What the U.S. Pharmaceutical Industry Could Learn from How Africa Solves Patient Access

A veteran of Pfizer, Sanofi, and Novo Nordisk who built patient access programmes across West Africa argues that the $500 billion medication adherence crisis plaguing American healthcare has already been solved - in markets the industry has never thought to look.

NEW YORK, NY / ACCESS Newswire / May 1, 2026 / The United States spends more on healthcare than any nation on earth - and loses an estimated $500 billion every year to a problem hiding in plain sight. Roughly half of all patients prescribed chronic therapies stop taking their medication within the first year. The downstream consequences are entirely predictable: disease progression, emergency hospitalizations, preventable deaths, and a pharmaceutical value chain that books revenue on prescriptions that never produce outcomes.

The industry's prevailing answer to this crisis is artificial intelligence. Predictive models identifying high-value physicians. Machine learning optimizing sales territories. Algorithms shortening the distance between diagnosis and prescription. The tools are sophisticated. They are also, according to Victor Unanah, aimed at precisely the wrong end of the problem.

Unanah is a pharmacist who spent over a decade at Pfizer, Sanofi, and Novo Nordisk, working across Nigeria, Ghana, Paris, and Copenhagen. His career placed him at the operational front line of some of the most ambitious patient access initiatives ever launched in sub-Saharan Africa - in markets where the infrastructure American healthcare takes for granted does not exist.

At Sanofi, he launched what the company described as sub-Saharan Africa's first Diabetes Patient Support Programme - branded MyPadi - which produced measurable, visible improvement in medication adherence. At Novo Nordisk, he co-designed iCARE (Insulin For Seniors), an initiative that enrolled approximately 1.13 million senior diabetes patients in Nigeria. He also built the Salesforce CRM architecture and Power BI dashboards his commercial teams ran on across West Africa, refining them until forecasting accuracy reached within five percent.

He has since published peer-reviewed research arguing that the very CRM infrastructure the industry already uses to optimize sales could - with the right analytical layer built on top - be retooled to predict patient dropout and, critically, diagnose why it is happening.

His central claim is counterintuitive: that pharmaceutical innovation in African markets, born of necessity in environments stripped of the systems American healthcare relies upon, has produced approaches to patient access and adherence that the U.S. system urgently needs and has largely failed to notice.

The logic Unanah advances begins with a fundamental difference in engineering philosophy. In the United States, the entire pharmaceutical commercial model is built on the assumption that once a prescription is written, a series of systems will carry the patient forward. The pharmacy will fill it. The insurer will cover it. The provider will follow up. The patient will return. Roughly half the time, for chronic therapies, that assumption proves wrong.

In Nigeria, that assumption was never available to begin with. Unanah and his teams knew the pharmacy might not stock the medication. They knew the patient might not afford the second refill. They knew there was no insurer sending reminders and no electronic health record triggering a follow-up. So they engineered around those failures from the outset - designing patient support programmes premised on the certainty that every link in the chain between prescription and sustained therapy would break unless something specific was built to hold it together.

The iCARE initiative, which enrolled 1.13 million senior diabetes patients in Nigeria, offers the clearest illustration of what that philosophy produces in practice. The programme was structured around four integrated interventions: subsidized pricing to address cost barriers; provider training to build clinical capacity for chronic disease management; targeted geographic outreach to reach patients in regions with limited specialist access; and ongoing patient education on disease self-management and monitoring.

The decisive design choice was integration. These four interventions were not offered as separate services. They were delivered through a single programme pathway so that every enrolled patient received all four simultaneously. That structure - addressing cost, education, access, and follow-up as a unified system rather than isolated fixes - is what drove the results.

In the United States, Unanah argues, those same four barriers exist for millions of patients on chronic therapies. Cost, even with insurance coverage, due to copay structures and deductible phases. Education, because most patients receive inadequate counseling on long-term medication management. Access, because specialist availability remains uneven across geographies. Follow-up, because the system is fragmented and no single entity owns the patient's adherence trajectory across providers, payers, and pharmacies. The American system addresses each of these in isolation, when it addresses them at all. The lesson from iCARE is that they must be addressed together.

The 40 percent adherence improvement Sanofi's MyPadi programme achieved in sub-Saharan Africa carries a lesson that challenges the dominant framing of the U.S. adherence conversation. Unanah is precise about what drove the result: the programme removed barriers, not reluctance. That distinction matters enormously.

American adherence strategy remains dominated by the idea that patients need to be reminded, nudged, or incentivized to take their medication. The African experience teaches a different conclusion. Patients stop therapy because of structural obstacles - confusing reimbursement systems, inadequate provider communication on the importance of chronic adherence, communities where standard patient education materials are inaccessible due to variable literacy. When those obstacles are removed, adherence improves dramatically, without behavioral intervention.

The MyPadi design reflected this. Provider training went beyond clinical protocol to equip healthcare professionals with the communication tools needed to explain why long-term therapy matters in ways patients could internalize. Education materials were designed for the actual literacy conditions of the communities being served, not for an idealized patient. The infrastructure was built for the real barriers, not the assumed ones.

The resilience of that design philosophy was tested directly during the COVID-19 pandemic, when Unanah worked with state-level Ministry of Health officials to design a logistics protocol keeping insulin supply lines open during lockdowns. Distribution was rerouted, cold-chain integrity was maintained during disrupted transport, and coordination was established between hospital pharmacies and community access points for patients unable to travel. The protocol was formally recognized by health authorities for its effectiveness.

The United States experienced its own pharmaceutical supply chain disruptions during the pandemic and discovered that a system everyone assumed was robust carried serious vulnerabilities for patients on chronic therapies. The difference, Unanah argues, is that Nigerian systems had already been designed for that kind of fragility. The mindset of building for disruption rather than assuming continuity produces more resilient infrastructure in any market.

Perhaps the most commercially pointed argument Unanah makes concerns the industry's existing technology infrastructure. The CRM systems pharmaceutical companies already operate - the same platforms he helped build and refine at Novo Nordisk to forecast commercial performance within five percent accuracy - track prescriptions, revenue, call frequency, and territory growth with considerable precision. What they do not track is what happens to the patient on the other side of that commercial transaction: whether the second refill was filled, whether it was affordable, whether anyone followed up.

That data exists, distributed across pharmacies, payers, and providers. What has not been built is the analytical layer connecting it. Unanah's published research proposes exactly that: a system sitting atop existing CRM infrastructure that identifies patients at risk of dropping off therapy and diagnoses the specific barrier driving that risk - cost, access, education, or provider follow-up - because the intervention is fundamentally different for each. A model that predicts dropout without identifying the cause, he argues, is not actionable.

Why has this layer not been built? Unanah's answer is organizational as much as technical. Inside pharmaceutical companies, adherence belongs to no one. Sales owns prescriptions. Medical affairs owns clinical evidence. Market access owns payer relationships. Adherence sits in the gaps between all three functions, and none of them carries the budget authority or the measurement mandate to build infrastructure addressing it. The incentive structure points consistently toward sales optimization - the function where results are most immediately visible and where analytical investment has traditionally been concentrated.

The technology talent building AI tools for the industry compounds this problem. Working primarily in the data environment of developed markets, these engineers have limited exposure to contexts where infrastructure cannot be assumed. They have not had to design systems premised on the certainty of patient fallout. That, Unanah argues, is precisely what working in West Africa produces: a fundamentally different engineering instinct, one forged by necessity in environments where the safety nets that American healthcare relies upon never existed.

The provocation at the center of Unanah's argument is deliberate. The United States has better infrastructure at every individual link in the pharmaceutical chain, more data, more funding, and more technology than any market where he has worked. It also has worse adherence outcomes than what his teams achieved with MyPadi on a fraction of the resources. That gap, he contends, is not a paradox - it is evidence of a design philosophy problem that the industry's AI investment, however substantial, will not solve unless it is directed at the right problem.

The solutions exist. They have been tested, at scale, in conditions more demanding than anything American healthcare faces. The question the U.S. pharmaceutical industry has not yet seriously asked is what it might learn from the markets it has historically treated as recipients of innovation rather than sources of it.