Opinion: Why markets should matter to health advocates

Today, one of global health’s biggest challenges — and opportunities — lies in strengthening the markets that make health products, services, and technologies available to those who need them most.

New Global Goals challenge us to work together to improve the health of all people by 2030. But we won’t reach those ambitious targets — and most importantly, save the lives of millions of people — without assuring the supply of quality, affordable, and appropriate products to meet demand; and that requires strengthening the markets for these lifesaving health products.

I have the privilege of overseeing PATH’s Market Dynamics program. This includes our efforts to ensure that markets function effectively so that health solutions reach people in need, especially women and children. Reflecting on this work often reminds me of the progress that has been made in global health since I took my first job with the World Health Organization in 1990. That year, 12.7 million children and more than 530,000 mothers died around the world, a staggering challenge that seemed insurmountable.

By last year, however, annual child deaths had been cut by more than half — down to 5.9 million — and maternal deaths were reduced to about 300,000. While these numbers are still far too high, they show the tremendous momentum in global health, spurred by better access to quality health care services and better tools and technologies.

This progress also reflects the passion and dedication of community, national, and global advocates who have worked tirelessly to shape policies, ensure financing, and hold government decision-makers accountable. As we better understand the importance of markets in improving health, one of our priorities is to mobilize more health advocates to join market strengthening efforts.

Why markets?

To many people working in health, “market strengthening” sounds pretty esoteric — a job perhaps best left to economists. However, the reality is that medicines and technologies can only save lives if they reach the people who need them, and markets for health products can only be as strong as the policy environments in which they operate.

Governments need to understand how their policies and systems support or hinder well-functioning markets, and, when needed, adapt them to improve access, safeguard citizens, and create market incentives for affordable prices and sustainable supply.    

We also need advocates to hold policymakers accountable to make these things happen. Advocates have the power to raise awareness about the costs and consequences of ineffective policies that affect availability, impact affordability, and allow the circulation and provision of poor-quality products. Advocates must communicate a sense of urgency, advocate for increased resources to regulate and procure products, and ensure policy coherence across sectors.        

Arming advocates with tools

At PATH, we arm national advocates with the evidence they need to call for change. For example, we recently produced a series of papers to highlight challenges and potential policy solutions in Nigeria and Bangladesh, to improve the availability and quality of three lifesaving maternal health products — oxytocin, misoprostol and magnesium sulfate. These papers provide evidence of market-based challenges that are undermining the maternal health program, and set forward clear and actionable advocacy recommendations for advocates.

In Nigeria, the Association for Reproductive and Family Health, a local nongovernmental organization dedicated to improving the lives of underserved communities, used this evidence to bring media attention to Nigeria’s maternal health crisis. Articles in the national New Telegraph and Authority news outlets help put a human face to the market issues in a way that engaged policymakers and the Nigerian public.

For example, 13 oxytocin products and four magnesium sulfate products registered in Nigeria have not been verified to meet international quality standards. Additionally, less than half of local drug shops have refrigeration capacity, which risks the safety and efficacy of oxytocin stored on shelves. These are important issues that advocates are and should continue to bring to the attention of Nigerians, particularly Nigerian policymakers. PATH and ARFH plan to build on this momentum by taking this issue to key government working groups.  

The power of advocacy

We know advocacy can make a difference in strengthening markets to help assure priority medicines are available. In Uganda, for example, local advocates recently helped usher in policy changes that will save infants’ lives by increasing access to newborn resuscitation devices that prevent birth asphyxia.

Through a partnership with the White Ribbon Alliance to investigate why shortages of the devices occurred throughout the country, we discovered two policy weaknesses: First, district health officials could not directly order newborn resuscitation devices when shortages occurred because procurement authority rested with the Ministry of Health, and second, there was no dedicated funding to procure, repair, or replace the devices.

In 2015, WRA successfully advocated to the MoH to transfer its procurement authority of newborn resuscitation devices to the National Medical Stores, and to include these devices on the NMS procurement list, making it easier for district officials to access them. The group also identified potential funding opportunities and is advocating for the government to increase budget prioritization for the devices.  

Building a network

Around the world, weak markets present a real and present danger to women and children. They also offer practical opportunities for support from advocates who can help strengthen and streamline policies and regulations and secure financing to make both new and established health technologies more widely available to those who need them.

But increasing political will and building strong policy environments for healthy markets won’t happen without a network of advocates, influencers and decision-makers who are engaged in and informed about market shortcomings for health products. For the health of women and children everywhere, we must join forces and commit to helping to build, support and connect this network.

Making Markets Work is an online conversation to explore what’s being done to make global health care markets accessible to people at the base of the pyramid. Over 10 weeks, we will amplify the discussion around effective health financing, analyze key challenges blocking universal market access in the health care supply chain, and explore the key strategies to make markets more effective. Join us as we look at this important issue, and share your thoughts by tagging #MakingMarketsWork and @Devex.