Putting health outcomes at the centre of procurement

As health systems face growing financial and operational pressures, procurement of medicines must be viewed as more than a transactional function. Its ultimate purpose is to support better outcomes through person-centred health systems.

The success of procurement should ultimately be judged by whether people live healthier lives because the right medicines and technologies reached the right people at the right time. Photo: Manuel Camacho-Navarro

Medicines procurement in low- and middle-income countries (LMICs) is often discussed in terms of price, efficiency, and supply continuity. These are undeniably important considerations. Governments and development partners face immense pressure to stretch constrained budgets, negotiate favourable terms (often on the basis of cost rather than value), and ensure that essential medicines reach the populations that depend upon them.

Yet procurement, however sophisticated, is not an end in itself. It is one component of a much larger health systems enterprise where the ultimate purpose is not merely the acquisition of products, but the improvement of health outcomes—whether for people who are healthy and seeking to remain so through prevention and vaccination, or for those living with illness and requiring diagnosis, treatment, and ongoing care.

This distinction of a focus on cost, versus a focus on health outcomes, matters profoundly.

Often procurement is treated as exclusively a purchasing function: a transactional exercise measured by unit costs, tender timelines, and contract compliance. Because many procured products are already well-established in clinical practice, the act of purchasing them can become viewed as routine or even automatic. However, when procurement is approached through this narrow lens, it risks becoming disconnected from the realities of care delivery and public health impact.

If procurement is treated as a purchasing function, health products may be acquired efficiently on paper while remaining unavailable at the point of care. Contracts may optimise for short-term savings while undermining long-term supply resilience. Products may be selected according to administrative or financial criteria without sufficient consideration of epidemiological need, health workforce capacity, patient adherence, or health system readiness.

Procurement processes also cannot fully account for the lived realities of patients and communities: the difficulty of travelling many hours over rough terrain to access a health facility; the cost of transport; the challenge of missing work or family responsibilities to seek care. Epidemiological analysis may estimate how many people in a district require treatment, but it cannot always predict whether those individuals are realistically able to access services. In such cases, procurement succeeds operationally while failing strategically.

If health outcomes are truly the objective—and it is reasonable to assume that they are when ministries of health rather than other government departments are responsible for procurement of medicines and health technologies—then the focus cannot rest solely on what is purchased. Equal attention must also be paid to how those medicines are delivered, accessed, and ultimately used within the health system. A test-and-learn system can provide vital feedback on impact. The rise of AI would be likely to find excellent use cases in LMICs when applied to a systems approach to purchasing, impact, and supply of medicines—assuming data can be reliably and easily collected and used to not just build forecasting models but identify gaps in care.

The challenge facing LMICs is therefore not simply how to buy affordable medicines, but how to procure medicines more intelligently within the context of integrated health systems or ones that are resource constrained. Effective procurement must be informed by disease burden, financing structures, distribution infrastructure, data quality, regulatory oversight, and the unique contextual factors of both providers and communities. In its best iteration, it must account for whether medicines can be stored appropriately, prescribed correctly, delivered reliably, accessed readily, and used safely.

It must also recognise that procurement decisions shape markets—including decisions by suppliers to participate, or not—and influence the long-term sustainability and resilience of healthcare systems. The least expensive option may not always represent the best long-term investment.

This special report arrives at an important moment. Global health systems are always in flux, but recently geopolitical instability and inflationary pressures have arisen, while inequities in access to essential medicines and technologies remain. These pressures have exposed both the fragility and the importance of procurement systems. They have also underscored that procurement cannot function effectively in isolation from the broader systems it is intended to support.

The articles and perspectives collected here challenge readers to think beyond procurement as a purely technical or administrative discipline. We hope they encourage a more practical understanding of how procurement intersects with governance, financing, supply chains, clinical practice, and population health—including the implementation and impact of universal health coverage and local health insurance schemes.

Most importantly, they remind us that the success of procurement should ultimately be judged by whether people live healthier lives because the right medicines and technologies reached the right people at the right time, and not simply by the number of commodities delivered.

For all stakeholders involved in the procurement and implementation of health decision-making, this systems perspective is not optional—it is essential. Procurement that is detached from health outcomes risks becoming an exercise in procedural efficiency rather than a mechanism for public good. Procurement that is embedded within a coherent, person-centred health system is a powerful instrument for equity, resilience, and sustainable development. And while it is likely we would all hope this is at the core of procurement, when deep in an efficiency-focused process, the impact of the person at the end of the line may be forgotten.

It is our hope that this special report contributes meaningfully to a broader conversation on the impact of procurement on person-centred health systems.

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The opinions expressed are those of the author and do not necessarily reflect the position of Re:solve Global Health.

Sean Lybrand is the head of Amgen’s Access to Healthcare unit, focusing on health systems strengthening and access in low- and middle-income countries. He has deep experience in developing multistakeholder collaborations and has established a range of important partnerships in health, including with academic centres, charities, NGOs, and national governments. Sean holds health-focused academic appointments at Macquarie University and Monash University in Australia.