African governments, regional institutions and international partners have agreed on a 10-year plan to overhaul how essential medicines and health technologies are financed, produced and delivered across the continent, as persistent shortages, high prices and heavy dependence on donor funding continue to undermine access to basic healthcare.
The agreement emerged from a high-level meeting of policymakers and health system experts held in Johannesburg in late November 2025, where participants set out a regional roadmap aimed at building more reliable, affordable and self-sustaining supply chains for the African Region.
The outcome of the meeting is the foundation of a Regional Strategy on Market Shaping and Supply Chain for Essential Health Products covering the period from 2025 to 2035. The strategy seeks to address long-standing weaknesses in Africa’s health product markets, where fragmented procurement systems, weak local manufacturing capacity and donor-driven funding models have left many countries vulnerable to supply disruptions and price volatility.
According to WHO data cited during the meeting, only about 35 percent of essential medicines are consistently available in public health facilities across the region, a gap that continues to undermine basic healthcare delivery.
The human cost of these system failures is reflected in how healthcare is financed in many African countries. Out-of-pocket payments account for as much as 90 percent of total health spending in some settings, exposing households to catastrophic health expenses.
In countries such as Malawi, external aid contributes up to 65 percent of overall health expenditure, leaving national health systems exposed to sudden shifts in donor priorities or funding cycles.
A recent WHO assessment found that 56 percent of African countries are currently experiencing shortages of essential health products, including vaccines, tuberculosis treatments, medicines for neglected tropical diseases and supplies for noncommunicable diseases. In some cases, stock-outs have forced health facilities to temporarily suspend services.
The new regional roadmap is intended to reduce these vulnerabilities by encouraging a more coordinated and self-reliant approach. Central to the strategy is a push for local and regional manufacturing of medicines and health technologies, supported by pooled procurement mechanisms that can aggregate demand across countries.
Policymakers argue that larger, more predictable markets would lower unit costs and make investment in local production more viable. During the COVID-19 pandemic, weaknesses in Africa’s supply chains became starkly visible, with at least 38 countries submitting urgent requests for emergency medical supplies as global competition intensified and export restrictions tightened.
The strategy also seeks to align health product markets with broader continental initiatives. It builds on the mandate of the African Medicines Agency, which is expected to play a growing role in regulatory harmonisation, and leverages the African Continental Free Trade Area to reduce tariffs and non-tariff barriers on locally manufactured health products. By easing cross-border trade, officials hope to encourage regional specialisation and reduce dependence on imports from outside the continent.
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Financing is another core pillar of the roadmap. Participants discussed ways to shift away from predominantly donor-funded models by strengthening domestic resource mobilization and exploring alternative instruments such as debt-for-health swaps and impact investment platforms focused on health outcomes. Current aid flows remain heavily skewed toward a small number of diseases.
Data presented at the workshop showed that roughly one-third of all health aid to Africa is directed toward HIV and sexually transmitted infections, with about 14 percent allocated to malaria, while less than 1 percent supports the prevention and treatment of noncommunicable diseases, despite their growing burden.
The Johannesburg meeting was described by WHO officials as an opportunity to rethink entrenched approaches. Dr Adelheid Werimo Onyango, Director for Health Systems and Services at the WHO Regional Office for Africa, said the discussions were about building systems that can deliver medicines reliably and affordably, rather than reacting to crises through emergency procurement. Participants examined governance reforms, digital supply chain tools, waste management systems and emergency preparedness measures, drawing on lessons from recent shocks.
International partners signalled support for the initiative. The European Union, which has been involved in health system strengthening across Africa, said the strategy aligns with its commitment to equitable access to essential medicines and resilient supply chains.
Once finalized, the 2025–2035 roadmap is expected to serve as a reference framework for governments, regional bodies and financiers, shaping investments and policy choices over the next decade as Africa seeks to secure more stable access to life-saving health products.
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