Diarrhea kills about 800,000 children each year, making it the second leading cause of death in children under five years worldwide. In Uganda diarrhea kills ~ 10,000 children every year, and is the third largest single cause of child mortality. Despite the existence of a simple, life-saving treatment (ORS[1] and Zinc), access to the medicines is still very limited. At a national level, 70% of caregivers seeking treatment for acute uncomplicated diarrhea in public health facilities receive ORS but just 3% receive zinc, with antibiotics taking up a much greater percentage.
Among some of the challenges to improving access to ORS and Zinc are issues ranging from the need to include instructions for boiling water to ensure water quality before administering ORS which comes in powder form, ORS being considered a low-margin, relatively low-volume product. This creates an unattractive market for suppliers to invest in production, marketing, distribution and sales. Zinc is priced highly which has limited its reach to poorer communities, additionally, there is very low care provider demand due to a lack of appreciation of the drug as part of the treatment course for diarrhea.
So how does Market shaping come into play? The concept involves strategies and implementation plans to create an enabling environment that helps ensure an appropriate supply of a product. For health commodities, this environment includes health policy, innovative financing mechanisms, supply chain strengthening, and regulatory approaches. This concept has been used by partnerships like the GAVI Alliance[2]. By forecasting and pooling demand from eligible countries and purchasing large amounts of vaccines, the Alliance has created a reliable market for vaccines in developing countries.
Clinton Health Access Initiative has for a long time used strategies related to shaping of markets to support a number of countries including Uganda in the ACT[3] and Peadiatric ARV[4] commodities space. The concept was applied most recently using different entry points like regulation, sales and distribution and demand generation. For example, under regulation, work was done on achieving the ‘Over the Counter’ status for Zinc and a recommended retail price for both the ORS and Zinc. This meant that drug shops were allowed to stock the items without requiring prescriptions, at the same time reduced the price barrier to zinc. Through a sales and distribution model, a collaboration was made with leading pharmaceutical distributors to improve the last mile deliveries in the private sector to even the most remote drug shops. In the public sector, a co-packaged formulation was introduced as a result of an engagement involving CHAI, the Ministry of Health, the National Drug Authority and a local manufacturer (already manufacturing separate ORS) importing Zinc. The outcome of this strategy was a comparably cheaper combined standard dose formulation on the market and in public health facilities.
Market shaping I have come to learn is an elaborate term in the context of health related programs. I originally assumed that a lot would involve supply chain partnerships and processes. Learning how the different angles to shaping markets whether local or on a broader scale, can be used to improve access to lifesaving commodities has been very enlightening.