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IMPROVING ACCESS TO AFFORDABLE QUALITY BASIC HEALTH CARE IN LOW-INCOME COUNTRIES THROUGH INNOVATIVE PERFORMANCE BASED HEALTH SYSTEMS.


IMPROVING ACCESS TO AFFORDABLE QUALITY BASIC HEALTH CARE IN LOW-INCOME COUNTRIES THROUGH INNOVATIVE PERFORMANCE BASED HEALTH SYSTEMS.


Initiated in 2000, PharmAccess is a fast growing international organization working in over 30 African countries. Our aim is to improve access to affordable quality basic health care in these low-income countries through innovative performance based health systems. A motivated team of medical, financial, socio-economic and administrative experts is dedicated to build systems to improve the health care provision in Africa. The approach is demand-driven and output-based geared towards efficient resource use and quality delivery. We place the client centre-stage and empower him or her to influence the system’s output. Simultaneously, we pay contracted parties, such as insurance companies and clinics on the basis of their performance in delivering accountable, transparent and

PharmAccess: the performance based approach

efficient medical and administrative services. A model that establishes ownership amongst all parties in the healthcare value chain: the clients, the clinics, insurance companies and other healthcare suppliers. A model that has received growing international attention. To simultaneously stimulate the demand and supply for health care, we provide a wide range of innovative services that complement and reinforce one another. Our services include supporting health insurance schemes, loans linked to quality standards to upgrade healthcare providers, private equity for healthcare companies, assessment of healthcare providers according to international standards and conducting scientific research. For us it is vital to constantly monitor and evaluate the health systems and our work. This enables us to develop quality improvement plans for healthcare providers and other stakeholder involved. These tailor made services are delivered in cooperation with various local and international public and private partners.


The main areas of our business PharmAccess has established a specific set of core businesses that contribute to the overall goal of building sustainable health systems. These are:

Background: overburdened health systems

Building medical and administrative capacity by assessing and upgrading health providers and

Our performance-based approach has been developed in response to the recognized need to change the way health care

insurers, including quality monitoring and evaluation of providers and training their medical and

is delivered in resource-poor settings. The current healthcare systems in low-income countries, particularly in Africa, are

administrative staff

overburdened and insufficiently equipped. Most systems are unable to meet the countries’ healthcare needs. To put theses

Introducing and supporting (public and private) health insurance. Examples are the Health Insurance Fund, insurance schemes in Namibia and Mozambique, and support for the National Health Insurance Scheme in Ghana and South Africa

needs into perspective: sub-Saharan Africa faces 60% of the world’s malaria cases, 30% of tuberculosis cases and two-third of HIV/AIDS cases. Malaria alone leads to one million deaths a year, mostly in young children. The result of the underperforming health systems is high levels of out-of-pocket expenses which disproportionably impact

Supporting wellness and HIV/AIDS workplace programs for national and multinational employers,

the poor. In addition, in the present situation the rich benefit more from the donor-funded public health care sector.

like Heineken, Zain, Shell, the Netherlands Ministry of Foreign Affairs, the Dutch development

Due to the lack of risk pooling, solidarity with respect to healthcare financing is limited. Paying for unforeseen medical

organization SNV, KLM/Air France and TNT

treatment or treatment for chronic conditions often leads to catastrophic financial shocks in the household budget of lowincome earners: causing them to make disastrous cutbacks in school fees, food and other basic essentials.

Co-founded the IFHA to mobilize private capital for health investments A second major problem is that out-of-pocket expenses for health by nature arbitrary; they do not form a regular revenue Complementary financial support for medical providers using an appropriate and affordable financing mechanism through the MCF Monitoring and surveillance of emerging (infectious) diseases in Africa and advising policy makers Development of novel health care products and (diagnostic) tools for resource-poor settings

flow for healthcare providers. This makes it difficult for these providers to obtain long-term capital, as the investment risk is perceived as too high. A lack of capital means that they cannot make the much needed improvements in the healthcare delivery. And without these crucial improvements people are not willing to pay for healthcare services.


Our achievements so far Since its inception in the year 2000, PharmAccess has been a pioneering organization, introducing novel approaches to the development of health systems in Africa. HIV/AIDS programs One of our first achievements was the introduction of workplace programs that encompassed both prevention and treatment of HIV/AIDS to staff of employers based in Africa. Over the years PharmAccess has reached over 100,000 employees in Africa through these programs. In 2003 PharmAccess secured unique funding for including HIV/AIDS into health insurance approaches, which culminated in the establishment of the first Risk Equalization Fund for HIV/ AIDS in Africa.

resistance. The gathered data is linked via LAASER (Linking African and Asian Societies for and Enhanced Response to HIV/ Aids) to TASER, a similar program in Asia. The information collected aims to contribute to African and Asian health policy makers with respect to choices of HIV/AIDS drugs in their respective countries. PharmAccess is also involved in supporting the

Introducing health insurance

development of novel health products, for example diagnostics. The Affordable Resistance Test for Africa (ARTA) program aims

Aware that there is still a lot more to be done, we took one of the biggest steps in our plan when

to develop a generic, affordable test algorithm for HIV drug resistance, a service that is unaffordable for Africa at this time. The

we co-founded the Health Insurance Fund. Armed with a 100 million fund from the Dutch Ministry

ARTA project is implemented by a unique consortium of public (academic) entities and private companies.

of Foreign Affairs and instructions to support health insurance schemes in four African countries over a period of six years, we launched the first scheme in Nigeria in 2007 targeting market women, farmers and their families. Improving access to capital PharmAccess initiated the development of a new Investment Fund for Health in Africa (IFHA), established in 2007 by SNS REAAL, AEGON and ACHMEA - three large Dutch financial corporations. In 2009, PharmAccess established the first Medical Credit Fund (MCF), a lending facility for lower tier private health care providers in Africa that includes systematic quality improvement process as a compulsory component of the loan. Research PharmAccess is also actively involved in basic and operational research and capacity building with respect to HIV/AIDS treatment. The PharmAccess African Studies to Evaluate Resistance (PASER) represents the largest regional network in Africa measuring the emergence of HIV drug

Measuring improvements For measuring the improvement process, PharmAccess has developed a unique set of tools, summarized as the ‘AFRI-QA methodology’. AFRI-QA assesses the quality of African healthcare providers in light of utilization and type of service delivery. This is done on the basis of: infrastructure, assets, processes and outcomes. A score is given that allows for (semi-)quantitative benchmarking


Working with public and private partners PharmAccess works closely with public and private healthcare providers, private insurers and companies, mostly in Africa. It links these private parties with public sector interventions and civil society through ‘public-private partnership’ arrangements. The collaboration with private partners is complementary to existing efforts in the public sector and PharmAccess always works with local organizations in Africa to further strengthen local capacity.

The organization PharmAccess has a multidisciplinary team of over 70 staff members working in 30 countries. It has offices in Amsterdam (coordinating center), Namibia, Nigeria, Kenya and Tanzania. The Chairman of the PharmAccess Supervisory Board is Joep M.A. Lange (Professor of Medicine, Head of the Center for Poverty-related Communicable Diseases, Academic Medical Center at the University of Amsterdam, and Executive Scientific Director of the Amsterdam Institute for Global Health and Development (AIGHD). Other board members are Maarten Dijkshoorn (Former CEO of Eureko/ACHMEA), Wilfred Griekspoor (senior partner at McKinsey & Company) and Barend van der Vorm, president of the Monaco Venture Capital and Private Equity Association (MVCA). Sjoerd van Keulen (CEO of SNS REAAL) is advisor to the Supervisory board. Onno Schellekens is the Managing Director of PharmAccess.


Trinity Building C - Pietersbergweg 17 - 1105 BM Amsterdam Phone: +31 (0) 20 5667158 Fax: +31 (0) 20 566 9440 E-mail: info@pharmaccess.org Website: www.pharmaccess.org


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