Access Accelerated in Action - May 2019 - KEY LEARNINGS IN PROGRAM DESIGN & IMPLEMENTATION
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Access Accelerated
in Action
KEY LEARNINGS IN PROGRAM DESIGN & IMPLEMENTATION
May 2019
About Access Accelerated CONTENTS
Access Accelerated is a unique cross-industry collaboration that seeks to reduce barriers to prevention, treatment, and
care for non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) through health systems 2 ACKNOWLEDGEMENTS
strengthening and alignment with Universal Health Coverage (UHC) objectives and priorities. For the first time, 24 global
3 ACRONYMS AND ABBREVIATIONS 28 PROGRAM CASE STUDIES
biopharmaceutical companies have come together to bring their global reach and local expertise in partnership with countries,
civil society, multilateral institutions, and non-government organizations (NGOs) to support cross-sectoral dialogue and 29 Patient-Centered Approach
drive on-the-ground implementation and action to address NCDs. Access Accelerated works towards a future where no one 5 WELCOME
30 Astellas: ACTION ON FISTULA™
dies prematurely from treatable, preventable diseases and all people living with or at risk of NCDs have access to appropriate,
31 Shionogi: Mother to Mother
quality, and affordable prevention, treatment, and care. This is in support of the United Nations’ (UN) Sustainable 6 FOREWORD
32 Eisai: Remember I Love You
Development Goal 3.4 to reduce premature deaths related to NCDs by one-third by 2030. Access Accelerated recognizes
33 MSD: SPARTA
that only by putting the needs of people living with NCDs first and acting in collaboration with partners can the global 7 EXECUTIVE SUMMARY
community make measurable and sustainable progress against NCDs in developing countries. 34 Strong Local Ownership and Engagement
8 OVERVIEW AND METHODOLOGY
35 Pfizer Foundation: Abundant Health
Visit https://accessaccelerated.org for more information. 9 Introduction 36 Sanofi: FAST (Fight Against STigma)
10 Content Overview 37 Takeda: Integrated Cancer Curriculum
12 Methodology
Access Accelerated member companies include: 38 Substantive Partnerships
14 CROSS-CUTTING PRINCIPLES 39 AMPATH: Academic Model Providing
• Almirall • Chugai • Menarini Group • Sanofi AND KEY LEARNINGS Access to Healthcare
15 Defining our Cross-Cutting Principles 40 Bristol-Myers Squibb Foundation:
• Astellas • Daiichi Sankyo • Merck • Servier
and Key Learnings Global HOPE
• Bayer • Eisai • MSD • Shionogi 19 Collated Key Learnings in Program Design, 41 Servier: Cuomo Pediatric Cardiology Centre
• Bristol-Myers Squibb • Eli Lilly and Company • Novartis • Sumitomo Dainippon Implemenation and Monitoring & Evaluation
42 Sustainable, Equitable Solutions
• Celgene • Ipsen • Pfizer • Takeda
22 KEY TRENDS, OPPORTUNITIES 43 MSD Foundation: Project ECHO
• Chiesi • Johnson & Johnson • Roche • UCB AND CALL TO ACTION 44 Daiichi Sankyo: Cultivating Healthcare
23 Key Trends Across Member Company Workers in China
NCD Programs 45 Sumitomo Dainippon Pharma: Promoting
26 Opportunities for Ongoing Program Sound Child Health Pilot Program
Access Accelerated in Action was developed in partnership with Rabin Martin. Rabin Martin is a mission-driven strategy consulting
Improvement 46 Roche: Breast Cancer National Access
firm that works at the intersection of the private sector and unmet public health need to help our clients become leaders in global
27 Member Company Call to Action Program, Kenya
health. By designing innovative yet pragmatic solutions, we deliver both business and societal value and help our clients make a
measurable impact on the health of people worldwide. Visit http://rabinmartin.com for more information. 47 Innovation and Continuous Learning
54 PROGRAM DEVELOPMENT GUIDE:
APPLYING PRINCIPLES IN PRACTICE 48 Chiesi: Global Access to Spirometry
55 Purpose & Use Project (GASP)
55 Key Considerations 49 Eli Lilly: The HOPE Centre
56 Program Development Process Checklist 50 Merck: Global Health Pharma Fund
57 Program Development Discussion Guide (GPHF)—Minilab
51 Rigorous Transparency and Measurement
64 METHODOLOGY AND REFERENCES
52 Novartis: Novartis Access
65 Appendix 1: Literature Review/Methodology
53 UCB: Health and Hope Fund
Foundations
67 References
Disclaimer: This report is provided for information only and is not intended to be relied upon by third parties for any purpose. The information contained
herein is subject to change and does not represent opinions or views held by the International Federation of Pharmaceutical Manufacturers & Associations
(IFPMA), the Access Accelerated initiative or their members.
Access Accelerated is a collaborative initiative, conducted subject to appropriate compliance processes and legal review and involving only publicly
available or non-confidential information.
Access Accelerated in Action: Key Learnings in Program Design & Implementation | 1
ACKNOWLEDGEMENTS ACRONYMS AND ABBREVIATIONS
The Access Accelerated Secretariat would like to thank the The team at Rabin Martin for conducting research, case AIDS Acquired Immune Deficiency Syndrome
following people and organizations for their contributions study interviews, and drafting the report, with support from
to this report. Yavier Rodriguez (Graduate Institute of International and AMPATH Academic Model Providing Access to Health
Development Studies, Genève) in the development of the
All 24 Access Accelerated members for making a foundational report methodology. BMS Bristol-Myers Squibb
commitment to listen, learn, and share experiences as
CHS Commune health stations
a core component of their efforts to expand access to The team at Weber Shandwick for visual design and layout
prevention, treatment, and care for non-communicable of the report. CHW Community health workers
diseases in low- and middle-income countries.
And most of all, we are immensely grateful to our program COPD Chronic obstructive pulmonary disease
The Access Accelerated Company Program Information teams, partner organizations, and communities for giving
Working Group for proposing, designing, and leading the us the opportunity to learn from their work and dedication CVD Cardiovascular disease
development of this report, under the leadership of Yoshimi tackling the challenges of non-communicable diseases
FAST Fight Against STigma
Ohno of Astellas Pharma Inc. and Rina Sakai of Takeda around the world.
Pharmaceutical Company Ltd. GPHF Global Pharma Health Fund
HER2 Human epidermal growth factor receptor 2
Astellas ACTION ON FISTULA™ partners and project teams
IFPMA International Federation of Pharmaceutical Manufacturers and Associations
Celgene AMPATH partners and project teams
LMICs Low- and middle-income countries
Chiesi Global Access to Spirometry Project (GASP)
M&E Monitoring and evaluation
Daiichi Sankyo Cultivating Healthcare Workers in China partners and project teams
MSD Merck Sharp & Dohme; known as Merck & Company, Inc. in the United States
Eisai Remember I Love You partners and project teams
NCDs Non-communicable diseases
Eli Lilly The HOPE Centre and AMPATH partners and project teams
NGO Non-governmental organization
Merck Global Health Pharma Fund (GPHF)-Minilab partners and project teams
PHO Pediatric hematology-oncology
MSD SPARTA and AMPATH partners and project teams
PHP Primary health care professional
The MSD Foundation Project ECHO partners and project teams
SDGs Sustainable Development Goals
Novartis Novartis Access partners and project teams
UHC Universal health coverage
Roche Breast Cancer National Access Program, Kenya partners and project teams
WHO World Health Organization
Sanofi FAST (Fight Against STigma) partners and project teams
Servier Cuomo Pediatric Cardiology Center
Shionogi Mother to Mother partners and project teams
Sumitomo Dainippon Pharma Promoting Sound Child Health Pilot Program partners and project teams
Takeda Integrated Cancer Management Training targeting Primary Healthcare Professionals (PHPs) and
Community Healthcare Workers (CHWs)
The Bristol-Myers Squibb Global HOPE and AMPATH partners and project teams
Foundation
The Pfizer Foundation Abundant Health and AMPATH partners and project teams
UCB Health and Hope Fund partners and project teams
2 | Access Accelerated in Action: Key Learnings in Program Design & Implementation Access Accelerated in Action: Key Learnings in Program Design & Implementation | 3
WELCOME
Non-communicable diseases (NCDs) are amongst the NCDs cannot be tackled in isolation. Access Accelerated
foremost health challenges of our time and the leading members and partners have a unique opportunity to
cause of death worldwide. Millions of people die each come together and work collaboratively to advance health
Drawing on global insights for designing and year from NCDs, many prematurely and often from and NCD care in LMICs. While this report reflects our
preventable, treatable conditions. Today, 85 percent of efforts to date, it also serves as a call to action to catalyze
implementing public health programs, we aim these premature deaths occur in low- and middle-income new, and scale up existing, solutions to tackle the global
countries (LMICs),1 where communities will continue to challenge of NCDs. We hope this will be a useful resource
to challenge ourselves to uphold the highest struggle with the social and economic consequences of in helping to advance NCD programs and galvanize
these losses for years to come.
standards in all that we do to address NCDs.
collaboration going forward.
In response, the global health community is working to We want to extend our sincere gratitude to all member
develop solutions. Every day, we learn more about how to companies and their partners that have contributed
prevent, prepare, and respond to the challenges of NCDs. voluntarily to this report. Your input has been invaluable,
Access Accelerated is the biopharmaceutical industry’s and your programs improve the health of millions of people
collective commitment to scale up action on NCDs with a around the world. Thank you.
focus on LMICs, as part of the global effort to achieve the
Sustainable Development Goals (SDGs). We recognize the Rina Sakai
biopharmaceutical industry’s role in advancing the SDGs as Takeda Pharmaceutical Company Ltd. and Access Accelerated
Company Program Information Working Group Co-Lead
part of a proactive, collaborative global effort to strengthen
health systems around the world. We are collaborating Yoshimi Ohno
with a broad array of stakeholders—including people living Astellas Pharma Inc. and Access Accelerated Company Program
with NCDs, healthcare providers, governments, academia, Information Working Group Co-Lead
civil society, multilaterals, and the private sector—to support
action on NCDs. We believe that by sharing experiences, James Headen Pfitzer
learning from one another, and drawing on our complementary Director, Access Accelerated
strengths, our collective action will be significantly greater
than the sum of individual company efforts.
This report is intended to serve as a contribution to building
and sharing the knowledge base and experiences of Access
Accelerated member companies working on NCDs. It aims
to articulate and illustrate a range of program approaches,
program considerations, good practices, and challenges
faced by Access Accelerated member companies. It defines
some of the principles that guide Access Accelerated
company programs as we work to meet patient needs,
empower local leadership, strengthen partnerships, develop
innovative sustainable solutions, and achieve concrete,
measurable results. Drawing on global insights for designing
and implementing public health programs, we aim to
challenge ourselves to uphold the highest standards in all
that we do to address NCDs.
4 | Access Accelerated in Action: Key Learnings in Program Design & Implementation Access Accelerated in Action: Key Learnings in Program Design & Implementation | 5
FOREWORD EXECUTIVE SUMMARY
Non-communicable diseases Understanding the road to forming effective public-private Access Accelerated in Action was developed as part of To capture how Access Accelerated member companies
(NCDs) remain a growing threat partnerships, through resources such as Access Accelerated Access Accelerated’s commitment to share learnings and have approached program design, this report:
to global health and development. in Action, provides a critical foundation to inform future continuously improve its approach to public health program
As the largest cause of preventable programmatic decision-making. This publication can spark design and implementation. It is the first collective effort 1. Articulates Access Accelerated’s commitment
morbidity and mortality worldwide, a broader dialogue on the opportunities for public-private from Access Accelerated companies to share information principles, identifying related key learnings and applying
NCDs negatively influence the partnerships to engage more deeply on NCDs in LMICs, on the NCD programs they are supporting in LMICs and them in program design;
lives of millions of people every driving much-needed action for people living with NCDs. demonstrates their commitment to greater transparency
2. Reviews 19 case studies on NCD partnerships, each
year. In 2018, the UN General Assembly High Level By establishing a culture of knowledge sharing, Access and accountability to improving health outcomes, the
underscoring a different principle in action and collating
Meeting on NCDs brought the need for action on NCDs Accelerated will continue to aid the development of novel global health community, and Sustainable Development
information gathered from the Access Accelerated
to the attention of the global community, specifically and innovative approaches to advancing NCD prevention, Goals 3.4 and 17. It articulates and explores some of the
website and Open Platform, and the Boston University
calling for multi-sectoral collaboration and integration of treatment and care. I welcome its publication and core principles—patient-centered program design, rigorous
Observatory; and,
NCDs into the development of universal health coverage encourage everyone interested in implementing new NCD measurement, local ownership, and more—that underpin
(UHC) systems around the world. initiatives – or thinking about how to improve the impact of the Access Accelerated commitment and examines how 3. Translates collective member company insights into a
existing programs – to study its lessons carefully. member companies have sought to incorporate these practical resource guide to support programmatic teams
Despite this, meaningful gains in NCDs remain aspirational principles into their programmatic work. In doing so, we as they design and develop new programs.
as many countries struggle to address the challenges Dr. Sania Nishtar hope to support Access Accelerated member companies
of cancer, diabetes, heart disease, respiratory disease and Co-Chair, WHO High-Level Commission on NCDs, and Chair, to learn from one another by identifying areas where Overall, this report identifies and responds to the need to
other chronic conditions effectively. Ministries of Health Poverty Alleviation Coordination Council, Pakistan
programs have been successful and common challenges. increase collaboration and sharing of learnings among NCD
in low- and middle-income countries (LMICs) lack the The report also highlights opportunities to deepen the stakeholders, along with the need for more sharable NCD
resources and capacity to advance NCD services at the pace impact of public-private partnerships, along with providing program design and implementation resources. By learning
we need to reach the billions of people around the world Over the past two years, we have a resource to strengthen collaborations among the public from the challenges and successes of the past, as well as
affected by NCDs, at all stages of the life course. It is seen Access Accelerated member health community, in service of expanding access to NCD understanding opportunities for the future, we hope Access
urgent that we find ways to work together to bridge these companies demonstrate their prevention, treatment, and care. Accelerated in Action can serve as key resource to support
gaps and support LMICs in developing robust, high-quality commitment to measurement future action on NCDs.
NCD service delivery as part of national health coverage. and transparent reporting by
sharing program information in a
Access Accelerated represents an opportunity as a common standardized way. This has been
initiative uniting companies across the biopharmaceutical done through the Access Observatory, a public repository
industry with multisector partners, including multilaterals, that we have established at the Boston University School
country governments in LMICs and NGOs. Through this of Public Health. With the publication of Access Accelerated
collective platform, Access Accelerated enables its members in Action, the Access Accelerated initiative has provided
and partners to enhance their work on NCDs, learning information on principles, best practices, case studies, and
from each other to launch new, stronger, and more ambitious a very useful Program Development Guide. The program
NCD collaborations in LMICs. development guide is a particularly valuable resource as it
offers practical, actionable steps for program design,
Access Accelerated in Action is an important resource in this
implementation, and monitoring & evaluation. We believe
effort, analyzing the experiences of 19 company-supported
this guide can serve as a framework for important discussions
programs implemented in partnership with more than
among biopharmaceutical companies, implementing
50 organizations. This report shares key learnings as a way
partner organizations, and other stakeholders to support
to improve global health program design, implementation
stronger collaborations for public health. The guide
and monitoring & evaluation. It highlights successes and,
may well be useful for other organizations interested in
more notably, looks at the challenges faced and overcome
addressing access to medicines and diagnostics in ways that
by public-private partnerships on the ground, extracting
facilitate transparent reporting and shared learning.
lessons for future initiatives.
Dr. Richard Laing
Professor, Department of Global Health, Boston University School
of Public Health
6 | Access Accelerated in Action: Key Learnings in Program Design & Implementation Access Accelerated in Action: Key Learnings in Program Design & Implementation | 7
INTRODUCTION
Access Accelerated represents a shared commitment It is important to note that this analysis represents a
by the biopharmaceutical industry to scale up its work starting point for Access Accelerated in sharing and
to expand access to prevention, treatment, and care for learning about strong public health program design and
non-communicable disease (NCDs) in low- and middle- development. The case studies that follow do not attempt
income countries (LMICs). This commitment, however, an evaluation on individual Access Accelerated programs
is not limited to individual action: one important way the or the initiative as a whole; they are meant to illustrate
industry can collaborate is by sharing our knowledge and the experiences of AA member companies as they design,
experiences and developing a common pool of resources develop, and implement public health programs. In speaking
to help countries, stakeholders, and partners strengthen to our principles and learnings identified through our
health systems to address the burden of NCDs. The NCD programs, we are not presenting a definitive or final
following analysis represents a first step in this process, viewpoint on how programs should to designed; rather, we
Overview
bringing together our experiences to date in designing, are presenting the opportunities that we have identified to
developing, and implementing NCD programs as an effort enhance programs, with the understanding and aspiration to
to contribute to Sustainable Development Goals (SDGs) continue to learn and improve our approaches to program
and Methodology
3.4 (by 2030, reduce by one-third pre-mature mortality from design and implementation. We hope to follow on this initial
non-communicable diseases (NCDs) through prevention and work by collaborating with partners and the broader global
treatment, and promote mental health and wellbeing) and 17, health community to broaden and deepen our collective
Partnerships for the Goals. knowledge. Ultimately, our aim is to support the efforts of
all stakeholders to address the growing burden of NCDs
Our goals for this report are three-fold: globally and improve the lives of people living with NCDs
and their communities.
1. Articulate our commitment to developing strong,
effective NCD-related programs, drawing on knowledge
and resources from the global health community as well
as our experience as the biopharmaceutical industry;
2. Learn from the work we have done so far, hearing from
our member companies about how they are working
to apply best practices in action and where they see
opportunities to strengthen their work; and
3. Share our experiences with the public health
community as a resource and starting point for future
conversations, strengthening our collaborations to
expand access to NCD prevention, treatment and care.
8 | Access Accelerated in Action: Key Learnings in Program Design & Implementation Access Accelerated in Action: Key Learnings in Program Design & Implementation | 9OVERVIEW AND METHODOLOGY OVERVIEW AND METHODOLOGY
CONTENT OVERVIEW PATIENT-CENTERED APPROACH
Cross-Cutting Principles: Articulating our Program Case Studies:
Cross-cutting MSD: SPARTA
Commitments → Patient-Centered Approach Experiences to date principle exhibited Through close engagement with patient groups and the Ministries of Health, MSD (known as Merck & Co. in the United States and
Canada) has developed a flexible technology platform to empower, educate, and support patients with treatment adherence.
→ Strong Local Ownership and Engagement by the case study
What do we seek to achieve in effective program design? How have Access Accelerated
OBJECTIVE SCOPE APPROACH
Provide comprehensive support for patient SPARTA programs are currently active in SPARTA draws on input from patients and
adherence to NCD treatment regimens more than 20 countries worldwide, including providers across different disease areas
What principles guide our work on NCDs? → Substantive Partnerships member companies applied
through a set of health technology
platforms, tools and resources designed to
address their needs and challenges.
several LMICs. and geographies to provide customized
informational and motivational support to
empower patients.
This report begins by articulating a set of six cross-cutting → Sustainable, Equitable Solutions cross-cutting principles in specific Adapting innovative tools to address
NCD programs?
KEY LEARNINGS
patient support needs
principles that can inform effective design in public health Program Engaging communities and patients informs effective
→ Innovation and Continuous Learning
SPARTA provides support to physicians and patients receiving program design and governance
various therapies to improve adherence to NCD treatments.
description
Sharing program results with patients drives
It incorporates a range of direct-to-patient resources such as
programming. These principles capture the vision expressed A series of program case studies
accountability and motivates behavior change
disease awareness training, motivational messages, linkages
→ Rigorous Transparency and
to health services, support for lifestyle modifications, and
in Access Accelerated’s Commitment Letter, calling on details current NCD initiatives
access to technological platforms for monitoring patient vitals.
injections. A similar program was implemented in six major
Originally developed in Australia, the SPARTA platform has
Measurement
schools in Brunei, which showed an 80% increase in children
been rolled out in more than 20 countries, adapting to local
receiving all three doses of the vaccine.
member companies to continuously improve the quality that bring a strong focus to each
government priorities and patient needs. In each new location,
MSD country teams:
Challenges and lessons learned
1. Meet with patients through a third-party vendor and
and effectiveness of their work. of our cross-cutting principles. patient advocacy groups to learn more about the challenges
they face at different stages of the patient journey; and,
• Integrating data systems: One of the most important
and sensitive aspects of the SPARTA program is data
These case studies serve to Relevant 2. Work with the Ministry of Health to align programming
with government priorities and ensure services and data
management. As the program is applied to different country
contexts, the SPARTA team works to ensure data captured
through the program respects patient privacy and complies
learnings collection are integrated into national systems.
with legal and regulatory guidelines. In addition, the team
illustrate how Access Accelerated By reaching patients through the most appropriate medium—
phone calls, emails, text messages, mobile apps, or other
strives to integrate its systems with existing national
health information systems. However, this process can be
challenging in countries that lack digital health records or
member companies have applied
tools—and providing them with essential information, SPARTA
programs can drive improved adherence. For example, data operate several parallel systems that are incompatible with
on diabetes patients in India found improvements in patient one another.
key learnings to specific challenges
confidence in managing and monitoring their condition, choosing
• Refining patient outreach: When SPARTA first began
a healthier diet and understanding the need for physical activity.
implementation in the Philippines working through
In addition, a recent analysis of 40,000 patients from seven
physicians’ offices, the program struggled to reach patients.
and contexts.
countries found that 85% of patients took their medications
MSD responded by exploring the patient experience
correctly 95% of the time for more than 10 months.
further, this revealed that patients often engage more
substantially with pharmacists than with physicians, regularly
Highlighted successes to date turning to pharmacists for advice. Subsequently, SPARTA
Key Learnings: Applying our principles PRINCIPLE RELEVANT KEY LEARNINGS
Between 2013 and 2017, the SPARTA program grew from
60,000 patients in Asia-Pacific to more than 200,000
began engaging patients at the pharmacy level, and
experienced an increase from 100 participating patients
to 15,000 in just 6 months.
in practice
patients worldwide. In Indonesia, for example, MSD worked
with the Ministry of Health to address the rising issue of
non-compliance to the HPV vaccine. MSD created a registry
for school children who received their first injection and
implemented an email reminder service to encourage each
PATIENT-CENTERED • Engaging communities, patients and their student and their guardians to complete the course of three
APPROACH caregivers inform effective program design
What does it mean to apply these principles in practice?
and governance
What have we learned from our experiences along the way?
Access Accelerated in Action: Key Learnings in Program Design & Implementation | 41
• Identifying opportunities to empower patients
We identify and define key learnings in program design and and advocates across program activities PROGRAM DEVELOPMENT GUIDE
amplifies the patient voice
implementation associated with each of these principles,
• Developing privacy guidelines ahead of
drawn from the experiences and insights of our member
program implementation safeguards individuals,
companies in implementing NCD programs. Input from including staff and patients PROGRAM DEVELOPMENT PROCESS CHECKLIST
our members is complemented by a review of expert • Sharing program progress and results with
This checklist outlines basic logistical steps in the program development process, to guide users as they move through the
more detailed discussion guide below.
literature (e.g., publications, position papers) from a variety patients and communities drives local
of stakeholders (e.g., academia, multilaterals, civil society)
accountability and motivates sustained Program Development Identify Parameters
Define the public health issue
Identify the target population
behavior change
to arrive at clear, shared terminology to describe our Guide: Resources to inform Assess the population health need
understanding of strong NCD initiatives. and strengthen new Assess Need Identify social determinants of health
Consult partners and key stakeholders
and existing programs Develop a vision
Checklist to guide users
Define Goals
& Objectives
Define program goals and objectives
Identify program contribution to global health
through the logistical
Moving forward, how can learnings steps of program design
Research intervention options and assess inc ontext
be applied most effectively across Design Activities
Create a sustainability plan
Create a measurement framework and set targets
all stages of program design and
PROG
Create an evaluation framework
implementation?
Trends & Recommendations: Shared themes Mobilize Partners
Identify and allocate internal resources
Define partner criteria
Key Learnings identified and To translate our principles and key & Resources Select partners
Engage partners and outline terms of engagement
What learnings arise across multiple NCD programs? In which areas are certain applied by multiple programs learnings into a practical, actionable PROGRAM DEVELOPMENT DISCUSSION GUIDE
Identify and prepare for challenges
programs breaking new ground? resource for Access Accelerated Anticipate & Respond
to Challenges
Ensure regular monitoring to respond to challenges
The Guide below walks through basic logistical steps 2. What is the population
member company program teams,
Turn challenges into opportunities
in program design, development and implementation, reach with a public hea
Looking across Access Accelerated member company experiences to date, we extract applying Access Accelerated’s cross-cutting principles at a geographic region or
Opportunities for learnings to partners and other stakeholders, Assess and reflect on program outcomes
high-level themes and recommendations for current and future programs. We identify Share Learnings Plan and communicate program internally and externally each step. As the user advances, guiding questions prompt social group, such as wo
be applied more broadly across we outline the basic logistical steps Share learnings and best practices consideration of relevant learnings in the form of practical, areas. If we have yet to
learnings shared across multiple programs, and highlight where new ideas could be actionable suggestions. Overall, the guide provides users considerations may be:
programs to strengthen work of program development alongside with a practical step-by-step resource in expanding or
applied more broadly to strengthen program effectiveness. launching programs. • Company presence: Ac
a discussion guide that prompts users company and partners
(e.g. commercial presen
to integrate relevant key learnings Discussion guide for Step 1: Identify initial parameters work); identify strong r
regional and national go
at each stage. 46 |
program teams to address
Access Accelerated in Action: Key Learnings in Program Design & Implementation
support program develo
As a first step developing a program concept, aligning
and integrate learnings on the initial scope is essential. A program may arise • Governance and stabili
to address treatment gaps in a particular disease area, governance practices; d
or meet the needs of patients in a specific region or a stable environment fo
country. Identifying these paraments where they and glean insights to he
exist—and defining them where they do not—is roadblocks early in prog
critical at the outset. conflict, economic hea
If we have identified the he
| Design & Implementation | 11 population focus:
1. What is the public health goal we are best positioned reviewing the following are
10 Access Accelerated in Action: Key Learnings in Program Design & Implementation Access Accelerated in Action: Key Learnings in Program
to address with a public health program? I.e. improving
health in a certain disease area; expanding access to a
• Country-level need: As
certain health service or technology; or overcoming
specific areas of unmet
a specific health systems barrier. If we have yet to
identify an issue, some considerations may be:OVERVIEW AND METHODOLOGY OVERVIEW AND METHODOLOGY
METHODOLOGY
In order to better understand the experiences of Access Step 3: Descriptive case research Collation of Key Learnings
Accelerated member companies in developing programs Through further consultation with the Company Program
and partnerships to advance access to NCD prevention, The third objective of this report was to better understand
Information Working Group, and the strategic and
treatment, and care, a three-step research process was the experiences of Access Accelerated member companies
programmatic leads of the 19 short-listed programs, a
developed. An overview of this process is below; please also applying these principles in practice in the process of
consolidation of key learnings was developed under the
reference the Appendix on page 64 for a more detailed designing and implementing programs to expand access
auspice of each initially outlined principle. These key
discussion of our methodological foundations and process. to NCD care in LMICs. Descriptive and exploratory case
learnings reflect the overarching outcomes emerging from
study research was identified as the most appropriate
efforts by Access Accelerated member companies to: (1)
methodology to deepen our understanding of these
Step 1: Definition of Access Accelerated retrospectively implement workstreams to support program
experiences and share these learnings. As expressed by the
commitment principles World Health Organization (WHO), case studies are an
enhancement; and, (2) implement solutions to tackle
challenges faced in program design, implementation, and
The first objective of this report was to establish a shared, important tool to capture the unique experience of a given
monitoring & evaluation.
working definition of the Access Accelerated commitment program in context, as well as to “foster the dissemination
in terms of specific principles for strong program design of inclusive and creative approaches” and “lead to a better The Cross-cutting principles & key learnings section on
and implementation. Building from the original Access understanding of what works and why.”2 page 14 provides an overview of the key elements of this
Accelerated Commitment Letter, Access Accelerated framework.
member companies developed and ratified a set of central, Case Framework
cross-cutting principles that define the initiative’s collective A case framework was developed and structured according Data Analysis
aspirations and values for programmatic work. A starting to the previously defined Access Accelerated principles. Information gathered on each program was compiled into
definition was developed for each of these principles, based For each program case study, the analysis focused on (1) case studies, with the case framework serving to structure
on consultations with the Company Program Information key learnings associated with the primary cross-cutting and guide the analysis. Following the compilation of
Working Group, consisting of strategic and programmatic principle and how these learnings informed the process of individual case studies, a preliminary cross-case analysis
leads from Access Accelerated member companies, and program development and implementation; (2) highlighted was undertaken to identify key insights into how member
a review of expert literature addressing the subject of each successes the program has achieved to date through companies have applied Access Accelerated principles in
commitment principle. this approach; and (3) challenges encountered and how practice to strengthen the effectiveness of programs to
lessons learned were applied over the course of program enhance access to NCD prevention, treatment and care in
Step 2: Identification of biopharmaceutical implementation. LMICs.
industry partnership examples
Data Collection The Key trends, opportunities, and call to action section on
The second objective of this report was to identify a range page 22 provides an overview of these insights.
of examples of biopharmaceutical industry partnerships For each case study, an initial scan identified and
expanding access to NCD prevention, treatment, and compiled all publicly available information, including the
care in LMICs. Access Accelerated launched an open International Federation of Pharmaceutical Manufacturers
crowd-sourcing call for members to nominate programs & Associations (IFPMA)’s Global Health Progress resource,
for inclusion in the report as illustrative examples of each the Boston University Access Observatory, the Access
cross-cutting principle in action. Over the course of a Accelerated Open Platform, and other sources such as
year, 18 out of 24 Access Accelerated member companies company and partner websites, reports, and press releases.
nominated a total of 26 potential programs, from which an In-depth interviews were conducted with program leads,
initial set of 19 programs were selected to illustrate diverse with supplementary information provided by some broader
program profiles (i.e. programs in different geographic program teams and partners as required between April
regions; of different scopes and sizes; employing a variety 2018 through March 2019.
of program strategies and activities; operating via different
partnerships models).
12 | Access Accelerated in Action: Key Learnings in Program Design & Implementation Access Accelerated in Action: Key Learnings in Program Design & Implementation | 13DEFINING OUR CROSS-CUTTING PRINCIPLES AND KEY LEARNINGS
This manual begins by articulating a set of six cross-cutting Our Experience
principles to consider for strong design in public health For Access Accelerated member companies, a patient-
programming. These principles encapsulate the vision centered approach is at the core of their strategies because
expressed in the original Access Accelerated Commitment it allows them to engage with patients to gather insights
Letter, which called on members to continuously improve to inform the design of effective health solutions.8 In
the quality and effectiveness of their work in alignment designing NCD programs in LMICs, a patient-centered
with these values. approach not only helps maximize the reach and health
For each principle, we begin by developing a shared impact of interventions, but also helps in understanding
definition, based on a review of expert literature on the barriers to care and the social and economic burden often
theory and application of each principle, including research linked to chronic diseases. Tools are available to support
Cross-Cutting Principles
and position papers published by key stakeholders (e.g., designing innovative, patient-centered interventions, for
multilateral institutions, prominent non-governmental example rapid testing methods, such as ‘Plan-Do-Study-
organizations, and academia). We follow by speaking to Act’, and help to develop effective, sustainable, patient-
centered solutions.9 Companies design patient-centered
and Key Learnings
our experiences, as the biopharmaceutical industry, and
why this principle is central to our vision for Access programs that foster open communication and information-
Accelerated. Finally, we consolidate a list of frequently sharing among patients, their broader communities, and
identified key learnings applicable to each principle to member company employees—supporting individual
support more effective future programming and drive empowerment and education.
sustained improvements in NCD care. These key learnings
are drawn from the input of Access Accelerated program Relevant Key Learnings
teams and expert stakeholders, and supplemented with • Engaging communities, patients and their caregivers
insights from evidence from reviews of available literature. informs effective program design and governance
• Identifying opportunities to empower patients and advo
CROSS-CUTTING PRINCIPLE #1 cates across program activities amplifies the patient voice
1
• Developing privacy guidelines ahead of program
implementation safeguards individuals, including staff
Patient-Centered Approach and patients
• Sharing program progress and results with patients
and communities drives local accountability and
Definition motivates sustained behavior change
A patient-centered approach refers to an approach that
responds to and respects patients’ expressed values, CROSS-CUTTING PRINCIPLE #2
preferences, and desired health outcomes, meaningfully
2
engaging people living with NCDs to become active
participants in their health and wellbeing. Patient-centered Strong Local Ownership
approaches are informed by, and designed to meet the and Engagement
needs of, individuals and communities. WHO has enshrined
patient-centeredness in its Framework on Integrated People-
Centered Health Services3 and re-iterated its importance in Definition
the recent Tokyo Declaration on Universal Health Coverage.4
Strong local ownership and engagement, which has been a
Furthermore, research demonstrates the value of this
tenet of bilateral and multilateral aid for several decades,
approach in LMICs, finding that introducing patient-
entails collaboration and open communication with local
centered approaches to care improves patient satisfaction
stakeholders at all stages of program development, execution,
and confidence in self-management.5–7
and evaluation. A good example of this principle in practice
is the Global Fund to Fight AIDS, Tuberculosis and
Malaria’s Country Coordination Mechanisms, which serve as
an active means of fostering stakeholder collaboration and
14 | Access Accelerated in Action: Key Learnings in Program Design & Implementation Access Accelerated in Action: Key Learnings in Program Design & Implementation | 15CROSS-CUTTING PRINCIPLES AND KEY LEARNINGS CROSS-CUTTING PRINCIPLES AND KEY LEARNINGS
participatory decision making in development activities.10 CROSS-CUTTING PRINCIPLE #3 Relevant Key Learnings Of key importance is sustaining gains while minimizing
Ensuring local ownership also means that programs align • Building trust and establishing strong, ongoing interruptions in the provision of care once the initiative ends.
3
with existing systems rather than being developed in parallel relationships with local governments, implementers and Companies have used strategies such as local ownership
and include capacity-building components to empower local communities strengthens partnership and engagement, integration of programs within existing
governments and partners. These elements are emphasized Substantive Partnerships health infrastructure, and alignment with national health
in important multilateral policy declarations, including the • Seeking diverse partners (e.g., partnerships across priorities as ways of ensuring enduring programs. Moreover,
Organization for Economic Co-operation and Development’s sectors) brings in complementary expertise in the face of inequities and disparities in healthcare,
Paris Declaration on Aid Effectiveness, signed in 2005, and Definition • Seeking partners with access to different networks (e.g., some companies have begun to develop comprehensive
the Accra Agenda for Action, endorsed in 2008.11 professional networks and distribution networks) can approaches to reaching the underserved, such as
The UN Sustainable Development Goals (SDGs)—and segmenting patients by income and providing products
expand program reach and streamline implementation
specifically SDG 17, which is devoted entirely to partnerships— and services targeted towards patients’ needs and ability
Our Experience • Co-designing program objectives and activities with
has underscored the importance of substantive cross-sector to pay in each segment,28 as well as using technological
For the biopharmaceutical industry, local ownership and collaboration in achieving sustainable development.14 key partners strengthens alignment and coordinated
solutions to increase the reach of initiatives and which can
engagement typically involves partnering with governments Substantive partnerships are those in which the talents, implementation
be integrated into national systems.
through their ministries, particularly Ministries of Health, expertise, and resources of each partner are drawn upon • Identifying potential partners based on relevant experience
and is a means of ensuring accountability, long-term effectively to both foster trust between partners and enable and demonstrated expertise strengthens program quality
sustainability, and a plan for eventual transition.12, 13 Relevant Key Learnings
increased impact on population health. Such partnerships
Locally-tailored approaches based on initial needs assess- • Identifying internal areas of expertise to support programs, • Designing activities that strengthen and use local
are characterized by collaboration models that clearly define
ments conducted in partnership with in-country institutions such as strategic planning and technical knowledge, can infrastructure helps to sustain and scale programs
each partner’s role and integrate coordination mechanisms
are an extension of patient-centeredness and have a high strengthen collaboration and communication
for optimal success. Open communication, which can be • Assessing need across different populations (e.g.,
likelihood of acceptability (and ultimately, success) since they aided by formalized structures like regular governance • Sharing data and reporting information among all low-income populations, rural inhabitants, women, and
best reflect the needs of the population.14, 15 Local support meetings or working groups, is a key feature of substantive partners encourages accountability and transparency children) supports equitable program implementation
and alignment to existing government structures is one partnerships and helps to establish accountability measures,
important way companies can ensure that their programs • Developing program transition plans and scale-up
manage expectations, and build mutual understanding CROSS-CUTTING PRINCIPLE #4
are as efficient and effective as possible, providing the most blueprints helps ensure gains achieved through the
among partners.17
4
benefit and value for people living with NCDs in LMICs. program are sustained and minimizes interruptions in the
provision of care and treatment once an initiative ends
Our Experience Sustainable, Equitable Solutions
Relevant Key Learnings • Measuring outcomes and the long-term impact of
Biopharmaceutical companies employ varying models
• Aligning program approaches with national laws, program activities generates evidence needed to sustain
of substantive partnership, including grants-based
policies, and public health strategies strengthens focus and scale-up interventions
collaborations, coalitions or networks, strategic alliances, Definition
on local priorities or long-term transformational partnerships that seek to • Analyzing outcomes across different populations helps
• Partnering with local leadership to assess needs prior initiate system-level change.18 Whichever model is pursued, Sustainable, equitable solutions aim to meet the health to ensure program reach is inclusive
to program development strengthens program design companies are increasingly entering into partnerships needs of LMIC populations, while considering long-term
and implementation in which all parties have a shared vision and goals, as viability from program initiation. Such programs are often CROSS-CUTTING PRINCIPLE #5
these form a foundation of trust, respect, accountability, intended to be scaled-up to settings beyond the initial
5
• Co-creating programs with local stakeholders aids pilot location for widespread benefit and specifically target
and transparency among partners. As well, a common
successful design and implementation
mission has been shown to build long-term partnerships reductions in health disparities.20 Unsustainable programs Innovation and
• Regularly and pro-actively engaging government where collaboration continues beyond the initial project which jeopardize positive health outcomes are major Continuous Learning
stakeholders sustains in-country program ownership remit. As a first step in the process towards building such concerns for donors, partners, and scholars alike; thus,
and commitment partnerships, companies are selecting their partners there is robust literature analyzing factors and approaches
utilizing external partnership tools, for example the World that make programs sustainable.21–26 For example, a policy Definition
• Integrating local stakeholders into governance
Bank’s PPP Infrastructure Toolkit.19 These tools help to brief published by the WHO’s Department of Essential
structures increases accountability (e.g., program Programs that prioritize innovation and continuous learning
identify partners with similar values and a demonstrated Medicines and Health Products identified the development
management structures include local stakeholders) are flexible and creative in the face of pressing challenges
effectiveness and credibility with the populations and in of clear transition plans as one way to ensure long-term
• Adapting program results and quality monitoring and frequently review their results to identify opportunities
the settings in which the partnership will operate. sustainability of public-private partnerships in health.12 Equity
processes to the local context helps to strengthen local for improvement. Innovation in program design has been
From there, companies and their partners are defining is also a concern identified in program design literature,
capacity and collaboration towards program goals defined by Dr. Thomas Frieden, the former director of the
organizational structures, instituting clear strategies, though many scholars have acknowledged the difficulty of
U.S. Centers for Disease Control and Prevention, as one
• Ensuring programs are aligned with, and integrated establishing measurable objectives, and implementing measuring it in the distribution of products and services.27
of the “six components necessary for effective public health
into, local health systems avoids the development of feedback mechanisms that help to enable effective program implementation.” In his paper on the topic, Dr.
unsustainable, parallel infrastructures partnerships that can achieve ambitious goals. Our Experience
Frieden argues that innovation feeds continuous learning and
• Strengthening the capacity and leadership of local For biopharmaceutical companies, the sustainability of their “can further build the evidence base for interventions by better
institutions helps sustain interventions investments is of the utmost importance, as most programs identifying those that are not working as expected and those
have a finite time horizon and resources threshold.
16 | Access Accelerated in Action: Key Learnings in Program Design & Implementation Access Accelerated in Action: Key Learnings in Program Design & Implementation | 17CROSS-CUTTING PRINCIPLES AND KEY LEARNINGS CROSS-CUTTING PRINCIPLES AND KEY LEARNINGS
that are effective and ripe for scale up.”29 Programs exhibiting often accompanied by an openness to innovation and COLLATED KEY LEARNINGS IN PROGRAM DESIGN, IMPLEMENTATION,
innovation and continuous learning engage end-users to continuous learning). Transparency facilitated by rigorous
better understand their needs and challenges and can adjust measurement is often hailed as a “gold standard” in
AND MONITORING & EVALUATION
as conditions change through course-correction. public-private partnerships. Stakeholders like the World
Bank have worked to make transparency a top priority The table below consolidates the relevant key learnings in program design, implementation, and monitoring & evaluation
Our Experience in development partnerships by publishing tools for associated with each of the Access Accelerated cross-cutting principles, for quick reference.
data collection, disclosure, and application in real-world
The biopharmaceutical industry fosters innovation in the
contexts.32 Additionally, academics and advocates have
research and development of medicines; this innovation
called for rigorous measurement of global health initiatives
can also carry over into program development. For example, PRINCIPLE RELEVANT KEY LEARNINGS
by neutral evaluators both as an accountability mechanism
companies’ desire to incorporate patient-centricity
and a way of broadening the evidence base on public-
through human-centered design has led to new innovations
private partnerships.33, 34 PATIENT-CENTERED • Engaging communities, patients and their caregivers informs effective
in health solutions as companies seek to learn from the
APPROACH program design and governance
knowledge and expertise of patients.28, 30 Programs
exhibiting innovation and continuous learning also share Our Experience
• Identifying opportunities to empower patients and advocates across program
insights from their experiences regularly, as well as apply Rigorous measurement often entails the development of a
activities amplifies the patient voice
increased understanding to their own solutions to improve set of key performance indicators that are publicly reported
the initiative or program. As companies strive to build against during predetermined intervals, having been • Developing privacy guidelines ahead of program implementation safeguards
the evidence base around their global health programs, outlined at program initiation. Biopharmaceutical companies individuals, including staff and patients
companies are partnering with academic institutions to report on their global health programs and disclose progress
evaluate initiatives and share their knowledge—about both against targets in Corporate Social Responsibility reports • Sharing program progress and results with patients and communities drives
successes and challenges—to enable the application of and voluntary indices like the Access to Medicines Index and local accountability and motivates sustained behavior change
similar approaches in other geographies and populations, the Dow Jones Sustainability Index. Individual companies
though more can be done.31 and multi-company initiatives like Access Accelerated,
STRONG LOCAL • Aligning program approaches with national laws, policies and public health
which is partnering with Boston University to develop its OWNERSHIP AND strategies strengthens focus on local priorities
Relevant Key Learnings monitoring and evaluation (M&E) framework, are working ENGAGEMENT
with third-party academic evaluators to better understand • Partnering with local leadership to assess needs prior to program development
• Testing and evaluating new approaches (e.g., services,
the performance of their programs, identify how their strengthens program design and implementation
treatments, program strategies, data systems, etc.) can
programs are contributing towards global targets, and share
help overcome current challenges
learnings from successes and challenges. Highlighting • Co-creating programs with local stakeholders aids successful design and
• Continuously engaging people living with NCDs and tangible results that emerge from the application of a implementation
analyzing the program helps to identify if objectives are stringent M&E process can help build trust and credibility
being met and activities require course-correction between partners and among the wider public. • Regularly and pro-actively engaging government stakeholders sustains
in-country program ownership and commitment
• Designing program evaluations to fill specific data gaps
provides a lasting contribution to the evidence base of Relevant Key Learnings
• Integrating local stakeholders into governance structures increases
effective public health programs • Developing clear objectives from the start helps track accountability (e.g., program management structures include local
• Sharing knowledge and results locally, nationally, progress, measure success, and improve alignment stakeholders)
regionally, and globally helps others adapt and scale across partners and external stakeholders
solutions to different settings • Adapting program results and quality monitoring processes to the local
• Using frameworks to design strategies and activities (e.g.,
context helps to strengthen local capacity and collaboration towards program
logic models, results frameworks, and theories of change)
goals
CROSS-CUTTING PRINCIPLE #6 helps create more clear, cohesive, and robust programs
6
• Conducting program evaluations increases internal • Ensuring programs are aligned with, and integrated into, local health systems
avoids the development of unsustainable, parallel infrastructures
Rigorous Measurement and external understanding of interventions successes,
failures, and lessons learned
and Transparency • Strengthening the capacity and leadership of local institutions helps sustain
• Working closely with third-party evaluators and interventions
implementing partners can lead to more robust and
Definition feasible measurement mechanisms
Rigorous measurement and transparency enables programs • Consistently measuring and sharing program
to track progress, demonstrate impact, and quickly approaches and results improves accountability and
identify and address challenges as they arise (and is thus builds public awareness, knowledge and engagement
18 | Access Accelerated in Action: Key Learnings in Program Design & Implementation Access Accelerated in Action: Key Learnings in Program Design & Implementation | 19You can also read
