Access Programs

ISSUE

APPROACH

CHAI works with governments and companies around the world to fundamentally change the economics of global health. Using a holistic, business-minded approach to secure lower prices for key commodities and improve laboratories in the developing world, CHAI helps patients access the care and treatment they need.

 

The Issue

Access to critical medicines and diagnostics is often limited in resource-poor settings, resulting in dire consequences for some of the world’s most vulnerable populations. Market failures are often at the root of this issue, and can prevent patients, especially children, from accessing lifesaving treatment for HIV, malaria, and other diseases. Many deaths could be prevented if barriers to access, such as high pricing and lack of in-country infrastructure, are addressed.

The Approach

CHAI’s Access Program approaches some of the most pressing issues in global health with a business-oriented strategy to fundamentally change the underlying economics. By addressing global market failures and accelerating access to the most effective, high-quality health products at affordable and sustainable prices, CHAI helps patients access the care and treatment they need.

Issue

Access to lifesaving medicines and diagnostics is often limited in resource-poor settings, putting some of the world’s most vulnerable populations at risk. For example, at the end of 2015, there were 36.7 million people living with HIV globally, primarily in low- and middle-income countries, yet only 17 million of them had access to antiretroviral therapy. Gaps in treatment expand beyond HIV/AIDS, and often affect children, who are especially susceptible to many preventable diseases. Low coverage rates for immunization and treatments for diseases such as malaria result in hundreds of thousands of deaths each year of children under 5.

Market failures are often at the root of this issue. Misaligned incentives between buyers and suppliers, lack of information transparency in the market, and other such barriers result in the inefficient use of available funding for lifesaving health products. These failures prevent governments from getting the most out of available dollars and create a risky environment for suppliers. As a result, patients in need are often unable to access critical health products, which can affect both individual health and population-level disease transmission. Many deaths could be prevented if barriers to access, such as high pricing and lack of in-country infrastructure, are addressed.

Approach

CHAI’s Access Program takes a holistic, business-minded approach to fundamentally change the economics of global health. By addressing global market failures and accelerating access to the most effective, high-quality health products at affordable and sustainable prices, CHAI helps patients access the care and treatment they need. Based on the fundamental understanding that suppliers must be able to generate profits in order to sustainably maintain production of essential health products, CHAI coordinates and engages with both governments and suppliers. CHAI partners with governments to build and consolidate demand around optimal products in terms of efficacy, formulation, quality, and price. Concurrently, CHAI works with suppliers to reduce the costs of production, enhance competition, encourage adoption of stringent quality standards, optimize product design, and accelerate the entry and uptake of new and better products. The work spans multiple health areas including HIV/AIDS, tuberculosis, malaria, vaccines, and family planning.

Change

CHAI’s Access Program has successfully applied this business-minded approach to achieve significant price reductions for lifesaving health commodities and enable increased patient access to treatment. For example, between 2007 and 2013, CHAI facilitated a 62 percent price reduction for an adult HIV medicine by developing a more efficient manufacturing process and identifying lower-cost, high-quality raw materials for two key components; the regimen is now recommended by the World Health Organization (WHO) as the preferred first-line treatment for adults. In 2014, CHAI also helped to negotiate a global access price for HIV viral load tests of US$9.40 per test, which reduced the average price by more than 40 percent in low- and middle-income countries. This will save more than US$150 million over five years and will dramatically improve the quality of health care that HIV patients receive.

Outside of HIV, CHAI’s Access Program has helped to secure over US$1 billion in savings over five years through work to reduce the price of three essential vaccines. The price reductions will help offset the increasing cost to fully immunize a child, allowing more children to access high-quality vaccines with existing funding levels. In 2016, CHAI negotiated supplier agreements that will reduce the cost of diagnosing and treating patients living with hepatitis C by 45-70 percent in six countries, providing a critical first step toward making treatment more affordable in low- and middle-income countries.

CHAI’s Access work also helped to secure a 50 percent price reduction for long-acting reversible contraceptives in 2013, which will result in more than US$420 million in savings over six years and improve health outcomes for women and their children.

Laboratory Services

Laboratory Services Overview

CHAI’s Access Program works to improve the availability and affordability of high-quality diagnostics in low- and middle-income countries, with a focus on products used for the diagnosis and treatment of HIV, TB, and Hepatitis. This includes work with manufacturers to secure reduced pricing, as well as helping countries prepare for the efficient implementation and scale up of better testing products and services. In particular, given that only 50 percent of adults and children living with HIV know they are infected, CHAI is working to address this gap by improving the targeting of HIV testing and supporting the use of better quality rapid diagnostic tests. Since 2006, CHAI has also worked to scale up access to early infant diagnosis for millions of HIV-exposed infants, and continues to address the gap in infant testing by supporting the introduction of point-of-care technologies that deliver same-day results. In addition to improving HIV diagnosis rates, CHAI is also working to ensure that patients on treatment can access the highest quality diagnostic monitoring services, by working to accelerate availability and uptake of viral load testing. After helping to negotiate a global access price of US$9.40 per test in 2014, CHAI has been working closely with countries to develop implementation plans and share best practices that will ensure successful and sustainable viral load programs.

Medicines

Medicines Overview

CHAI’s Access Program aims to ensure rapid access to the best available medicines at affordable and sustainable prices, with a focus on drugs for the treatment of HIV, tuberculosis, and malaria. CHAI works along the entire life cycle of a medicine, from incentivizing manufacturers to develop new and better products, to ensuring that in-country systems are able to reliably deliver the products to patients.

For example, CHAI’s early life cycle work catalyzed the development of a new, low-cost drug formulation for the treatment of HIV in children. The new formulation is more palatable, enables more accurate dosing by parents and caregivers, and provides additional supply for the preferred first-line regimen in patients less than 10 years of age. CHAI partnered with two pharmaceutical companies, ViiV Healthcare and Mylan, to accelerate the development and market entry of the new product, which will help meet the needs of the 872,000 children on treatment in low- and middle-income countries. An example on the latter part of the life cycle is CHAI’s work to accelerate patient uptake of atazanavir-ritonavir, a second-line HIV drug for adults that offers clinical benefits, better convenience, and lower prices than the alternative product. CHAI worked with countries to adopt the product into national treatment guidelines, accelerate availability at all levels of the health system, and support patient and provider acceptability. An estimated 22 percent of second-line patients are using ATV/r as of 2015, with an expected increase to 54 percent by 2020.