The growing epidemic of non-communicable diseases (NCDs) has emerged in recent years as one of the greatest global public health challenges. The onset of chronic diseases in developing countries impedes economic growth and threatens to drastically increase health care costs. In Kenya, this is not tomorrow’s challenge: the World Health Organization (WHO) estimates that 46% of adult Kenyans have hypertension.
AstraZeneca launched Healthy Heart Africa in October 2014 to support the governments of Africa in their effort to reduce the burden of heart disease – specifically hypertension. In doing so we recognized that we could not achieve our mission solely by increasing access to high-quality medicines through an in-kind contribution program. Instead, we approached it as a market-creating effort, one which would strengthen local healthcare systems, help build our own capabilities and, most importantly, benefit patients.
This comprehensive approach leverages our unique commercial and scientific assets for the greater good. AstraZeneca has a long history of expertise in cardiovascular disease, and we think we have something to offer. But operating in this particular environment is relatively new for us. We cannot do this on our own.
Our approach requires close collaboration with partners who share our vision for making a positive impact on NCDs and are keen to develop a solid understanding of progress against key metrics, fluid program management and, perhaps most importantly, a willingness to learn by doing.
We began by conducting a comprehensive analysis of barriers to care and treatment. This informed the development of a program based on three pillars, currently being tested through an initial series of demonstration projects in Kenya:
- Raise awareness by leveraging community health worker networks to drive education and awareness activities using materials developed with the Kenyan Ministry of Health.
- Train providers and drive care lower in the health care delivery chain by developing and implementing a simplified treatment protocol for hypertension together with a training package for healthcare workers.
- Ensure access to and availability of affordable medicines by implementing up to 90% price reductions for the AstraZeneca medicines being offered through the program and establishing a secure, low-cost supply chain by which to deliver them.
Creating a Sustainable Model
Our ambition is to make Healthy Heart Africa sustainable. This is not a donation program. We view this as part of our business strategy in a manner that will dramatically improve the health of people in sub-Saharan Africa.
Equally, this is also not about short-term profitability. We’re developing this model in order to create longer-term value for all stakeholders. We think about this in the following key ways:
- It’s helping us to recognize patient needs which are unique to Kenya. Through emphasis on monitoring and evaluation, baseline studies and demonstration projects, we are gaining a deeper understanding of the relative lack of public awareness of hypertension and cardiovascular disease, with a view to strengthening the healthcare system’s ability to provide care, treatment and long-term disease management.
- We are obtaining a greater understanding of distribution models that will work in sub-Saharan Africa. This will help us to ensure our product supply chain is economical, effective, and efficient in delivering quality medicines to the “last mile.”
- We are deepening relationships and sharing knowledge with valued new partners, including key health officials, implementing partners and others who will help ensure that the program is sustainable and, ultimately, stands on its own.
As AstraZeneca improves its capacity, understanding of and ability to navigate the market environment in Kenya, we will be in a much better position to work with our partners to help them keep patients healthy, while also strengthening their broader health system. Although our initial focus is hypertension, we believe this approach will help with the management of many other chronic diseases.
Initial Program Results Encouraging
We believe we are already making good progress. Since we began reaching sites in April 2015, Healthy Heart Africa has:
- Activated 250 health facilities;
- Trained over 2,500 healthcare workers;
- Screened over 1,000,000 people;
- Identified around 130,000 hypertensive patients; and
- Treated over 20,000 patients.
We know that treatment levels are not where we believe they should be in order to manage the condition. Our focus here is to address three big challenges: increasing our ability to identify the right patients, improving linkage across the patient pathway, and addressing issues related to compliance to medication. Initial signs are positive that we are moving in the right direction across each of these areas, but a long-term focus is required.
Ultimately, we aspire to reach 10 million hypertensive patients across sub-Saharan Africa by 2025 in line with the WHO’s goal of a 25% reduction in the prevalence of raised blood pressure by 2025.
This is undoubtedly an ambitious target. However, at AstraZeneca we believe that by working together, we will have a dramatic effect on patient health, raise awareness of hypertension and cardiovascular disease, improve health care workers’ skills in diagnosing and treating hypertension, and increase the number of people receiving treatment and long-term disease management for this major burden on society.
Mark Mallon is Executive Vice-President for the International Region for AstraZeneca and is responsible for the growth and performance of AstraZeneca’s commercial businesses in various geographies, including Asia Pacific, Russia, Latin America, the Middle East and Africa.