Financial Times article - September 2008

The Financial Times published an article entitled "A Healthier Future", about the pioneering work of International Health Partners.

"Anthony Dunnett founded International Health Partners as a way to donate drugs to provide acute care to regions suffering from humanitarian disasters, writes Andrew Jack. He soon discovered there was as great a need to provide support for more structural chronic treatment to many entire countries.

In the past three years, his fledgling UK-based charity has channelled drugs and other medical supplies given by 80 companies to treat more than 4m patients. Now it is starting to respond to the need to tackle longer term underlying health problems.
“Companies want to do something, but they are often fed up with governments and NGOs [non-governmental organisations] just talking and criticising,” he says.

Recognising the need to combine so many piecemeal initiatives, his response has been to develop a pilot country-wide health project in Gambia. Different international and local groups will work together to build a health system, covering everything from advice on hygiene through pharmacy distribution to clinical diagnosis, out-patient treatment and surgery.

The method – one of a growing number of projects taking shape around the world – is to bring the private sector together with its public and non-profit counterparts to tackle the three health-related Millennium Development Goals.

At first glance, the goals seem far removed from business: to reduce child mortality; improve maternal health; and combat HIV/Aids, malaria and other diseases. In reality, there are many ways in which companies can help.

While healthcare is one of the world’s largest and fastest expanding economic sectors, it is highly fragmented. Although most drugs are developed by a small number of multinational companies, many other aspects of medical practice are much more diffuse. Few companies manage clinics or hospitals in more than one country or region, for instance. Most are local operators; many work through the state.

Equally, much of the effort in improving healthcare in the developing world has focused on better provision by government. Faith-based groups and other non-profit entities gain less official attention and resources; business far less still.

Many innovative actions in developing world health in recent years have also been public-sector dominated. Innovative financial mechanisms have been set up in health since the turn of the millennium, such as the Global Fund to fight Aids, TB and Malaria, with commitments now exceeding $10bn. Yet the vast majority of its money comes from governments, and little is received by for-profit health providers.
The International Finance Facility for Immunisation has raised more than $1bn through bonds to support the Global Alliance on Vaccines and Immunisation. But the money is raised against future government aid pledges, and largely also paid out to developing country governments (albeit partly to buy vaccines).

That is not to say companies have been absent. They have helped channel a share of profits from sales of goods and services to socially conscious consumers, with money for the Global Fund generated through Product Red. They have also begun to contribute funding to the Global Fund directly, although the rules forbid in-kind donations, including medicines. Frustrated by insufficient control over the money they offer, and the long-standing lack of accountability or ability to deliver by international bodies such as Roll Back Malaria, many companies have instead acted unilaterally.

Some have donated large qunatities of drugs for developing world disease, such as Merck’s long-standing programme for Mectizan to fight river blindness. Groups such as Anglo-American, De Beers, ExxonMobil and Marathon, which have a substantial presence in poor countries, have provided treatment and elimination programmes to employees, their families and the local community.

A number of the drug companies, with philanthropic support, have developed public-private partnerships to discover new drugs, vaccines and diagnostics for “neglected” tropical diseases such as the Medicines for Malaria Venture and the TB Alliance.
Collectively, the pharmaceutical companies with HIV treatments have run the Accelerating Access Initiative to boost the use of antiretrovirals in low-income countries at substantial discounts.

They have also taken a growing interest in “differential pricing” in the larger emerging economies such as India, where the practice has a clearer commercial pay-back. If not addresing the “bottom of the pyramid”, they are at least cutting prices to boost sales some way below its prosperous but tiny peak.

But there is potential to do much more. Partly, that requires a shift in approach by governments. A recent United Nations report pointed out that import duties and other bureaucratic obstacles contributed to the high prices of essential medicines.
A study published last year by the International Finance Corporation, the private sector arm of the World Bank, on healthcare, specifically in Africa, concluded that there is potential to work much more with the private sector.

Business opportunities range from locally-based generic pharmaceutical companies producing cheap medicines, through to pharmacy distribution networks, private medical practitioners, clinics and health insurers.

Whether desirable or not, in many parts of the world “out of pocket’ spending on health is far larger than anything provided free by the state. That may be through explicit fees for service, or via “under the counter” bribes to ease delivery. For the IFC, and a number of companies and funders, it seems better to work with, support and regulate such activities rather than to ignore or suppress them.

Altruism may well long remain the dominant factor in any corporate support in the poorest countries. Mr Dunnett’s Gambia Health Alliance is tapping not only money and products but corporate expertise.

He hopes to develop a model that can be applied in other larger and more complex countries. He believes he can also help create the conditions – whereby even in small and poor nations such as Gambia – companies will be motivated by profits to continue.

“In the short term, we are using donations, resources and skills to rebuild capacity in the south,” he says. “But that will change in the medium term. You should not start something if it cannot become sustainable.”