Employing a system dynamics approach, this study first examined how the introduction of malaria interventions, bundled into a given system, resulted in observed outputs and outcomes and how limited resources can be optimally deployed. Using this framework, the study examined the allocative efficiency in a set of Global Fund grants for malaria.
A well designed vaccine pricing architecture can ensure more equitable vaccine prices and result in greater access to new vaccines globally. Using game theoretical models, this research project explored the optimal architecture for vaccine pricing and procurement.
Artemisinin Combination Therapies (ACTs), the recommended treatment for malaria, remain unaffordable to large segments of populations in malaria endemic countries. ACTs were scaled up through financing from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the US President’s Malaria Initiative and through the Affordable Medicines Facility for malaria (AMFm). A deeper understanding of the markets for manufacturing and distributing ACTs is critical to ensure the appropriate market interventions to make ACTs more affordable are enacted. WDI uses technical analysis to advise multiple stakeholders on intervention strategies, methods to match supply and demand, and policy levers that can create more affordable ACTs.
The use of framework contracts and other more mature procurement practices is very limited in Ministries of Health in Sub-Saharan Africa because of a perception that these practices work against the spirit of fair and transparent procurement. WDI captured best practices in more effective public procurement methods from U.S. federal procurement and other public sector procurement systems. The procurement methods investigated included framework contracts, prime vendors models, and other approaches that illustrate how transparency and flexibility in procurement are not always conflicting goals and can be achieved simultaneously.
WDI is engaged in developing a better understanding of treatments for illnesses that most significantly impact child health. Utilizing market dynamics and supply chain research as a framework, the Healthcare Market Dynamics & Supply Chain initiative looks for ways to improve accessibility and affordability of medicines and vaccinations as well as improvements to the overarching early childhood healthcare architecture.
Active Pharmaceutical Ingredients (APIs) play an important role in the quality and cost of medicines, but so far very little is known about the market structure, cost drivers, and incentives for capacity expansion for key APIs in HIV/AIDS, malaria, and TB drugs. WDI is helping to generate new information and thinking around the competitive landscape, market needs and opportunities in the upstream production stages of manufacturing across these three therapeutic areas. Better visibility into the API and finished product markets will help inform future global health work and continued improvements in access to HIV/AIDS, malaria, and TB medicines.
WDI is implementing research in Kenya and Benin to identify the structural and operational costs associated with the distribution of key products used in the prevention, diagnosis, and treatment of malaria including long lasting insecticide-treated bed nets (LLINs), rapid diagnostics tests (RDTs), and artemisinin combination therapies (ACTs). Analysis of in-country costs will be used to develop an extrapolative model. The model may be used by countries to more accurately estimate and budget for the costs of using the public sector health system to procure, deliver, and monitor the quality of key malaria products.
Well-functioning and healthy global markets for pharmaceuticals, vaccines, preventative technologies, and many other health products are key for achieving sustainable outcomes in global health. WDI helped to further the evidence base needed to move the global health community towards systematic approaches to designing and selecting market interventions. Through this work, funded by the Bill & Melinda Gates Foundation, WDI facilitated a common understanding of the mechanisms through which these market interventions operate. It also ensured that systematic knowledge about the successes and failures of market interventions flows from one product market to another. The project focused on the market for malaria, family planning, and other global health products.
WDI is developing a forecast for the demand for the injectable contraceptive depot medroxyprogesterone acetate (DMPA) in predominately low- and middle-income countries. The forecast takes into consideration key factors which are likely to have an impact on demand for DMPA in the future. WDI also assessed the impact of DMPA manufacturers who are likely to be prequalified in the future and enter the market.
In many countries there is considerable variability in the regimens used for multidrug resistant tuberculosis (MDR-TB) treatment. Tailoring MDR-TB treatment regimens will aid in better adherence and improve individual treatment outcomes, thus potentially reducing opportunities for onward transmission. However, extensive regimen variation can limit opportunities for negotiating lower drug prices (and thus for increasing access) in what are already considered small-demand drug markets. For a country making decisions regarding drug procurement, this raises the question: What is the most cost effective strategy for national level procurement of MDR-TB drugs?
WDI, in partnership with Imperial College London and the University of Michigan, is collaborating to help determine optimal treatment regimens for drug resistant TB for India using a combined modeling approach. This approach combines epidemiological transmission as well as relevant market factors to understand if and/or how those factors impact the design of an optimal treatment regimen and budgetary allocation for MDR-TB in India. The project team is conducting a comprehensive topical literature review, meeting with key stakeholders, collecting price data, developing the baseline epidemiological model, and writing a technical report summarizing different regimen scenarios on market and health outcomes.