Improving Access for Drugs: The A4D Framework

Many countries are increasingly facing drug shortages even during normal times. These shortages prompt fundamental questions why shortages happen, how they are linked, and what interventions can be effective. This paper contrasts medical criticality of the drug with its supply chain risk. We propose a simple visual framework to improve access for drugs by helping stakeholders to systematically deal with three key issues: gathering evidence, increasing alignment, and developing a system view. The framework introduces a 4-step improvement cycle (Analyze, Assess, Act, Align), inspired by the Plan-Do-Check-Act method commonly used in quality control. This paper describes the framework in detail, argues why it is necessary and how it can be used in different circumstances and for different purposes.