Pooled procurement strengthening Africa’s medicine supply

Regional pooled procurement is emerging as a key response to fragmented medicine purchasing across Africa. By pooling volumes, countries can improve prices, strengthen supply reliability, and expand access to essential medicines.

Public procurement of medical supplies has long faced challenges, coming under renewed scrutiny in Zambia when Covid-19 health kits contained defective medicines. Photo: Denis Ngai

In Zambia, public procurement of medical supplies has long faced serious and persistent challenges that undermine efficiency and trust in the health system. Concerns over limited transparency, secrecy around tendering processes, bid rigging, flawed contract allocation, and, most critically, the procurement of substandard medicines and healthcare supplies have persisted for years.

These weaknesses came under renewed scrutiny during the Covid-19 pandemic, when reports indicated that standard procurement procedures were bypassed, resulting in the Ministry of Health procuring health kits containing defective medicines.

Zambia’s experience is an extreme example, but it reflects broader challenges facing many low- and middle-income countries (LMICs) in delivering affordable, high-quality medicines to their populations. Access is constrained by a web of interconnected issues: global economic systems that allow companies to dominate markets and keep prices high, limited transparency about how medicines are priced, and chronically underfunded health systems.

Regional pooled procurement—formal collaboration among regions and countries to consolidate purchases and strengthen bargaining power—of medicines and healthcare supplies is touted as a key solution to these challenges, offering the promise of reduced prices, increased availability, and more efficient and transparent procurement processes.

Emergency health products

Organisations like The Global Fund and Gavi, the Vaccine Alliance have facilitated pooled procurement across Africa for years, and during the Covid-19 pandemic many countries obtained emergency health products through these mechanisms. “During emergencies, the financing agencies buy in bulk for countries as they need the same products at the same time,” explains Lloyd Mbewe, a former procurement officer with the Zambia Medicines and Medical Supplies Agency (ZAMMSA), the country’s regulatory body.

In a landmark step designed to strengthen Africa’s health security, in 2024 Africa CDC officially launched the African Pooled Procurement Mechanism. It enables African countries to purchase essential medicines, vaccines, and diagnostics together as one market, explains Africa CDC regional director Dr Reik Lul.

“It drives down costs [by facilitating] purchase directly from manufacturers, eliminates supply gaps, and ensures faster, fairer access to essential health products,” he says. “It will also strengthen Africa’s ability to prepare for and respond to outbreaks, reduce dependence on external suppliers, and create a more stable demand base that supports local pharmaceutical manufacturing.”

The first African Pooled Procurement Mechanism tender for essential medicines for reproductive, maternal, and newborn health... achieved substantial cost savings, delivering 30–90% lower prices compared with individual country benchmarks.

Most importantly, Lul says, it shifts Africa from fragmented purchasing to collective power, building solidarity, advancing self-reliance, and laying the foundation for stronger, more resilient health systems across the continent.

This is in line with the Africa Health Security and Sovereignty Agenda, which is a plan to help the continent’s countries build stronger and more independent health systems. It aims to ensure that countries can pay for, produce, and manage their own medicines, vaccines, and health services, reducing reliance on outside support and improving their ability to respond to health emergencies.

Early results suggest the initiative may deliver significant gains. The first African Pooled Procurement Mechanism tender for essential medicines for reproductive, maternal, and newborn health, covering 10 priority products across 10 countries, achieved substantial cost savings, delivering 30–90% lower prices compared with individual country benchmarks, along with improved supply security and half of products involving African manufacturers, according to Africa CDC.

It builds on earlier successes like the work of the East African Community to improve coordination of medicine procurement across Burundi, Kenya, Rwanda, Tanzania, and Uganda through the African Medicines Regulatory Harmonisation Initiative.

Through this system, which ran from 2012–17, countries jointly purchased essential medicines instead of buying separately. A common technical document reduced average drug approval time from 24 to 12 months. Member states also agreed on a common market approach that included a non-discrimination clause for public procurement and provided technical assistance to local manufacturers with the view to increasing their output.

Regional pooled procurement can reduce the risk of stockouts, especially in smaller countries with limited order volumes. Photo: Tima Miroshnichenko

Regional pooled procurement can also reduce the risk of stockouts, particularly in smaller countries where limited order volumes make suppliers less willing to engage. During the pandemic, small markets like Zambia were able to secure PPE, diagnostics, and vaccines through the Africa Medical Supplies Platform, established under the African Union and Afreximbank, which they may have struggled to procure independently.

Navigating approvals and financing

Despite their obvious appeal, regional pooled procurement mechanisms are rarely a simple, uniform, one-size-fits-all solution. Before countries can pool their buying power, they need a shared workaround as each country requires its own medicine approval process—especially when countries have legislation that only allows them to buy medicine that is registered specifically in their country.

This creates a problem when countries want to pool their resources to buy medicines together, but have separate approval processes and may require medicines to be registered nationally before they can be procured, explains Andy Gray, senior lecturer in the School of Health Sciences at the University of KwaZulu-Natal.

“To support regional procurement, countries may need to revise these rules and accept trusted approvals, such as World Health Organization (WHO) prequalification or approvals from recognised regulators, to ensure medicines are safe, effective, and can be purchased across borders,” he explains.

South Africa is a telling example of a country where national procurement law is restrictive. The public sector relies on national tendering, which requires that any product offered on tender is registered by South African Health Products Regulatory Authority (SAHPRA). While South African law does not prohibit pooled procurement, tenders are generally restricted to medicines registered in South Africa.

Nonetheless, South Africa participates in regional and cross-border efforts to procure and distribute medicines, vaccines, and other health commodities, particularly through the Southern African region and continental African initiatives.

“Pooled procurement should increase buying power, but only if the funds are guaranteed and flow as promised.”

Another significant challenge to regional pooled procurement relates to the availability of funding. For pooled procurement to work, suppliers must trust that the mechanism can reliably purchase products and meet contractual obligations—which depends on stable and sustainable financing. As many LMICs move from dependence on donor funding to greater reliance on domestic financing, the reliability of those funding streams will come under greater scrutiny.

“Pooled procurement should increase buying power, but only if the funds are guaranteed and flow as promised,” Gray emphasises. “Pooled procurement relies, to a great extent, on the promise of predictable and sustainable funding. Many LMICs are, unfortunately, not in a position to fulfil that promise.”

UNICEF procurement specialist Margaret Doyle agrees that regional pooling can increase purchasing volumes, enabling lower unit prices, better negotiation power, and reduced transaction costs. “However, [pooled procurement] is not universally superior,” she says. “Effectiveness depends on governance capacity, product type, and market maturity.”

Doyle notes that regional pooled procurement is most effective when countries are buying expensive, standardised products such as vaccines or oxygen systems, “when demand can be combined and predicted accurately” and “strong governance and oversight systems are in place”.

National approach works best

Indeed, there are cases where national procurement performs better than regional pooled procurement, and it is crucial that countries assess which model is best suited to their market size, purchasing needs, and health system capacity.

When the needs are urgent or small-scale, national systems can often procure medicines, vaccines, and equipment more quickly and efficiently as regional systems often involve longer coordination processes. National systems are also often better aligned to country-specific disease burdens and epidemiological trends and variations in health facility consumption patterns.

Nutritional commodities often require national-level pipeline management due to seasonal spikes in malnutrition and localised emergencies. Photo: Lagos Food Bank

For example, nutritional commodities such as Ready-to-Use Therapeutic Food— a nutrient-dense paste for severely malnourished children—often require national-level pipeline management due to seasonal spikes in malnutrition and localised emergencies.

At the same time, regional pooled procurement can face operational and political constraints. Misalignment among member states, delays in financial contributions, and weak enforcement of agreements can undermine its effectiveness.

“The bottom line is regional procurement does not universally outperform national systems, but it significantly enhances efficiency, cost savings, and access when applied strategically.”

Doyle says pooled procurement initiatives within the Economic Community of West African States, for example, have faced difficulties when some countries failed to meet their commitments, leading to fragmentation within the pooled system. “Countries began buying separately, supplier confidence declined, and the expected savings and efficiencies were reduced,” she explains.

Heavy reliance on regional pooled procurement can also reduce national capacity development by undermining domestic systems and limiting the growth of local supply chain capacity. “The bottom line is regional procurement does not universally outperform national systems, but it significantly enhances efficiency, cost savings, and access when applied strategically,” Doyle says.

Working with a hybrid model

Doyle encourages a hybrid model: regional pooling for high-value, standardised commodities like vaccines, antiretrovirals, and oxygen systems, and national procurement for routine essential supplies, emergency procurement, and last-mile responsiveness. “If I were to have a motto, it would be: ‘Regional where scale matters, national where context matters,” Doyle says.

Examples of this hybrid method are found in South Africa, which mainly buys supplies through its own national procurement system and uses regional price comparisons to help negotiate better prices.

Uganda has participated in regional and cross-border pooled procurement initiatives through the East African Community and other regional health supply collaborations, but most medicine procurement has continued to be conducted nationally through the National Medical Stores while the East African Community pooled procurement mechanism is under phased development.

This is reflected in the country’s national model effectively procuring crucial drugs for cancer. The Uganda Cancer Institute successfully pushed for direct procurement of cancer medicines and products, introducing a more efficient and cost-effective procurement system by negotiating directly with manufacturers for lower prices. As a result, the availability of essential cancer medicines increased from 28.5% to 85%, despite operating under the same limited budget, exceeding the World Health Organization (WHO) target of 80%.

“Almost all essential cancer medicines are now available throughout the year, with minimal interruptions in treatment. It’s really a success story that we can help replicate in other countries,” says director Dr Jackson Orem.

A hybrid model for procurement balances regional and national approaches. Photo: Ron Lach

Like many countries in the region, Zambia has not fully institutionalised a standalone regional pooled procurement system, but it actively participates in cross-border pooled procurement mechanisms through The Global Fund, UNDP, and US-supported supply chains alongside ZAMMSA.

With donor support fading and the push for self-reliance gaining momentum, Mbewe says formal regional pooled procurement mechanisms will become increasingly important. “Regional and cross-border pooled procurement is not just about lowering costs; it is about strengthening collective bargaining power, improving access to essential medicines, and building resilient health systems that no country can achieve alone,” he notes.