Building sustainable partnerships
We work to mobilise awareness of the importance of fighting diabetes. Our approach to access builds on the United Nations (UN) defined cornerstones on the right to health and aligns with the UN Millennium Development Goals, which offer a common vision for tackling some of the major challenges facing the world.
Building sustainable partnerships to expand access to diabetes treatment and develop healthcare system capacity is the primary goal of our long-term efforts to confront the diabetes epidemic in developing countries. Our commitment extends to people who lack access to treatment, those who face barriers due to inadequate healthcare infrastructures and the high out-of-pocket costs that can be a part of having a progressive, chronic disease.
In 2001, we launched an access to diabetes care strategy with the aim of improving diabetes care in developing countries. Within the framework of this strategy, we developed specific initiatives to deliver action for improving access to care in developing countries with emphasis on building healthcare system capacity. Among these initiatives are the:
- World Diabetes Foundation
- Our differential pricing policy for LDCs
- World Partnership Programme
See 'Future Focus' below for current initiatives.
Measuring progress
Setting ambitious objectives and targets and reporting on progress in meeting our goals are core elements of the Novo Nordisk Way of Management. However, we face two major challenges in measuring the impact of efforts to expand access to care. First, we need to develop meaningful and useful indicators for measuring performance in areas where there is yet no corporate precedence for reporting. Second, we need to find ways of dealing with the challenges of obtaining good quality data in regions where monitoring of health care quality is not standard.
To guide our future direction, we are working on setting specific, measurable medium-range targets for our access initiatives. We will use these to learn from our experiences, measure, and improve our progress and impact.
Supporting the UN Millennium Development Goals
Beyond our donations to the World Diabetes Foundation, our approach to expanding access builds on the right to health and aligns with the UN Millennium Development Goals (MDG), which offer a common vision for tackling some of the major challenges facing the world by 2015.
Over the next decade, our emphasis will be on areas selected because of their ability to have an impact on current and future generations, with a long-term impact consistent with our role as a sustainable business. Our areas of emphasis support three of the UN Millennium Development Goals.
- treating children with type 1 diabetes
- confronting diabetes in pregnancy
- building partnerships and capacity through donations to support World Diabetes Foundation and differential pricing
Treating children with type 1 diabetes
Despite progress, children with type 1 diabetes in developing countries continue to have high mortality rates, with life expectancies in sub-Saharan Africa of less than one year. In an effort to reduce child mortality - UN Millennium Development Goal 4 - Novo Nordisk has made an ambitious five-year, 25 million USD commitment to treat children with type 1 diabetes. The Changing Diabetes® in Children programme responds to the International Diabetes Federation's plea that no child should die from diabetes. Our goal is to work in cooperation with local partners, including governments and diabetes associations, to build sustainable national capacity in some of the world's poorest countries and create well-functioning diabetes clinics for treatment of children with type 1 diabetes.
The programme provides the necessary medical and laboratory equipment, organises training of health care professionals, establishes diabetes patient education, and creates systems for adequate monitoring and follow-up. In addition, insulin and diabetes supplies are being provided free-of-charge for the duration of the programme.
In Bangladesh, one of the countries in the world with the lowest healthcare spending per capita, the programme has been rolled out as a joint initiative with the Diabetic Association of Bangladesh (BADAS). As in most other developing countries, there are no existing facilities for treating children with diabetes.
"Currently, children with diabetes are managed primarily by adult diabetes clinics or general medical outpatient clinics, but treating diabetes in children is different from treating diabetes in adults," says Professor Azad Khan, president of BADAS. "They have other needs and delayed treatment can often lead to devastating complications."
More than 400 children were diagnosed and enrolled during 2009 in Bangladesh, Cameroon, Democratic Republic of Congo, Guinea, Tanzania and Uganda. Our ambition is to reach 10,000 children as we expand the programme into additional countries
over the next few years.
Diabetes in pregnancy
Over 10 million women develop gestational diabetes during pregnancy every year. Due to the decreasing age of onset for type 2 diabetes, increasing numbers of women also have diabetes prior to pregnancy. Diabetes makes pregnancies higher risk and can lead to long-term complications for both mother and child.
More than half of women who develop gestational diabetes will go on to develop type 2 diabetes during the next decade, and their children have a substantially increased risk of developing type 2 diabetes.
In support of Millenium Development Goal 5, targeting maternal health, we are initiating activities to raise awareness of the impact of diabetes in pregnancy, address knowledge gaps, support community-based maternal health programmes, and advocate for sustainable change, which ultimately will increase access to diabetes screening, treatment, and lifestyle education. Through our commitment to address the needs of women with diabetes, we aim to improve the health outlook for women and their families today as well as for future generations.
Differential pricing and building partnerships
Differential pricing in developing countries
The cost of therapy still constitutes a significant barrier for better healthcare in the developing world. In many countries, the availability of medicines at public health facilities is often very poor due to inadequate funding, lack of incentives for maintaining stocks, inability to forecast accurately, or inefficiencies in procurement, supply and distribution. Among the targets for UN Millennium Development Goal 8 is a call for cooperation from pharmaceutical companies to provide access to affordable essential drugs in developing countries.
Read more under the 'performance' tab of this 'access to health' section.
Building partnerships and capacity
The Millennium Development Goals include a global partnership for development. The huge challenge of tackling development and diabetes poses numerous dilemmas for the developing world that require innovative approaches. While our strength is in diabetes care, working in partnership is crucial to help address organisational matters and increase the impact of our efforts.
Read more under the 'performance' tab of this 'access to health' section.
Foundation support
Part of our contribution is our continued long-term financial commitment to the World Diabetes Foundation; totalling 1.2 billion Danish kroner allocated over 15 years. In 2002 and 2008 our shareholders voted to contribute a portion of net insulin sales to WDF. These donations are reported annually on our Income statement.
The independent and non-profit WDF supports the prevention and treatment of diabetes where it is needed most, providing funding for local initiatives that improve healthcare system capacity. Since it was founded by Novo Nordisk in 2001, it has supported 216 projects in 83 countries.
For more information on WDF's activities visit their website.
As our focus on haemophilia has expanded, so has our commitment to the global haemophilia community. We established the Novo Nordisk Haemophilia Foundation (NNHF) in 2005 to address the significant need for improving haemophilia care and treatment in developing countries. Our donations to NNHF, including 15.4 million Danish kroner, support projects and fellowships in developing and emerging countries. By working with partners with local ownership of projects, the NNHF aims to ensure the sustainability of capacity building programmes. See NNHF.org for more information.
Differential pricing policy
Novo Nordisk has formulated a differential pricing policy offering insulin to the world's Least Developed Countries (LDCs) at or below a price of 20% of the average prices for insulin in the Western world. The Western world is defined as Europe (EU, Switzerland and Norway), the United States, Canada and Japan.
In 2009, Novo Nordisk operated in 37 of the 49 LDCs. For 2009 the differential pricing policy was offered, as part of the global health initiatives, to all LDCs as defined by the United Nations. During 2009 Novo Nordisk sold insulin in accordance with our differential pricing offer in 36 LDCs compared to 32 in 2008.
We did not sell any insulin during 2009 in 12 LDCs, for various reasons. In several cases, either the government did not respond to the offer, there are no private wholesalers or other partners with whom to work, or wars or political unrest made it impossible to do business. While Novo Nordisk prefers to sell insulin at the differential price through government tenders, the company is willing to sell to private distributors and agents. In Nepal the public authorities have been offered the opportunity to buy insulin at the policy price, but in 2009 the insulin was sold to the private market without using the policy price.
Novo Nordisk has no way of guaranteeing that the price at which Novo Nordisk sells the insulin will be reflected in the final price to the consumer.
Healthcare providers and people with diabetes trained
A measure of the company's contribution to global health is the number of healthcare professionals directly trained, educated, interacted with or reached through awareness campaigns and the number of people with diabetes targeted with training or awareness. The aim is to continue activities for educating healthcare professionals and to train people with diabetes.
In 2009 805,000 healthcare professionals were trained or educated and 415,534 people with diabetes were trained. The increase in numbers is due to more affiliates reporting on more activities reaching a greater number of either healthcare professionals or people with diabetes.
World Partnership Programme
In 2001, we launched the World Partnership Programme with the intention of developing models of care for improving treatment outcomes for people with diabetes in developing countries. Lessons from these projects include our successes in Tanzania and Bangladesh.
- In Tanzania, we collaborated with the Tanzania Diabetes Association and the Ministry of Health to incorporate diabetes care into the existing healthcare system and assist with the development of a national strategy for non-communicable diseases. Activities included establishing diabetes clinics to make diabetes care more widely available and ensuring appropriate equipment was available for follow-up treatment and monitoring. Novo Nordisk has funded the establishment of 12 clinics in Dar es Salaam and on Zanzibar, which operate within existing government hospitals and under the jurisdiction of the Ministry of Health.
Other clinics are supported by the WDF and donations by Novo Nordisk employees. Delegates from several African countries have visited Tanzania to learn from the Tanzanian experience.
- In Bangladesh, together with the Diabetic Association of Bangladesh, we helped implement a certification programme for Bangladeshi physicians to treat people with diabetes. In total, 3,000 doctors have received training through this programme.
Affordability in developed countries
We are also addressing access issues in the developed world. Novo Nordisk Patient Assistance Programs help people in the US who:
- do not have private health insurance
- do not qualify for private, local, state or federal prescription reimbursement.
If approved, a free 90-day supply of medicine will be sent to the prescribing healthcare providers' office to be picked up at the patient's convenience. We also follow-up with the healthcare provider 90 days later to approve a therapy refill.
Patients in need of assistance may download forms to get started at www.novonordisk-us.com.