We all agree we need partnerships between the public and the private sector to meet the Sustainable Development Goals. Public-private partnerships (PPPs) require a better understanding between partners and innovation around institutional structures to ensure accountability, risk and benefit sharing, and value for money. These are fine words but, as the representative of a large, research-based multinational, I have found that things are not always that simple.
From the private sector viewpoint, governments need to provide clear laws and regulations, zero tolerance to corruption and a secure environment for business to operate. But they also need to avoid unnecessary bureaucracy, and have the flexibility to ensure that the partnership between the private sector and public sector is beneficial and delivers on national objectives. Support is available – the International Finance Corporation, a division of the World Bank, has been running a Pilot Health Public-Private Partnership Advisory Facility which advises governments on how to best approach partnerships in health.
Some African governments see PPPs as a key route to move their health system toward financial independence. One example of a successful collaboration is in Kenya, where Novo Nordisk has partnered with county governments, the Ministry of Health and faith-based organizations to build supply chain capacity to allow intensive monitoring of excessive mark-ups for insulin, driving down the price of a vial by 70%. Another example is the work done by the African Health Markets for Equity (AHME), which is working in Nigeria to improve the quality of healthcare in the private sector. Led by the PharmAccess Foundation, AHME partners with governments, donors, and public and private sector providers to provide health insurance for rural people through a subsidized annual premium. By reducing out-of-pocket payments for health services, the scheme is contributing to increased financial protection for the poor.
As Africa faces new health challenges, the need for transformational PPPs becomes even more necessary. Longevity in many African countries has jumped since 2000. The leader is Malawi, with life expectancy at birth rising by an astonishing 42%, while Zambia and Zimbabwe have both seen rises of 38%. Many other African countries are also up more than 30%.
This has been achieved mainly through substantially reduced maternal, infant and child mortality, and success in dealing with Africa’s traditional killers such as HIV, malaria, and tuberculosis. At the same time, economic prosperity and urbanization have led to the rise of diseases common in older people and in higher-income countries, such as cancer, heart disease and diabetes. Such chronic, non-communicable diseases (NCDs) require a very different approach to the way infectious diseases are managed by health systems.
Many of these countries are aware of the dangers that NCDs pose, and the need to keep their health systems evolving to combat them effectively. In an effort to institutionalize the fight against chronic diseases, Kenya, Nigeria, and Cameroon are among many African countries which have developed government programs to fight NCDs.
But even for proponents of PPPs, there are challenges in extending them into a close, integrated long-term working relationship on chronic diseases. Finding effective solutions that have the biggest health impact requires novel solutions on both sides. We are trying out exactly this through a new program called Novartis Access, which launched in Kenya in 2015 and will be rolled out across multiple African countries by 2020.
The programme provides a portfolio of medicines against the most common chronic diseases (hypertension, diabetes, heart disease, cancer and respiratory illness) to health systems at a cost of $1 per treatment per month. This is combined with capacity-building support for supply chain improvement and education for healthcare providers on how to manage the most common NCDs. For a private company, offering very affordable pricing in a portfolio model is a transformative idea that carries great volume opportunities but also risks. For governments, moving from single drug procurement to a portfolio approach requires a mindset shift and sometimes adapting the way medicines are procured.
Novartis Access aims to be profitable in the medium term, albeit at low margins, so it is sustainable long-term. The programme is not dependent on donor funding but relies on governments continuing to see both the supply of affordable NCD medicines and the investment in training as cost-effective solutions to improve the health and wealth of their people.
We are still at the very early stages of our journey. We don’t pretend to have the solution to improving access to medicines, but I believe programmes like this offer compelling examples of how the pharmaceutical industry can work with other partners – including other private sector companies, government, and faith-based organizations – to overcome access issues in poor countries.