March 2021

Evaluation of the Accessto Medicine Foundation
Final Report – Executive Summary

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March 2021

Evaluation of the Access to Medicine Foundation
Final Report – Executive Summary
Thyra de Jongh, Matthias Ploeg, Anneloes de Ruiter, Liana Petrosova, Lonneke
Schrijver, Ivette Oomens

Executive summary
The Access to Medicine Foundation (hereafter referred to as the Foundation) was establishedin 2003 to improve equitable access to medicines, vaccines and diagnostics (hereaftercollectively referred to as access to medicine, ATM). Since then, it has developed from a small
initiative into a solid and efficient organisation with a track record of rigorous research andeffective change-making.
The independent evaluation
In 2020, the Foundation commissioned Technopolis Group to conduct an independent
evaluation of the progress of the Foundation in advancing access to medicine in low- andmiddle-income countries (LMICs). This evaluation focused on assessing the influence of theFoundation on the pharmaceutical sector, progress and impacts on the ground achieved bypharmaceutical companies’ actions, as well as exploring the mechanisms through which theFoundation affects companies to achieve positive change. This evaluation also assessed thevalue for money (VfM) of the Foundation to current and prospective funders.
The evaluation has drawn evidence from desk research, stakeholder interviews and abenchmark analysis. The desk review consisted of analysis of internal documentation of theFoundation and reports to its funders, as well as academic and grey literature to support thedevelopment of impact cases studies. Semi-structured interviews were conducted with a large
number of representatives from pharmaceutical companies both within and outside of thescope of Foundation’s work, funders, signatory investors, and other important actors in the ATM
space such as global donors and non-governmental organisations, ATM experts andrepresentatives from LMICs. The VfM analysis adopted the United Kingdom’s Foreign,Commonwealth and Development Office (FCDO) “4E framework” and thus explored theeconomy, efficiency, effectiveness and equity of the Foundation as compared to similarorganisations.
Confirming the validity of the Foundation’s Theory of Change and the effectiveness of its
mechanisms of influence
The evaluation was able to confirm the validity of the Foundation’s Theory of Change and theeffectiveness of the mechanisms of influence used by the Foundation to drive positive change
in the pharmaceutical industry on access to medicine. The Foundation uses a number of ‘tools’
to encourage and inspire change, including the development and publication of company
rankings, provision of tailored advice to industry stakeholders, engagement with the investor
community and contribution to global ATM advocacy efforts.
The Access to Medicine Index (hereafter the Index) remains the Foundation’s flagship product.
The framework for action that the Foundation has developed and continues to refine that
underpins the Index has become a standard for both the industry and other stakeholders
working on ATM and antimicrobial resistance (AMR) issues. The appreciation of theFoundation’s Index and framework for action is also seen among companies that are currently
outside of the scope of the Foundation’s programmes.
By providing tangible indicators for access performance, the Foundation supports companies
and other ATM stakeholders in learning a shared “language of access”, which helps enhance
the collaboration between these actors. The Foundation has successfully maintained and evenexpanded its role as a consensus-builder around issues of ATM and AMR.

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Whilst the Foundation has been effective in triggering the competitive nature of thepharmaceutical industry through comparing and benchmarking company performances, italso offers recognition for companies on specific aspects of the framework for action regardlessof their overall performance in the Index. The Foundation does so by spotlighting industry bestpractices in various areas of ATM, through the Index and AMR Benchmark (AMRB) as well as
through thematic studies. Companies report that the public recognition of efforts helps thembuild relationships with partners to further advance their ATM programmes. Stakeholders also
highlight the strong reputation of the Foundation among industry and other global ATM players.
The Foundation has managed to encourage companies to structure their internal reflections
on access matters and to improve their performance on areas identified by the Foundation as
opportunities for improvement. In doing so the Foundation relies on its relationships withcompanies’ internal change-drivers, i.e., employees that are in a position to influencecompany commitment to ATM and translate this into action. Several company representatives
consider the support of the Foundation to have been instrumental in their internal accessadvocacy and believe that in this way the Foundation truly drives change within companies.
By applying a comprehensive assessment framework, the Foundation has also contributed togreater transparency in the pharmaceutical industry. Some company representatives indicatethat the data collected by the Foundation is more thorough than what they make available
via their own communication channels. The standardised analysis of this data allows for directcomparison between companies and highlights best practices, as well as areas wherecompanies fall short. The data companies provide to the Foundation represent one of the rareexamples of (relatively) transparent and comprehensive ATM reporting by the industry. The
measure of transparency that the Foundation brings is valued by many in the global ATM field,
some of whom have indicated that their own decision to engage with a company is informedby how well it performs in the Foundation’s Index or AMRB.
Over the evaluation period, the Foundation has strongly developed its engagement with theinvestor community. Since the start of their investor engagement efforts, the Foundation has
drastically increased the number of investors it works with and intensified the ways by which itengages with investors. Interviewed investors value the outputs of the Foundation and theindividual tailored support the Foundation provides them. This supports their own efforts toinfluence how companies approach ATM.
From influence to impact: four case studies
In line with the findings of the Foundation’s 10-year progress report and industry trends outlinedin the 2021 Access to Medicine Index, the evaluation confirms that, apart from changes in theattitudes of companies regarding ATM and an increase in internal ATM reflection processes,
there has also been a major shift in the ways in which company efforts are translated intopractice. Many stakeholders believe that the Foundation has played an important role infacilitating such changes. Whilst it is not possible to draw any direct causal connections
between the work of the Foundation and increased access to medicine, as there are manyother actors and actions in between these elements – not least the companies themselves –,this evaluation has sought to show how the Foundation contributes to access by use of four
illustrative case studies. These case studies have focused respectively on voluntary licensing,access planning during R&D, company transformation to mainstream access into sustainablebusiness models and global policy shaping.
The Foundation’s work on encouraging voluntary licensing, particularly in connection to theMedicines Patent Pool, is recognised by many as a substantial contribution to increased accessto medicine in LMICs with associated cost savings to health systems in these countries. A
conservative estimate of the Foundation’s impact in this space points towards tens of3thousands of additional people having access to treatment across the world and millions ofdollars in savings. The impact of the Foundation on getting companies to begin accessplanning during R&D rather than at the end of the product development process is as yet lessvisible, since most companies are still to implement this at scale but specific product-related
examples included in this evaluation show the potential of these actions. If companies continue
to step up their efforts in this area, under the watchful eye and guidance of the Foundation,
this may increase access for many thousands of people in the short-term and many more in
the longer-term.
Potentially the most impactful change in the pharmaceutical industry lies in the transformationof approaching access as part of corporate social responsibility to mainstreaming access for
LMICs into a company’s business model based on different considerations of volume and priceand a need for concurrent investments in health systems. Such impacts could not be quantified
in this evaluation, as they are not clearly distinguishable from those resulting from more
traditional business approaches. The Foundation’s contribution to the transformation is alsodifficult to delineate as it takes place against a notable shift in how companies approach
emerging markets in general. Nonetheless, it is fair to assume that by signalling opportunities
and providing companies with advice on how to approach particular issues, the Foundation isfacilitating this transformation, thus contributing to impact. Even when assuming a minor
contribution by the Foundation, the overall impact will be very significant given the expected
reach of this development.
The impact of the work of the Foundation in shaping global policy around ATM issues is likewisevery challenging to estimate. In some of the areas where the Foundation has done so, there ismuch promise but as of yet little tangible impact. In other areas, there are very significant
impacts from the work global health actors are doing collectively but the role of the Foundationis comparatively small to that of other, more influential players. However, considering its modest
scale as an organisation, it is noteworthy how much other organisations value the work of theFoundation as a thought-leader and access champion.
Conclusions about impact, value for money and return on investment for current andprospective donors
Although methodological challenges and data limitations do not allow extrapolating from oraggregating across the illustrative impact cases, jointly they show that the work of theFoundation has likely already contributed to improve access to medicine for millions of people
and also produced millions in cost savings for LMICs. This impact is set to grow further ascompanies continue to improve their performance on issues of access and AMR.
The VfM analysis shows that the Foundation performs well across all assessment areas. The
expenditures of the Foundation, including its staff remunerations, cost of principal activities aswell as overhead costs, are in line with that of the organisations against which the Foundation
was benchmarked. The effectiveness of the Foundation is clearly visible in the analysis of itsimpacts. The Foundation also applies strategies to ensures equitable distribution of results of
their efforts.
This evaluation concludes that, since the last assessment, the Foundation has continued tostrengthen its position as a driver of positive change in ATM efforts within the pharmaceuticalindustry. Compared to the overall budget of the Foundation, which stands at around €3 million,
its impacts offer a many-fold return on investment. The size of the organisation is particularly
noteworthy in comparison to the significant influence on the companies it targets and theassociated positive impacts on the ground. Effectively, the Foundation’s staff embody theproverb of ants moving mountains.

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