PhD defence K. (Koray) Parmaksiz

Brief summary:

While medicines have been playing a vital role in preventing illness, curing disease and protecting health, ensuring access to affordable and quality-assured medicines remains a global problem. The World Health Organization estimates that nearly two billion people worldwide lack access to essential medicines—those needed to address the most urgent health priorities. This lack of access not only threatens public health but also places significant financial strain on individuals and governments. Addressing this issue requires a collaborative effort between multiple stakeholders across sectors.

This thesis explores two such collaborative approaches: pharmaceutical track & trace systems and pooled procurement mechanisms. It examines how these approaches can improve access to affordable, quality-assured medicines, and how to make such systems work in practice. 

Medicines move through a complex pharmaceutical supply chain before reaching patients. Pharmaceutical track & trace systems offer a way to manage this complexity by making (global) supply chains more transparent. This thesis shows that implementation of new technologies is generally driven by political and economic factors, and that technology alone is not sufficient to make such systems work in practice. For these systems to work, they need to be embedded in well-defined legal frameworks and supported by adequate regulatory capacity. Without these safeguards, track & trace systems risk becoming an efficient system that deliver poor-quality medicines to patients.

So, how can we ensure that affordable, quality-assured medicines make it into the supply chain? By procuring the right product, for the right price, and the right quality, at the right time, at the right place. Pooled procurement, where buyers combine their purchasing power to negotiate better deals on medicines, has been seen as a promising solution in resource-limited settings. While effective in theory, this thesis shows that pooled procurement is not a one-size-fits-all solution. These mechanisms are complex, diverse, multi-component and context specific, and vary widely in their structural form, operational level, and product types. For example, mechanisms set up to address communicable diseases that pose a potential threat to global health security are more likely to succeed compared to mechanisms that lack these preconditions. Setting them up is not a singular event, but a non-linear process that evolves over time. The multi-year study on the East African Community pooled procurement mechanisms emphasizes that such mechanisms require ongoing work and effort by the actors involved to align and sustain the various motivations, goals and design.

To help stakeholders navigate these complexities, I have translated my findings into a comprehensive Pooled Procurement Guidance, an analytic tool to facilitate collecting, structuring and analyzing data on pooled procurement mechanisms.