McMullan Patrick, Ajay Vamadevan S, Srinivas Ravi, Bhalla Sandeep, Prabhakaran Dorairaj, Banerjee Amitava
a University of Birmingham Medical School , Birmingham , UK.
b Health System Unit , Centre for Chronic Disease Control , New Delhi , India.
Glob Health Action. 2018;11(1):1434935. doi: 10.1080/16549716.2018.1434935.
In India, 50-65% of the population face difficulties in accessing medicines. The Health Impact Fund (HIF) is a novel proposal whereby pharmaceutical companies would be paid based on the measured global health impact of their drugs. We conducted a key stakeholder analysis to explore access to medicines in India, acceptability of the HIF and potential barriers and facilitators at policy level.
To conduct a stakeholder analysis of the HIF in India: to determine key stakeholder views regarding access to medicines in India; to evaluate acceptability of the HIF; and to assess potential barriers and facilitators to the HIF as a policy.
In New Delhi, we conducted semi-structured interviews. There was purposive recruitment of participants with snowball sampling. Transcribed data were analysed using stakeholder analysis frameworks and directed content analysis.
Participation rate was 29% (14/49). 14 semi-structured interviews were conducted among stakeholders in New Delhi. All participants highlighted access to medicines as a problem in India. There were mixed views about the HIF in terms of relevance and scaleability. Stakeholders felt it should focus on diseases with limited or no market and potentially incorporate direct investment in research.
First, access to medicines is perceived to be a major problem in India by all stakeholders, but affordability is just one factor. Second, stakeholders despite considerable support for the idea of the HIF, there are major concerns about scaleability, generalisability and impact on access to medicines. Third, the HIF and other novel drug-related health policies can afford to be more radical, e.g. working outside the existing intellectual property rights regime, targeting generic as well as branded drugs, or extending to research and development. Further innovations in access to medicines must involve country-specific key stakeholders in order to increase the likelihood of their success.
在印度，50%-65%的人口在获取药品方面面临困难。健康影响基金（HIF）是一项新颖的提议，即制药公司将根据其药物对全球健康的可衡量影响获得报酬。我们进行了一项关键利益相关者分析，以探讨印度的药品获取情况、HIF的可接受性以及政策层面的潜在障碍和促进因素。
对印度的HIF进行利益相关者分析：确定关键利益相关者对印度药品获取的看法；评估HIF的可接受性；评估HIF作为一项政策的潜在障碍和促进因素。
在新德里，我们进行了半结构化访谈。通过滚雪球抽样有目的地招募参与者。使用利益相关者分析框架和定向内容分析法对转录数据进行分析。
参与率为29%（14/49）。在新德里的利益相关者中进行了14次半结构化访谈。所有参与者都强调获取药品是印度的一个问题。对于HIF在相关性和可扩展性方面存在不同看法。利益相关者认为它应该关注市场有限或没有市场的疾病，并可能将直接投资纳入研究。
第一，所有利益相关者都认为获取药品是印度的一个主要问题，但可负担性只是其中一个因素。第二，尽管利益相关者对HIF的理念给予了相当大的支持，但对其可扩展性、普遍性以及对药品获取的影响仍存在重大担忧。第三，HIF和其他与药品相关的新健康政策可以更加激进，例如在现有知识产权制度之外开展工作，针对仿制药和品牌药，或者扩展到研发领域。药品获取方面的进一步创新必须让特定国家的关键利益相关者参与进来，以增加成功的可能性。
