Can market shaping improve medicine access across Africa?

More affordable medicines do not always lead to better access. As donor funding becomes less certain and the burden of non-communicable diseases continues to rise, African countries are exploring whether market shaping can create more reliable medicine supply.

Many African countries are shifting to a market shaping approach to make medical supply markets more predictable, affordable, and sustainable. Photo: Ninthgrid

In theory, a successful procurement deal ends with lower prices. In practice, however, that is often where the uncertainty starts.

For years, global health campaigns have focused on one overriding goal: lowering the price of medicines and vaccines for low- and middle-income countries (LMICs). But across much of Africa today, the bigger challenge often begins after a deal has already been signed.

Medicines still fail to reach patients consistently because procurement systems remain fragmented, financing is unstable, demand forecasts are weak, and supply chains continue to break down. In many countries, governments are also confronting a new reality: the donor-backed health financing systems that shaped global access are becoming far less certain.

That pressure is especially visible in the fight against non-communicable diseases (NCDs) such as cancer, diabetes, and hypertension, which now account for a growing share of illness and death across LMICs. Yet despite the rising burden, NCDs continue to receive only a small fraction of global health financing.

As a result, attention in many African countries is increasingly shifting beyond price reduction alone to “market shaping”—strategies designed to make medicine markets more predictable, affordable, and sustainable. The idea is that influencing how markets function can improve access to medicines and other healthcare products for the patients who need them most.

A holistic view to access

Healthcare markets in LMICs can be unpredictable and companies can be wary of investing in developing or manufacturing products for them. Supporters of market shaping argue that if governments and partners can better coordinate financing, demand, and procurement, suppliers gain confidence to provide medicines at lower and more stable prices. But experts say access depends on far more than negotiating cheaper products.

“Procurement is not just about buying medicines; it’s about making supply and demand work together.”

“The whole concept of market shaping is really taking a holistic view to access. If any one of these steps is broken, then access does not occur,” explains Herb Riband, executive director of Access Accelerated. “Procurement is not just about buying medicines; it’s about making supply and demand work together.”

That challenge is becoming more urgent as African governments face growing pressure to finance larger portions of their own health systems while also responding to rising chronic disease burdens, health workforce shortages, and continued dependence on imported medicines and vaccines.

At the same time, African health leaders are pushing for greater influence over the global systems that shape access itself. Gerald Herbert Manthalu, head of division, public financial management, and Lusaka agenda at Africa CDC, explains that the African Union has established a high-level council aimed at reforming the global health financing architecture and strengthening Africa’s role in decision making around affordability and access to medicines.

“One of the key objectives of this process is to make sure there is equity in terms of how Africa is represented, not just in health financing conversations, but also in the governance of the global health architecture,” he notes.

Market shaping in action

The concept of market shaping first gained prominence in the global response to infectious diseases such as HIV, tuberculosis, and malaria, where large-scale donor financing helped drive down the cost of medicines and vaccines through coordinated purchasing and long-term supplier agreements. Over time, those approaches helped transform access to lifesaving products that had once been prohibitively expensive for many LMICs.

Today, similar strategies are increasingly being applied to NCDs, even as experts acknowledge the challenges are far more complex. At its core, market shaping attempts to make medicine markets more predictable. Governments, donors, procurement agencies, and manufacturers work together to align demand, financing, and supply in ways that encourage lower prices, stable production, and wider access.

“There’s been a tendency historically to focus on one or two pieces of the access puzzle. Perhaps lowering prices, procurement, or regulation alone. But access fails if any one of the steps breaks down.”

Market shaping can involve pooled procurement systems that combine purchasing power across programmes or countries, volume guarantees that give manufacturers confidence to lower prices, advance commitments for future purchases, or blended financing mechanisms that combine public, donor, and private-sector funding.

Experts involved in these efforts say one of the biggest misconceptions is that affordability alone solves access problems. “There’s been a tendency historically to focus on one or two pieces of the access puzzle,” Riband says. “Perhaps lowering prices, procurement, or regulation alone. But access fails if any one of the steps breaks down.”

Background discussions with experts at Clinton Health Access Initiative (CHAI) highlighted how many market-shaping efforts now focus as heavily on procurement systems, forecasting, and supply chains as on negotiating lower prices themselves. In practice, medicine shortages often stem not only from cost, but also from fragmented purchasing systems, weak demand forecasting, inconsistent financing, and difficulties coordinating suppliers—challenges that are often amplified in decentralised and uneven health systems. Suppliers facing uncertain demand, delayed payments, or fragmented procurement systems may also struggle to maintain stable pricing and supply.

The complexity is one reason why many recent initiatives have shifted toward more holistic approaches to access, linking pricing negotiations with regulatory support, procurement reform, supply-chain strengthening, and long-term financing planning.

Governments and global health organisations must rethink whether existing procurement and financing models are sustainable in the long term. Photo: RDNE Stock

Riband says one example is the Cancer Access Partnership, a collaboration involving CHAI and the American Cancer Society that worked across multiple African countries to improve access to cancer medicines through coordinated supplier agreements and market-shaping strategies. But while the initiative demonstrated how structured partnerships could improve pricing and availability, it was later discontinued after funding constraints emerged.

That uncertainty is now forcing governments and global health organisations to rethink whether existing procurement and financing models are sustainable in the long term, particularly for chronic diseases that require continuous treatment and follow-up rather than one-time interventions.

Lower prices not enough

Experts familiar with procurement efforts in Nigeria describe recurring challenges around coordination, forecasting, and continuity of medicine supply, particularly for chronic diseases that require uninterrupted treatment over long periods. Even where medicines become more affordable through supplier negotiations or market-shaping arrangements, maintaining stable access can prove difficult when health systems face funding interruptions, workforce shortages, or weak distribution systems.

In Ghana, Health Minister Kwabena Mintah Akandoh says governments are facing difficult trade-offs between financing medicines, building infrastructure, recruiting health workers, and expanding emergency preparedness systems.

“You can’t leave any of these behind,” Akandoh explains, outlining pressures ranging from hospital construction and workforce recruitment to digitisation and ambulance systems. Ghana, he says, has increasingly looked to private-sector partnerships to help sustain investments in infrastructure and equipment while freeing government resources for other priorities.

In Africa, most medicines, therapeutics, vaccines, and diagnostics are imported. Photo: Cpkhanal

At the same time, public health experts warn that sustaining access to medicines for chronic diseases requires more than procurement reform alone. Unlike vaccination campaigns or short-term treatment programmes, conditions such as diabetes, hypertension, and cancer require continuous diagnosis, monitoring, and long-term follow-up.

Dr Mohamed Janabi, World Health Organization (WHO) regional director for Africa, notes that managing NCDs depends on prevention, early detection, and long-term treatment adherence—all of which place additional pressure on already stretched health systems. “Our continent is still struggling with access to affordable medicines,” Janabi says. “Almost 90% of medicines, therapeutics, and diagnostics are imported.”

Shaping the market from within

As global health financing becomes more uncertain, African health leaders are increasingly questioning whether existing procurement and financing systems give countries enough control over the medicines and vaccines they depend on. With countries expected to assume greater responsibility for their own health systems, conversations are shifting toward questions of sustainability, negotiating power, and regional manufacturing capacity.

“One of the key objectives of this process is to make sure there is equity in terms of how Africa is represented, not just in health financing conversations, but also in the governance of the global health architecture.”

At the centre of those discussions is a broader push by African institutions to reshape how the continent participates in global health financing and procurement decisions. “One of the key objectives of this process is to make sure there is equity in terms of how Africa is represented, not just in health financing conversations, but also in the governance of the global health architecture,” Manthalu says.

Part of that strategy involves reducing dependence on imported medical products to improve supply security, strengthen negotiating power, and make access to medicines and vaccines more resilient during global disruptions. According to WHO African Region, Africa still imports roughly 90% of its medicines and nearly all of its vaccines, a dependence that became especially visible during the Covid-19 pandemic, when many countries struggled to secure timely access to vaccines and other supplies.

Manthalu says Africa CDC is working with partners including the European Union on a blended financing mechanism intended to support African pharmaceutical manufacturing. The organisation is also collaborating with Gavi, the Vaccine Alliance, on a vaccine manufacturing accelerator aimed at expanding local production capacity.

Sustaining access over time

Even among experts who strongly support market-shaping approaches, there is growing recognition that the next phase of global health access will depend less on short-term pricing gains and more on whether countries can sustain health systems capable of delivering medicines consistently over time.

For many African countries, the transition is already underway. Donor-funded programmes that once absorbed large portions of procurement and treatment costs are becoming less predictable, forcing governments to make difficult decisions about what they can realistically finance themselves.

Stronger regional manufacturing capacity is one of the approaches set to shape the future of medicine access in Africa beyond traditional donor-led procurement models. Photo: Proudly Swazi

At the same time, experts say the future of access will likely depend on a broader mix of approaches than traditional donor-led procurement models alone. Those may include blended financing arrangements, expanded private-sector participation, digital forecasting tools, stronger regional manufacturing capacity, and procurement systems designed to create more stable long-term markets.

Riband argues that no single financing mechanism will be sufficient on its own, particularly for NCDs. Instead, he says, countries will likely need combinations of domestic financing sources, multilateral support, insurance models, and innovative financing tools adapted to local realities.

Technology may also increasingly shape how procurement systems evolve. Health organisations are already exploring whether AI-driven forecasting and digital procurement tools could help countries better predict demand, reduce stockouts, and improve supply-chain coordination.

But experts caution that such tools are only as effective as the systems and data supporting them. “There’s a huge gap between the growing burden of NCDs and the minimal resources that get allocated to addressing them,” Riband says.

Still, he argues that the current disruptions in global health financing could also create an opportunity to rethink how access systems are built. “We just need to continue to show the art of what’s possible,” Riband says. “There are challenges, but it would be a tragedy if we got into a doom-and-gloom mindset that we really can’t make progress.”