Look more broadly at the population. By 2015, 221 million additional basic needs consumers (defined as those between the $1,000-$5,000 income bracket) will enter
the market in Africa. This represents 55 percent of Africa's population, compared with 39 percent who fell into the basic
needs category in 2005. While this income bracket is still low compared to other developing regions, it represents a new market
base that will likely not be reached with traditional access approaches. To reach the full patient base, consider how market
potential can be maximized by segmenting across the affordability spectrum. For example, by putting in place cost sharing
strategies for medium-priced drugs that allow patients to pay only what they can afford and bringing in other parties to cover
the remainder, higher income patients are in essence able to "subsidize" lower income patients—thereby growing the patient
Consider the role of willingness to pay. In low affordability environments, willingness to pay must be considered as strongly as ability to pay. Unless the condition
is debilitating enough to limit future income generation, preventing or even treating non-essential health issues is not always
a priority for a patient that falls in or below the "basic needs" bracket. This is particularly true for chronic diseases
that are often progressive in nature. For these reasons, educating patients so they understand the need for prevention or
treatment, ensuring that your product value is communicated clearly by influencers, and pricing your product appropriately
Select and monitor distribution channels carefully. Availability in pharmacies can often dictate product purchase so a carefully maintained supply chain and distribution system
should be in place. In addition, to avoid price inflation, "cutting out the middle man" is an important reality in the African
market. Intermediaries and markups can sometimes increase net selling price by four to six times.
Remember the importance of ongoing corporate social responsibility (CSR) efforts. While many companies' presence in Africa to date have been tied to CSR efforts alone, the changing landscape and growing commercial
opportunities should not mean the end of these initiatives. Instead, socially responsible market access practices that are
sustainable should be seen as complements to CSR practices.
Leverage partnerships with local governments and organizations. Working with governments to support policies and integrated health delivery systems that work in unison with, but not parallel
to, existing health systems, is a primary way to ensure that private sector investments in infrastructure garner the proper
ROI for commercial sustainability. Instead of detailing products via a local sales force for example, take a step back and
consider the need for clinical treatment guidelines and work closely with local governments to develop them. Furthermore,
organizations on-the-ground that have local knowledge and relationships can also serve as tremendous assets to establish a
footprint and help navigate barriers to market.
Invest in smart infrastructure and capacity initiatives. Focus on skills transfer, and ensure commitment to this at the company headquarters level early in the market access strategy
In time, the results of these initiatives will become the foundation of commercial success in Africa. While it is a longer-term
solution, pharmaceutical companies willing to take the effort and make the investment will no doubt reap the rewards. In essence,
when it comes to Africa, the market is what you make it.
Joseph Saba, MD, is Co-Founder and CEO of Axios International, a healthcare consulting company specialized in the delivery of sustainable
solutions to drive access to care in emerging markets. He can be reached at firstname.lastname@example.org