Access to medicines in low- and middle-income countries

Jul 2019 14:00 - 17:30

Access to medicines in low- and middle-income countries (LMICs) is a complex challenge and there is no ‘one size fits all solution. It requires deep understanding of the context, actors, economics and operational functions. The payer (global donors, national governments and private out-of-pocket) and procurer (supranational, national and sub-national) environment for LMIC markets is complex, heterogeneous across therapeutic categories, and is also rapidly-changing/evolving. Companies find it increasingly difficult to navigate this environment. Global market access teams have to learn new techniques and skills to understand this multi-stakeholder environment. This course brings together a faculty team with vast and rich experience in the theory and practice of access to medicines to help navigate/make decisions to be successful in LMIC markets.

While grounded in strong theory, the course will use case studies and practical examples as a pedagogical approach. The high profile of the international experts and the faculty involved in the course will ensure a highly interactive and rewarding learning environment.


The program is designed for global market access managers interested in enhancing their understanding of the complexities in market access in LMICs and engaging with their peers.

Expected outcomes

  • Deep understanding of the payer landscape for products with supranational payers (Global Fund, Global Alliance for Vaccines and Immunization (GAVI), Global Financing Facility (GFF), StopTB’s Global Drug Facility (GDF):
  • Deep understanding of the nature of procurement processes and market-shaping strategies used by supranational payers to promote access
  • Deep understanding of the payers for therapeutic categories which are paid for national governments, private insurers and out-of-pocket payments in LMICs
  • Familiarity with the in-country procurement eco-system in LMICs
  • Understanding the architecture of drug and medical device regulation in LMICs, supranational e.g. World Health Organization, Eurasian Conformity Mark vs national Food & Drug Administrations. Also, different groups e.g. Global Harmonization Task Force (GHTF)
  • Designing successful route to market strategies for products in LMICs
  • Modalities for an effective engagement with key market access stakeholders and how to address possible conflicts of interests.
  • Understanding the structure of medicine distribution in LMICs and how it differs from high-income markets
    • Government-run distribution
    • Pharmacies, private hospitals, and wholesalers/distributors
  • Case studies of successful public partnerships to improve distribution reach
  • Innovative distribution models and opportunities to disrupt the distribution market
  • Provide participants with the concepts, tools, lingo and insights that will foster stronger communication with counterparts working in global agencies and LMIC country governments.
  • Comprehend the opportunities and pitfalls of using tiered pricing in LMICs
  • Understand health technology assessment, pricing and reimbursement approaches used in LMICs
    • Supranational HTA
    • Country level HTA and reimbursement decisions
  • Organizational design for success in LMICs
  • Address project management capacities issues.

Duration, dates and fee

The course will last 2 days and it will be conducted in SDA Bocconi during the second week of July 2019: 11th of July (afternoon) – 13th of July (morning)

The course will be coordinated by Viviana Mangiaterra and Monica Otto.

Program fee
€ 2.500 plus VAT (if required). The program fee covers tuition, case materials, the use of BBoard Platform and lunches.


  • Claudio Jommi, SDA Bocconi Professor of Practice
  • Viviana Mangiaterra, SDA Bocconi Associate Professor of Practice
  • Dr. Brenda Waning, Chief, Global Drug Facility, Stop TB Partnership
  • Dr. Prashant Yadav, Harvard Medical School


Brenda Waning is the Chief of the Stop TB Partnership’s Global Drug Facility (GDF) – the world’s largest supplier of tuberculosis medicines and diagnostics for the public sector. Waning is a leading expert with more than 20 years of experience in promoting access to medicines in low-resource settings, with a focus on the intersection of pharmaceutical policy, market strategies, and access to medicines. She serves on several expert advisory groups across many different disease and technical areas. Prior to joining GDF, Waning led the strategy and investment team at Unitaid, a donor organization at the World Health Organization, monitoring access and market trends in HIV/AIDS, tuberculosis, and malaria; identifying strategic opportunities to intervene in these markets; and, assessing the public health and market impact of Unitaid-funded projects. Before moving to Geneva, Waning held leadership positions in the faculties of Boston University Schools of Medicine and Public Health where she authored numerous peer-reviewed studies on pharmaceutical policy at local, national, and global levels. She has led training programs across the globe for high-level policy makers and provided policy, strategic, and investment consulting services for donors, governments, and international organizations. Her research results and consulting advice have led to dramatic changes in global policy and practice.


Prashant Yadav is a Sr Lecturer at Harvard Medical School and Strategy Leader-Supply Chain at the Harvard Medical School. Yadav is globally recognized scholar in healthcare supply chains in frontier markets. His work has also been featured in prominent print and broadcast media such Economist, Financial Times, Nature, and BBC. He has authored over 40 peer reviewed publications on healthcare supply chains. Outside academia, Yadav works closely with multiple organizations on policy and investment strategy design for healthcare supply chains and has provided expert testimony on healthcare supply chain issues in legislative bodies around the world, including the US Congress. Yadav also serves on the boards of many global organizations and social enterprises.  Before his current role, Yadav was Vice President of Healthcare at the William Davidson Institute at the University of Michigan and a faculty member at the Ross School of Business at the University of Michigan. Before that he was Professor of Supply Chain Management at the MIT-Zaragoza International Logistics Program and a Research Affiliate at the MIT Center for Transportation and Logistics. Yadav is a Chemical Engineer with a MBA and PhD in Operations Management.