The Clinton Health Access Initiative: Saving Lives in Africa and Other Places Across the Globe
The Clinton Health Access Initiative’s, which has gotten so big that it’s been spun off into its own organization but still under the Clinton Foundation umbrella, work is divided into eight programs: Access Programs, Applied Analytics, Health Financing, HIV/AIDS + TB, Human Resources for Health, Malaria, Maternal Newborn + Child Health, and Vaccines.
This is the crown jewel of CHAI’s work, and the original mission of CHAI. Through their pioneering work, CHAI’s Access Program helped to lower drug prices and save millions of lives in the process.
I was first confused as to how exactly CHAI managed to lower drug prices. It can be quite complex but here’s how the World Health Organization sums up CHAI’s method:
“The second large-scale strategy involves third-party consultation and price negotiation with generic ARV suppliers, a practice introduced by the Clinton Foundation HIV/AIDS Initiative (CHAI) in 2003. In practice, CHAI attempts to make ARVs more affordable by negotiating price ceilings that reflect suppliers’ costs plus reasonable and sustainable profit margins. Moreover, CHAI furthers this strategy by providing direct technical assistance to some suppliers to help lower their production costs. The resulting ceiling prices are made available to all members of the CHAI procurement consortium. Countries that wish to become part of the consortium sign a memorandum of understanding with CHAI and manufacturers are required to offer ARVs to these countries at prices equal to or less than CHAI-negotiated ceiling prices.”
Explaining it another way, they try to turn and have turned a low volume, high margin business to a high volume, low margin one. In a recruitment slide, they explained the various duties and goals of the CHAI Access Team:
- Aggregate Potential Demand
- Credible Forecasting of Volume Increases Over Time
- Prompt Payment by Purchasers
- Standardization of Treatment Guidelines
This turned a $1000-5000 cost per patient for drugs to a less than $200 per patient back in 2005. 9.9 million people in seventy countries have been helped by CHAI-negotiated ARV medication prices, and they also try to help out suppliers by advising them on how to lower the costs to develop and manufacture these drugs. They’ve since applied this method towards other diseases like TB and childhood diarrhea and towards vaccines.
This is more technical. They basically help by studying problems related to health care delivery or policy and formulating solutions on how to improve and make it better.
Many people in the developing world cannot afford health care, and CHAI works to correct that. Working with the governments of Cameroon, Ethiopia, Lesotho, Malawi, Rwanda, South Africa, Swaziland, Zambia, Zimbabwe, and others, CHAI does studies for governments to see how much providing health care would cost. They’ve shown that sometimes it’s lower than governments believe, encouraging them to fund these endeavors. CHAI also studies the health care infrastructure of countries and advise them on how best to manage it.
HIV/AIDS + TB
CHAI’s HIV/AIDS work isn’t just limited to the Access Program. They advise governments, especially in Africa, on how best to handle the treatment of their HIV/AIDS population. Preventing mother to child transmission of HIV and treatment of pediatric AIDS are two such issue areas they focus on. TB is included here as TB and HIV/AIDS co-infection, meaning that TB comes with a weakened immune system, cause one quarter of all AIDS related deaths according to the health experts at CHAI.
Some statistics related to HIV/AIDS can be sobering. In Swaziland, a country in southern Africa, 26% of the population is infected with the disease, the highest in the world. CHAI works with the Swaziland government to help manage this public health problem.
Human Resources for Health
This part of CHAI’s mission aims to build up the health care infrastructure of developing countries by looking for ways to train and increase the number of the health care workforce in those countries. At the requests of individual governments, CHAI analyzes the state of a country’s workforce and gives recommendations on ways to improve it such as pinpointing where in the country to best deploy needed health care workers. They also help in more direct ways.
In Malawi for instance, CHAI, through a grant, invested in building nursing training centers in that country as well as providing scholarships for Malawian students. A thousand more nurses are now in Malawi because of CHAI’s work.
Malaria is a preventable and treatable disease, but countries in the developing world often don’t have the health care infrastructure to handle it. CHAI assists governments on how best to manage the spread and prevention of the disease. Malaria elimination is the goal, and using the Access Program methods for malaria drugs is one way to meet this objective, though that’s just one part of their work.
CHAI’s malaria program operates in many sub-Saharan African countries; the Southeast Asian countries of Vietnam, Laos, and Myanmar (Burma); and the Caribbean and Latin American countries of Haiti, Guatemala, and Honduras.
Maternal, Newborn, + Child Health
This program area focuses on child diarrhea, family planning, nutrition, and maternal and neonatal health (MNH). The Child Diarrhea initiative, done because diarrhea is the second leading cause of child mortality in the world, came from the impetus of Chelsea Clinton, who joined the Clinton Foundation in 2011.
The CHAI Family Planning program with funding from the Bill and Melinda Gates Foundation works to reduce family sizes and overpopulation. This program advocates the use of long-acting reversible contraceptives (LARC), like implants and intrauterine devices inside a woman’s uterus, which prevents the fertilization of egg and sperm.
The Access Program expanded to vaccines, and some of their accomplishments include helping to effect a 67% reduction in the price of the rotavirus vaccine over five years in developing countries and a 56% reduction in the price of the inactivated polio vaccine also over five years in developing countries. CHAI partners with governments, UNICEF, and other NGOs like the Bill and Melinda Gates Foundation to do other vaccine related work like devising immunization strategies for countries in the developing world.
CHAI and the Clinton Foundation
These eight program areas represent the crux of the Clinton Health Access Initiative. Their headquarters are in Boston, and as of 2013, they have a $127 million dollar budget. When considering the unfair controversy regarding the Clinton Foundation, it’s important to remember just how much life-saving work that CHAI alone has done in Africa and many other parts of the world