Increasing Access to Pneumonia Treatments in High-Burden Countries

The Challenge

Pneumonia is the leading killer of children under five globally. Approximately 900,000 children under the age of five died from a pneumonia-related death in 2015 — more than from HIV/AIDS, tuberculosis and malaria combined — despite the existence of an effective World Health Organization (WHO)-recommended treatment: amoxicillin dispersible tablets (amox DT). Although amox DT has a number of advantages over previous treatment options — such as simplified dosing and supply chain requirements, and a relatively inexpensive cost (about $0.50 per course of treatment) — access to this lifesaving commodity remains abysmally low in many low- and middle-income countries.

The Opportunity

Given the large burden of pneumonia and the fact that about 70 percent of pneumonia cases are left untreated every year, it is essential that high-quality, affordable amox DT is made available to all affected children.

To investigate and identify the factors inhibiting the scale-up of amox DT, Results for Development completed a holistic market analysis that included country visits to four high-burden countries and interviews with more than 160 demand, supply and global actors across 65 organizations, including procurers, manufacturers and distributors, donors and other key stakeholders.

The analysis identified several key drivers for the lack of amox DT uptake:

1. Demand-side barriers such as regulatory issues, problems with accurately forecasting and planning for needs, and limited options for government procurement.
2. Supply-side challenges such as manufacturers not wanting to engage in complex registration processes without a clearer picture of demand.
3. A lack of funding for this important issue.

Our Approach

R4D is working at the global and country levels to urgently address the underlying causes of the lack of effective access to amox DT in high-burden countries, with a specific focus on Ethiopia and Tanzania. This work will result in millions of children receiving increased access to high-quality pneumonia treatment.

Through the end of 2019, R4D is conducting the following activities:

• Conducting rigorous market analyses in high burden countries in Africa and Asia to identify and address barriers to increasing access to amox DT.
• Serving as a “market manager” for amox DT, working across stakeholders to facilitate a coordinated and sustainable scale-up in areas such as national guidelines updates, improving country-level forecasting and starting national procurement.
• Engaging with high-quality global and local manufacturers and suppliers of amox DT to increase transparency of markets in high-burden countries and sharing business cases for country-level drug registration to ensure a readily accessible supply of amox DT.
• Working with national governments and key pneumonia stakeholders to identify sustainable, long-term financing for amox DT.
• Using time-limited funding, purchasing and donating amox DT to the governments of Ethiopia and Tanzania to secure a rapid switch from inferior pneumonia treatments, drive scale up of amox DT, and address near-term financing gaps and constraints to save lives.
• Activating distributors, wholesalers and drug shops to drive improved supply of amox DT in the private sector in Tanzania.
• Tracking trends in availability, stocking and dispensing in multiple rounds of survey in Tanzania to help the national government monitor whether increased procurements at the national level lead to improved availability in frontline points of care around the country.
• Conducting formative research to ascertain current rates of over- and under- diagnosis of pneumonia and their underlying causes in public health facilities.
• Identifying and piloting programmatic interventions to drive increased appropriate diagnoses of childhood pneumonia, and appropriate prescription and dispensing of amox DT for improved quality of care and rational use of medicines for childhood pneumonia.
• Exploring additional cost-effective areas for impact such as oxygen therapy and pulse oximetry diagnostics for addressing severe pneumonia.

This work is being conducted in close coordination with country governments, implementing partners, local and international manufacturers, and donors to ensure that children’s lives are saved through increased and sustainable access to high-quality treatment and services for pneumonia.

Photo © Brant Stewart/RTI/USAID