Medicines in Health Systems: Advancing Access, Affordability and Appropriate Use. Chapter 5 – Annex 4: Social Business Interventions to Improve Access to Medicines
(2014; 28 pages)


Many clinically effective medicines exist to effectively treat diseases, decrease morbidity, and prevent premature deaths. However, many people in low and middle-income countries cannot access quality medicines, risk impoverishment by their spending on health care and medicines, or suffer negative health and wealth consequences of inappropriate medicines use. At the same time, countries and health systems struggle to provide sustainable access to needed medicines for all members of their populations, particularly the poor and near poor —the Bottom of the economic Pyramid (BoP).

Several multi-national pharmaceutical companies have begun to engage in innovative public-private partnerships intended to improve medicines access for people at the Bottom of the Pyramid while at the same time generate profit, sometimes termed social business, Social business innovations promise to improve affordable access to quality medicines for the poor by targeting health system shortcomings and facilitating efforts to improve access to medicines. At the same time, like any intervention in a complex system, social business interventions have the potential to cause unintended harm. Furthermore, perceived and real conflicts of interest exist when pharmaceutical companies intervene in systems that may affect current and future markets for their products.

System-focused assessments of social business interventions are crucial to ensure that these approaches achieve their intended outcomes and do not result in an unacceptable degree of unintended side effects such as clinically unnecessary or economically inefficient utilization, discontinuities in patient care, or harmful disruptions in pharmaceutical markets. Such assessments will require explicit conceptual models of complex relationships among actors in health systems, insights into different stakeholders’ perspectives and behaviors, and evidence on a range of relevant input, process, and outcome indicators. Practical and valid system frameworks, metrics, and measurement tools are needed to assess social business interventions to improve medicines situations.

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