiambu, Kajiado, Machakos, Makueni and Mombasa. These centres each provide pharmacy and nursing services, as well as insurance schemes and financing for healthcare.
• In Zambia, GSK is training local people as entrepreneurs who can provide affordable health products to their communities, supported by lower interest loans provided savings are passed on. These entrepreneurs sell oral health, pain control, contraceptive and other health-related products, together with goods such as cooking stoves.

Capacity building to enable access
The Index also reports that African countries are the focus of companies’ efforts to support and build the capacity of local healthcare systems and supply chains. These initiatives are diverse. As an example, Takeda works with the Kenyan Ministry of Health and other partners to ensure more people can access cancer care services. In Ghana, Merck KGaA is working with partners including the government to establish a new local vaccine manufacturing plant. Capacity building efforts are critical for advancing universal health coverage (UHC).

“The Index first noted pharmaceutical companies taking a strategic interest in Africa in 2014,” says Gabrielle Breugelmans, Director of Research at the Access to Medicine Foundation, which publishes the Index. “Today, we, see signs that this interest is deepening. The next challenge to ensure the best ideas benefit the poorest people.”

Companies generally first invest in capacity building in markets where there is commercial potential. In the Index analysis, Kenya has the most capacity building initiatives, followed by South Africa and then China. Overall, the Index analysed 141 capacity building initiatives in African countries. The Index analysis only included initiatives that meet local needs for specific capacities and covers 50 of the 54 countries in Africa. Of these, 22 countries have no initiatives that qualified for analysis.

Important gaps: are products available?
A medicine or vaccine can only be marketed in a country once it has been registered for sale. Yet the Index finds important gaps in the registration of new innovative products in African countries. While some countries have seen new products being filed, such as Nigeria, Ethiopia, Uganda and Tanzania, there are 13 countries across Africa with no new product registrations identified by the Index, including Sudan, South Sudan, Angola and Somalia, which are together home to 150 million people. One factor that promises to improve this situation is the creation of the new African Medicines Agency (AMA), which has been tasked with speeding up the registration process of pharmaceutical products across Africa.

“Companies are deepening their focus and working with local partners – we see this as a good sign of long-term commitment to improving health,” says Jayasree K. Iyer, Executive Director of the Access to Medicine Foundation. “To radically ramp up progress, more companies must stay engaged for the long haul.”