A new medicine is only a scientific achievement until someone takes it. Everything between regulatory approval and a patient receiving treatment is infrastructure: budgets, procurement rules, diagnostic capacity, trained clinicians, political priorities that shift with every election cycle. In Latin America and across emerging markets, that infrastructure is where most innovation stalls. Pharmaceutical companies have spent decades treating those systems as external conditions, variables to be navigated rather than built. Rolf Hoenger, a Healthcare Leader and Co-Founder of Movement Health who has spent more than 30 years bringing innovative treatments to patients across Latin America, Central Asia and the Caucasus, argues that the distinction is false and expensive. The question of whether a treatment reaches the patient who needs it is not downstream of the business. It is the business.
Industry Is Inside The System, Not Beside It
The conventional posture is adversarial by design. Companies price, governments push back, and access becomes a negotiation where each side treats the other’s constraints as obstacles. Hoenger has watched a different approach produce better results, and it starts with a shift in self-perception. “The strongest progress I’ve seen comes when companies treat health systems as something they help to build,” he says. “That means understanding the budget, priorities and pressures on the public side.”
That sounds like a soft principle until the operational consequence becomes clear. Designing an access strategy around a ministry’s fiscal reality, rather than around what a company wishes the reality were, produces something a government can plausibly say “yes” to. Hoenger’s team built an access-planning framework for Latin America that began with the specific conditions of each country, rather than a regional template imposed from headquarters. It worked well enough that the company later adopted it globally. The lesson running underneath is unflattering to standard practice: the frameworks that travel furthest are the ones built closest to the ground, not the ones exported from a central office that has never had to defend a line item in a public budget.
Partnership Is A Structural Requirement
Cross-sector collaboration has become one of the most reliably hollow phrases in global health. Conferences are built on it. Very little of it survives contact with the quarter. Hoenger’s version is narrower and more demanding, resting on a simple diagnosis of why complex access problems stay unsolved. “Governments, industry, technology, and civil society each hold a piece of the solution,” he says. “Real change happens when they share a goal and work toward it together.”
The operative word is pieces. If no single actor holds a complete solution, then unilateral effort is not merely slower, it is structurally incapable of finishing the job. A company can fund a program; it cannot reform procurement. A ministry can set policy; it rarely has the technology capacity to execute at scale. That logic led Hoenger to co-found Movement Health, a cross-industry coalition applying technology to make health systems more effective in Latin America, Africa, and Eastern Europe. What distinguishes a coalition like that from a conference panel is a shared goal, which forces participants to accept that their individual contribution is partial. Most corporate social investment is built the opposite way, designed so a single company can claim the whole result. That design choice is precisely what keeps the result small.
Talent Outlasts Products
Pharmaceutical investment is overwhelmingly weighted toward the product: trials, launch, market shaping, and lifecycle management. It is measurable, defensible to a board, and tied to revenue a finance team can model. Investment in people, by contrast, resists that equation. Hoenger’s position, drawn from three decades in markets where system capacity is the binding constraint, is that the imbalance is a strategic error rather than a philanthropic gap. “Health systems are run by people,” he says. “In every country I’ve worked in, the longest lasting impact came from developing local talent and future leaders. Strong teams keep strong systems moving forward for years to come.”
Consider the asymmetry in durability. A product has a patent life and a competitive window. A clinician trained to diagnose earlier, a health economist who can build a defensible budget case, and a ministry official who understands how to structure a reimbursement pathway – those capabilities compound for decades and apply across every therapy that follows. Companies working across 32 countries, as Hoenger does, encounter the same bottleneck repeatedly: the system cannot absorb what the science delivers. Building absorptive capacity is slower than a launch campaign and almost impossible to attribute to a single balance sheet. It is also the only intervention that makes every subsequent launch easier. The firms that understand this are investing in the conditions under which their own future products will succeed, which is a commercial argument before it is an ethical one.
Hoenger’s three principles converge on an uncomfortable implication for the industry. Understanding, partnership, and people all require accepting a longer horizon than quarterly reporting rewards and a smaller share of credit than marketing departments prefer. “Industry brings innovation, expertise, and a long-term view,” he says. “When we put those strengths to work alongside the public sector, more patients gain access to the care they deserve.” The companies still treating access as a pricing problem will keep discovering that approval and availability are different things. The ones treating it as a system-building problem are quietly changing what their science is capable of reaching.
Follow Rolf Hoenger on LinkedIn for more insights on health system strengthening, patient access, and cross-sector partnership in emerging markets.
