Six companies systematically match activities to local priorities when strengthening health systems.
Gaps in local healthcare infrastructure are hampering the delivery of medicines and vaccines to millions of people, mainly in poorer countries. Most pharmaceutical companies in the Index are building a range of health system capacities in low- and middle-income countries. The 2016 Index has identified six pharmaceutical companies that are consistently addressing independently prioritized gaps through their capacity building programmes: AstraZeneca, GSK, Johnson & Johnson, Merck & Co., Inc., Merck KGaA and Novartis.
These companies are building local capacities across the pharmaceutical value chain: for R&D, manufacturing, supply chain management and pharmacovigilance (systems for ensuring drug safety). They work with governments and NGOs, among others, often in formal partnerships, to understand where action is most needed. They also frequently evaluate the impact of those activities.
Five actions to achieve best practice
The 2016 Index has identified five common actions companies take to ensure initiatives are filling local capacity gaps:
- Work with local partners to understand and align with country-specific needs
- Define specific and measurable goals with partners
- Explicitly define roles, responsibilities and accountability mechanisms for all partners, and establish transparent systems to manage conflicts of interest
- Agree to clear commitments over appropriate timeframes
- Ensure continuous improvement through regular, transparent monitoring and evaluation
The six companies are using a range of best practice approaches to build capacity. In manufacturing, for example, Merck KGaA has a system for continually improving quality standards, including at 53 third-party manufacturing sites on four continents. The company conducts audits, monitors quality control and carries out technology transfers. It also provides additional training, tailored to each third-party site’s needs. Critically, it immediately shares lessons from local inspections across its manufacturing network. Most companies (18) in the Index are improving local expertise in medicine production, mainly in large manufacturing countries such as China, India and Brazil.
AstraZeneca has developed a best practice approach to improving manufacturing standards across the Chinese industry. In 2006, the company identified widespread issues in pharmaceutical manufacturing in China, particularly with meeting safety standards. Tianjin University in northern China is an established industry partner for resolving manufacturing issues. Rather than training individual manufacturers, AstraZeneca works with the University’s Chemical Engineering School to help address identified skills and knowledge gaps, training students as well as site staff.
China is also a focus area for building R&D capacity, alongside Brazil, with some companies also building R&D capacity in Kenya and South Africa. GSK has supported a comprehensive investigation into local R&D skills gaps and capacity building needs in sub-Saharan Africa. It worked with the Liverpool School of Tropical Medicine’s Capacity Research Unit to assess the capacity of key institutions in Africa to undertake research on non-communicable diseases.
Sub-Saharan Africa receives more attention than other areas when it comes to improving supply chain management. For example, Novartis’ SMS for Life programme is a public-private partnership that aims to keep pharmacy shelves in sub-Saharan Africa well stocked. It enables healthcare workers at public health facilities to use mobile phones to track stock levels and help prevent stock-outs. The data collected belongs to the relevant national ministry of health.
Merck & Co., Inc. is working with partners to improve delivery of a range of contraceptives to local health centres in Senegal through an Informed Push Model. This involves logistics professionals from regional supply pharmacies making deliveries to local health centres, where they collect stock data to help prepare for the next delivery cycle. The model was piloted in two districts in 2012, in partnership with local and international stakeholders (including the Senegalese government), and scaled up nationally between 2013 and 2016. Management of the programme is being handed over to Senegal’s National Supply Pharmacy.