The Access and Delivery Partnership
Building Capacity for Access and Delivery of New Global Health Technologies for Tuberculosis (TB), Malaria, Neglected Tropical Diseases (NTDs), and other Diseases in Low and Middle Income Countries (LMICs)
What We Do
The adverse impact of TB, malaria and NTDs on development outcomes has resulted in new approaches and partnerships to tackle the global deficiencies in research and development, and treatment access. One such initiative is the strategic partnership between the Government of Japan and UNDP, which promotes research and development, and expedites access to and delivery of health technologies for the prevention, diagnosis and treatment of TB, malaria and NTDs. This partnership comprises two complementary components, which reflect the Government of Japan’s and UNDP’s strategic goals on global health:
- The Global Health Innovative Technology (GHIT) Fund, which focuses on the promotion of innovation and research through the development of drugs, diagnostics and vaccines for TB, malaria and NTDs. The GHIT Fund stimulates research and development of new health technologies through funding research and product development partnerships between Japanese and non-Japanese organizations
- The Access and Delivery Partnership (ADP), which aims at assisting low- and middle-income countries (LMICs) enhance their capacity to access, deliver and introduce new health technologies for TB, malaria and NTDs
Led and coordinated by UNDP, the ADP is a unique collaboration between UNDP, TDR (The Special Programme for Research and Training in Tropical Diseases, which is co-sponsored by UNICEF, UNDP, the World Bank and WHO) and PATH. Working together, the project partners will leverage the expertise within each organization to provide the full range of technical skills necessary to strengthen capacity in LMICs. The ADP emphasizes consultation, collaboration and implementation with partner country governments and stakeholders, working to develop LMICs’ capacities to access and introduce new health technologies.
New health technologies are broadly defined as drugs, diagnostic tools and vaccines that are relevant for the prevention, treatment or cure of TB, malaria and NTDs, but are not yet available for market introduction or have not been introduced in LMICs. The introduction of new health technologies can place burdens on existing health systems, including new requirements for drug regulation, supply and distribution and health personnel training. Accordingly, the ADP will focus on providing LMIC stakeholders with the necessary skills to develop the systems and processes required to effectively access new health technologies, and introduce them to populations in need.
The ADP is a five-year project global project, running from April 2013 until March 2018, funded by Japanese Government, working in Indonesia, Ghana, Tanzania and with Thailand as technical partner country.
The ADP is providing valuable technical and capacity-building support to important government bodies within Indonesia to ensure affordable, efficient and timely access to and delivery of quality health technologies. The ADP is enhancing national competencies in promoting legal, policy and regulatory coherence across multiple sectors; building effective systems for procurement and supply chain management; and strengthening capacities to conduct implementation research and health technology assessment. Together, these functional areas are critical for Indonesia to achieve universal health coverage and the SDGs.
The ADP has focused on the development and implementation of policy approaches that are appropriate to national priorities and needs. Indonesia is currently rolling out a national health insurance system, which includes the goal of making basic care available to all by 2019. As such, the ADP is working with the Ministry of Health (MOH), the Ministry of Law and Human Rights and the national competition authority (KPPU) on delivering an integrated approach towards multisectoral policy and decision-making, as related to improving the availability, affordability and accessibility of medicines and other health technologies, as well as the efficient delivery of these technologies.
The ongoing collaboration with these agencies supports the effective integration of public health perspectives into the national policy and legal frameworks, helping to animate a cadre of technical personnel within the various ministries with relevant capacities in policy review and analysis. National policymakers from various sectors have articulated their support for the ADP approach on promoting policy coherence. The ADP will continue to respond to requests from stakeholders and provide the relevant technical and policy support to enable intersectoral policy coherence.
The decentralized health services in Indonesia face persistent challenges at the local level, affecting service delivery. A recognized need exists to strengthen capacity for implementation research towards improved service delivery and robust, sustainable health services in general. Following prior support to strengthening of implementation research capacity at the Universitas Gadjah Mada (UGM), helping to establish it as a related resource centre in the region, the ADP has been working with UGM in supporting the MOH to conduct in-depth analysis of national capacity for implementation research.
Having assessed the country’s capability for implementation research, the ADP supported the MOH in reaching a consensus on an implementation research strategy on TB, malaria and NTDs. Implementation bottlenecks faced by the disease control programmes were mapped and the major factors responsible for a relatively limited implementation research capacity were identified. As a follow up to this assessment and the resulting framework for capacity-strengthening, a series of training activities will be delivered by the ADP in partnership with UGM, focusing on identifying and training managers and senior researchers to build their capacity for developing proposals for implementation research, resource mobilization and study implementation.
With an estimated 32,000 new multidrug-resistant TB (MDR-TB) cases annually, Indonesia has been identified as one of five pilot countries where bedaquiline is being introduced as part of combination therapy for MDR-TB in adults. In accordance with WHO interim guidance on the use of bedaquiline to treat MDR-TB, active pharmacovigilance measures must be in place to ensure early detection and proper management of adverse drug reactions. This has provided an entry point to support the development of tools, approaches and systems for active surveillance of adverse events of other new health technologies, including those that will be entering the Indonesian market in the near future.
The ADP is supporting the capacity strengthening of the National Pharmacovigilance Centre (NPC), including the participation of key staff members in a regional forum on pharmacovigilance for knowledge exchange and building of partnerships between pharmacovigilance experts in the region. The ADP has also supported capacity strengthening in active safety monitoring and pharmacovigilance within the national TB programme and the pharmacovigilance teams in hospitals, to ensure early detection and proper management of adverse drug reactions, with a specific focus on bedaquiline.
With the national health insurance programme aiming to reaching full population coverage (253 million) by 2019, the government is focused on ensuring affordability and cost-effectiveness of health technologies. In this context, the ADP, in partnership with Thailand’s Health Intervention and Technology Assessment Programme (HITAP), introduced the Health Technology Assessment (HTA) approach to policymakers as a tool to inform the process of prioritization, selection and introduction of health technologies. The ADP supported the MOH in establishing the HTA committee (HTAC) within the Centre of Health Insurance to manage the HTA implementation process. Efforts by the ADP further extend to facilitating the institutionalization of HTA through the development and implementation of the national HTA roadmap and action plan, which includes strengthening the capacity of policymakers and key technical personnel to assess the need, effectiveness and safety of new health technologies. The HTA approach will be critical in generating best value for money and addressing equity considerations, and to inform the development of a health financing strategy to deliver the benefits package as Indonesia moves towards UHC.
A country assessment and consultations with stakeholders involved in the public procurement process, particularly the National Public Procurement Agency (LKPP), identified significant challenges faced by sub-national service procurement units. These challenges relate to effective decision-making around planning and procurement of new medical equipment and health technologies, and are largely due to limited product knowledge, and lack of information on quality standards and market prices. The ADP is supporting LKPP in addressing these impediments with the aim of improving the availability of new health technologies in the more geographically remote provinces, such as Papua, North Sulawesi and East Kalimantan, where expertise on new technologies and financial resources are limited. This included development of a training module on planning, procurement and distribution of medical and laboratory equipment and other new health technologies. This training module will be incorporated into the national standard procurement training programme and will be used for further training activities aimed at increasing capacities for planning and procurement in over 700 hospitals across Indonesia. The ADP has also supported the planning and procurement process for TB commodities and diagnostic equipment as part of the introduction and national scale-up of new TB medicines and diagnostics.
To address significant gender-based inequities in access to treatment and other related health services in LMICs, ADP is focused on enhancing access to prevention, diagnostics and treatment for TB, malaria and NTDs, all of which disproportionately impact on women and children.