The Challenge
Every year more than 5.5 million children die before their fifth birthday and more than 300,000 mothers die due to pregnancy- or childbirth-related causes. Interventions exist that can prevent more than half of these deaths. However, access to life-saving medicines for mothers, newborns and children under the age of five remains particularly low in Sub-Saharan Africa (SSA), where the majority of global under-five and maternal mortality occurs.
The COVID-19 pandemic has made the situation much worse. During this period, maternal and under-5 deaths are estimated to increase by up to 40% and 45% respectively. At exactly the moment when the public health landscape is most dire, countries will have the least financial resources as fiscal space shrinks due to the economic shocks from COVID-19.
The Opportunity
The UN Sustainable Development Goals set a target to end preventable maternal, newborn and child (MNCH) deaths by 2030s. To accomplish this, increased access to life-saving MNCH medicines is essential.
To-date, many MNCH medicines have not benefited from the kinds of coordinated market shaping interventions that have been more commonplace in other essential health commodity markets such as vaccines and HIV/AIDS medicines. These market shaping solutions are critical to rationalize products, reduce costs, ensure high quality, increase efficiencies and improve commodity availability.
A strategy to shape these MNCH markets requires a clear understanding of the landscape and key barriers to access. Unfortunately, this kind of fact base had been absent due to the fragmented nature of the MNCH market and the lack of coordination. Fundamental questions around what are governments’ priorities around MNCH, what is the total forecasted need, which medicines are actually being procured with limited budgets and at what volumes and prices, who is the dominant funder, etc. remained open.
In this context, R4D conducted a holistic and empirically grounded examination to identify the main market challenges impeding access to a priority set of 14 MNCH medicines. The medicines were determined based on synthesizing country needs, public-sector health facility priorities, and government strategic priorities.
Our Results
Through collaborations with procurement agencies, national drug regulatory authorities, ministries of health, implementing partners, donors, and other stakeholders, R4D systematically analyzed financing, procurement, pricing, quantification, and regulatory data across five SSA geographies – Ethiopia, Kenya, Tanzania, Uganda, and the state of Kano in Nigeria – which in aggregate, procure large volumes of MNCH products and are all Global Financing Facility (GFF) countries. Overall, the following key market barriers were identified:
- Product selection: There are significant product mismatches at global and country levels, and within countries, across guidelines, quantifications, and procurement. This is leading to severe fragmentation, which in turn results in suboptimal allocation of resources, with countries not holistically focusing on priority medicines.
- Procurement and suppliers: Governments drive the vast majority of MNCH procurement, but important inefficiencies are seen from quantification to procurement, including product diversification and mismatches, high transaction costs, supplier fragmentation and long delays in shipment of medicines. Together, these signal room for support and optimization.
- Financing: Governments are by far the dominant funder of these medicines, with GFF resources not widely used for MNCH medicine procurement. Large hurdles are experienced vis-à-vis adequate and timely disbursement of funds; closing the gaps will require greater targeted support while balancing a few factors.
- Quality: Very few high-quality verified manufacturers (those manufacturers that have been Stringent Regulatory Authority and/or WHO Prequalification Programme approved for specific medicines) are registered across the focus geographies, and countries are procuring from even fewer of them, with limited fiscal space to procure from higher quality manufacturers if they are higher-priced.
- Pricing: All of the above factors are interdependent with each other and with pricing. While governments are procuring at prices lower than global agencies/donors, cross-country and within country temporal price variations (not entirely explained by related volume adjustments,) indicate explorations are needed for pricing rationalization to improve certainty and affordability.
In 2021, R4D has begun to develop solutions to the market challenges identified through its comprehensive assessment. Solutions that harmonize the market will be co-created with a range of relevant market actors at global, regional, and country levels. These solutions will enable decision-makers to make well-informed strategic decisions regarding how best to catalytically implement changes to improve access for life-saving MNCH medicines.
