Antonio Carlos Matos da Silva, general manager of Roche Ecuador explains how his ability to manage by influence has helped him transition smoothly into his first GM position. The Brazilian manager has great ambitions for the Ecuadorian affiliate of the oncology global giant, elaborating on Vision 2020; a plan he built in active collaboration with two thirds of his employees that aims at shaping the regulatory environment, transforming the company’s portfolio in line with the global strategy and contributing to the personal development of the 90 employees he currently has under his responsibility.

How have you adapted to your first position as a general manager and what have been some of you main achievements?

My responsibilities at Roche Brazil were important enough to prepare me well for this challenge. Indeed, for six years I learnt how to work collaboratively and influence my peers and teams towards to reach all company’s common goals. These skills have helped me adapt fairly quickly to the new environment I was exposed to when taking over the Ecuadorian affiliate of Roche.

Leveraging my prior experiences in the most important market in Latin America, I found solutions for the challenges our Ecuadorian affiliate was facing. Firstly, I had to agilely navigate the new cultural environment I was plunged into. Ecuador’s business practices are based on significantly more hierarchical relations, and finding way to encourage everyone to voice their opinion was no cinch. Additionally, I had to find ways to foster the collaborative spirit among coworkers.

Secondly, coping with the extremely fast paced regulatory environment was a challenge. Ecuador revises the healthcare’s regulatory framework on a monthly basis and changes profoundly affecting the operations of pharmaceutical companies in the country occur regularly. Furthermore, healthcare authorities have changed three or four times since I was appointed 18 months ago. This modifies the manner in which the industry and public sector can dialogue and the likelihood that agreements passed with the public system are applied in the future. Thus, I have had to deal with high uncertainty levels.

What is your vision for the affiliate and what strategic actions have you taken so far?

[Featured_in]

Three months following my arrival in the country we started working on the company’s strategic vision, a plan that would guide our operations until 2020.

Unfortunately, when we started developing the affiliate’s vision, our team was not on-board of the project. I did what was necessary to engage the team and made sure that all employees would share this vision. In fact, out of the company’s 90 employees, 63 people actively partook in the creation of the affiliate’s 2020 vision. The plan encompasses 4 areas: the financials, people, stakeholders and internal process improvements, which we want to have accomplished by 2020. Overall, I am looking forward to making the affiliate the leading company in the Ecuadorian pharmaceutical market, contributing to the personal development of my employees and making Roche a key partner for all of its stakeholders here.

More specifically, one of the pillars of this plan is to establish a sustainable relationship with the government. Eventually, we hope to shape the environment in which the company evolves in for the benefit of the patient. In fact, Roche has been fully committed to collaborate actively with the development of the organic health code (COS) currently being revised by the National assembly in Ecuador. [The COS is Ecuador’s health legislation backbone – Ed.] Moreover, at the end of February, the congress asked Roche’s legal teams and our healthcare experts to continue contributing to the establishment of health regulations aimed at improving market access and reimbursement policies, educational processes in healthcare in order to improve quality and reducing inequities to achieve the best care for patients.

Our second main project is called ‘Ecuacción’, the contraction between Ecuador and action in Spanish. With this flagship project, Roche intends to accelerate the patient access to innovation through enhanced market access policies. The process to be included in the country’s national formulary takes four years on average. Therefore, it appears the environment needs to be shaken up. For instance, by regulation Ecuador’s national formulary should be updated every two years but has not been since 2014. As a result, Roche has not been able to gain broad access for the innovative drugs in some important therapeutic areas such as oncology and RA. In light of what is being done by our neighbor countries, such as in Brazil, I believe the Ecuadorian administration should implement a rolling application basis for products to be included on the national formulary list rather than claiming it can update the list every two years. In the meantime, my market access teams are doing their best to build the value of Roche’s product offering.

How would you assess the evolution of dialogue levels since Moreno’s administration has taken over the country?

[related_story]

At first, the investment in infrastructure, including in health, that the country has made in the last 10 years is impressive. However the private sector was reticent to dialoguing with authorities. The country was just coming out of period during which dialogue was very limited and many stakeholders did not know to what extent they could dialogue with the new government. Nonetheless, I would say that the situation has evolved and that a culture of dialogue between the public and private organizations is in the process of establishing itself. Collaborative projects, roundtables and discussions are regularly organized by the government to unleash the country’s potential through the development in Ecuador. It goes without saying that Roche is an active member of such initiative.

Roche is changing its global portfolio focus to include new types of diseases. How do you see this impacting your business?

Indeed, Roche is currently a global leader in oncology, with around 60 percent of its revenues coming from this therapeutic area. In Ecuador our main products currently consists of three molecules: Avastin®, Herceptin® and Mabthera®. The company is now looking at ways to strengthen its position in multiple sclerosis, hemophilia and lung cancer therapeutic areas. In line with the company’s global strategy, the Ecuadorian affiliate will be looking to launch the related range of products on the market and gain fast and broad access from them.

For sure 2018 is an exciting year for Roche Ecuador because we have the opportunity to launch 3 new products Tecentriq® (Lung Cancer), Hemlibra® (Hemophilia) and Ocrevus® (Multiple Sclerosis). The environment we are currently faced at is rather unfriendly and it is hard to predict when Roche Ecuador will have get public access for these products. In fact there seems to be a chicken and egg situation in the country: To speed up the process we need to prove the value of them for the patients and to the healthcare system, yet our products can only be successful if they have been used in the first place. By 2020, we hope to have included all of Roche’s new products in the three therapeutic lines the company is looking forward to address.

Rolf Hoenger, the general manager of Roche in Brazil recently told us that one of Roche’s main performance indicators was the number of patient treated. What is Roche’s contribution in to Ecuador in this regard?

Indeed, we use the number of patients as an internal measurement of the affiliate’s progression. However, this tool is not used in our primary-care business area (retail segment) because of the too large confidence interval. Rather, our patient-o-meter is used as a tangible element of Roche’s contribution to a country’s health environment to provide our employees with a genuine sense of purpose.

Having said this, using the patient-o-meter as an internal measurement instrument proves just how patient centric the company is and in this regard, Roche’s Ecuadorian affiliate is no exception. As a matter of fact, our Ecuadorian affiliate stands out not only from using patient numbers as a key performance indicator but additionally we track adherence because we strongly believe that for the better outcome for the patients, stay on treatment according the label is key. Roche Ecuador is finding ways to increase treatment adherence, the only way to guarantee good patient outcomes. Precisely, we have implemented partnerships with four hospitals in the country to achieve this goal. Patients of these hospitals receive friendly reminders that they need to follow up on a medical appointment and in some cases Roche even arranges for medicine to be delivered at their place of residence or for patients to be transported at the hospital to receive care. It is an example that is possible to establish alliances in a very transparent way and respecting a high level of compliance for the patient’s benefits. Given the tremendous success of these initiatives, we are looking forward to increase the number of hospitals involved in Roche’s attempt to improve treatment adherence among Ecuadorians. Additionally, Roche has also developed a personalized reimbursement model based on the ability to pay of patients.

Roche is also involved in building awareness around cancer. What have been the main motives and outcomes of the Cancer raising awareness campaign you led in collaboration with the University Sports League (LDU)?

The partnership was the result of a reflection carried out jointly by Roche and the Universidade Deportiva de Quito (LDU) to find ways in which we could improve the conditions in which breast cancers are detected and treated. As a result of this work, we developed an awareness campaign, the equivalent of the Pink October. From a one-month campaign targeted exclusively at breast cancer, we decided to extend this to all types of cancer forms, especially considering that gastric Cancer is the most prevalent form of oncologic disease in Ecuador.

Last year, our cancer awareness action reached over 200,000 Ecuadorians, and nurses delivering leaflets about the risk-increasing factors of cancers ensured the continuity with Roche’s work and commitment to the health of Ecuadorians. In fact, President Lenin Moreno personally highlighted the importance of Roche’s contribution to cancer awareness through a letter sent to all of Roche Ecuador’s collaborators. Therefore, I am looking forward transforming this initiative a long term project, across the country. Also, in my opinion, increasing the operation’s timespan, will largely effect the awareness levels of Ecuadorians vis-a-vis the cancer problem currently faced by society because we can decrease the mortality of this life threat disease if we get the early diagnostic.

How would you summarize Roche’s contribution to Ecuador?

Roche has been operating in Ecuador for the past 31 years and will be operating here for a long time. I am convinced Roche portfolio is composed of innovative products that have a genuinely positive impact on patients’ lives and that our activities are an important contribution to Ecuadorian society and economic development at large. For instance, a recent internal analysis found that for each direct employees of the company in Ecuador, there is the generation of 14 indirect employment positions within the suppliers sectors as well as induced jobs through consumption stimuli emanating from the re-spending of income.

Additionally, our structure here aims to be a ramp of success for talented Ecuadorian professionals. Taking over the position as a general manager here, I realized that people contributing to Ecuador’s operations went under Roche’s senior management’s radar. The country is smaller than others and therefore, talent promotion is not a guarantee. We took upon ourself to promote local talent at an international level and give them the opportunity to deepen their understanding of Roche’s business abroad whenever possible. As a matter of fact, we regularly support the employees, in all levels, to attend the meeting with Roche LATAM’s senior management to share the contribution of talented professionals to Roche Ecuador’s operations.

What are some of the skills that you are currently developing here for your next position?

Undeniably, the flexibility required to operate in Ecuador is an asset that can be useful anywhere around the world. Most importantly, the high levels of uncertainty one has to deal with as a general manager in the country is great for learning how to let go of things, empower those that are more experienced with these situations and progress on a personal level.