Learning from the past
Before addressing key market access considerations in Africa today, it is important to look at what we already know.
Much has been learned from the industry's efforts in Africa to date, and similarly, African governments have grown significantly
more informed in their approach to working with the private sector. Gone are the days of "I'll take what I can get." In its
place is a new generation of leaders who have overcome epidemics and political instability and now demand smart, actionable,
long-term strategies that will address the growing burdens on national healthcare systems. The same goes for the general
population. After two decades of external influence from private companies and donors alike, African patients have grown more
sophisticated and have developed distinct behaviors and preferences when it comes to healthcare choices (see Profile of the
African Patient sidebar).
Profile of the African Patient
The last 10 years have been tumultuous for the pharma industry as it struggled to establish a truly global presence beyond
the mature markets of the United States, Europe, and Japan. While each region of the world has its own unique business context,
barriers to entry led by low affordability and limited infrastructure are the overarching themes that join all developing
or emerging markets. Pharmaceutical companies have built significant expertise on how to overcome these barriers in developing
markets through their work in Asia, Latin America, and the Middle East. It is important that this knowledge is leveraged as
market access strategies are developed for Africa.
Any blueprint for African growth should consider the following:
First and foremost, the ability to pay must take informal sources into consideration. Traditionally, income, expenditures, or wealth have been used as a primary indicator of financial status. However, informal
and cash economies, predominant in African countries, make it difficult to accurately assess real ability to pay. An approach
that looks at a range of indicators together should be considered.
There is a significant middle income bracket of the population that is not being reached by traditional access solutions.
Health insurance in developing countries is neither widely available nor affordable for most people and the majority of patients
pay for healthcare expenses out of pocket. Although the very wealthy can afford to pay for patented medications, and the very
poor may be able to participate in donation programs organized by pharmaceutical companies, those in the middle of the economic
scale face substantial hurdles to accessing needed drugs (see Patient Opportunity Spectrum in Developing Markets figure).
Building up the value of a product in the eye of the payer(s) is essential given the low affordability, limited to no reimbursement, purchasing decisions that are not always dictated by prescriptions,
and the availability of generic alternatives. Value building comes in many forms, from setting the right price to utilizing
marketing tactics that target informal channels of influence. Regardless of the method utilized, what is important is that
your value proposition is locally relevant, applicable to patient preferences and mindful of the competitive landscape in
There is significant competition for how a low monthly wage should be spent in resource-poor settings. Many patients are paid
weekly or on an ad-hoc basis, so ability to purchase may vary from week to week. Patients must constantly prioritize purchases
based on needs and available financial resources and this plays a significant role on healthcare expenditures.
With low doctor to patient ratios, prescriber-focused sales and marketing techniques have their limits. Deploying a sales force to target key physicians as your primary means of outreach will likely limit your market potential.
Instead, coupling a well-trained local sales force with initiatives to educate informal channels of influence, such as community
health workers, nurses, and pharmacists, may be more effective in reaching the full patient spectrum across affordability