When forecast needs are not translated into adequately funded budgets, financing becomes insufficient or unpredictable. Fragmented financing then weakens purchasing power. Instead of aggregating demand and procuring predictable volumes, central medical stores may place smaller orders or resort to emergency procurement which may result in higher and more variable prices.
Cash-flow problems may deepen the spiral. Central medical stores and medicine suppliers may face delayed payments because health facilities do not have adequate and timely budget release, or the funds available to them do not cover their procurement commitments. Unpredictable demand and payment make it more difficult for medicine stores and suppliers to establish stable, longer-term relationships with manufacturers.
Eventually, these problems appear at the end of the supply-chain as stockouts and inconsistent product availability. Health facilities resort to stopgap procurement, often at higher prices. Patients may then have to purchase medicines privately or go without treatment.
This changes how we should think about supply-chain strengthening. Better warehouses, distribution networks and logistics information systems remain important, but they cannot fully solve medicine availability problems if the financing feeding the supply chain remains fragmented and unpredictable.
More predictable financing can allow countries to consolidate demand, plan larger procurements, negotiate from a stronger position and reduce reliance on emergency purchasing. Timely payment can reduce risks for suppliers. Better market intelligence can improve negotiations and price transparency. And stronger central medical stores and medicine suppliers and wholesalers can create more credible relationships with manufacturers.
Countries are beginning to connect the dots and introduce promising reforms to address the bottlenecks identified
All four countries assessed recognize these problems and are implementing sustainable solutions. Their approaches differ, but they share the same principle: remove silos and reduce fragmentation between health financing and supply-chain systems.
Ethiopia is developing a Committed Demand and Supply System that brings financing and budget officials together with supply-chain officials. Forecast requirements are considered alongside available resources, allowing gaps to be identified and priorities adjusted when the budget cannot finance the full forecast.
Ghana is increasingly using the purchasing power of the National Health Insurance Scheme, which covers approximately 60% of Ghanaians, alongside the central procurement agency and market intelligence. The aim is to connect negotiated prices through framework arrangements with the budgets and payments received by providers. Ghana's e-pharmacy platform now captures every procurement transaction in one place, so government can see prices, variability and where money is going.
Tanzania is taking steps to improve procurement-price transparency and align those prices across different parts of the system. This includes ensuring that prices and distribution costs are better reflected in budgets and payments so that facilities have sufficient purchasing power to procure through the Medical Stores Department or other approved channels.
Nigeria is advancing efforts to align medicines financing, procurement, and pricing. The MediPool initiative aims to aggregate demand and negotiate lower, standardized prices, while published National Health Insurance Agency (NHIA) medicines price lists provide reference prices for provider payment rate setting. A pilot digital consignment model in tertiary hospitals links automated ordering and verified deliveries to weekly reimbursements, demonstrating an operational approach to aligning financing flows with commodity supply. These initiatives offer a foundation for more coordinated purchasing, although systematic alignment between insurance payment rates and state Drug Management Agency procurement prices remains a priority.
Why this matters for NCDs
NCD treatment often requires continuous access to medicines over many years, so supply interruptions may compromise treatment adherence, disease control, and continuity of care. In LMICs, NCDs frequently receive less financing and have weaker data than other health priorities. Where system inefficiencies limit what existing budgets can purchase, governments may be reluctant to expand benefit commitments, and emerging priorities such as NCDs may be deferred. Economic data and investment cases may support advocacy for investing in NCD medicines by demonstrating the growing need today and how effective treatment can help prevent more expensive complications later.
Countries will need to both increase allocations to historically underfunded priorities such as NCDs and get more from the resources already available. Improving and aligning the efficiency of financing and supply-chain systems can make existing resources go further and potentially expand the range of medicines governments can sustainably finance.
Linking forecasts with budgets, improving cash flow, strengthening medicine procurement, aligning provider budgets and reimbursement with medicine prices, and connecting data systems are interventions that will benefit NCDs and other diseases. As we continue to explore and address the disadvantages faced by NCDs including NCD-specific financing and access barriers, we should strengthen systems that ultimately support a broader range of products from essential medicines to future innovative medicines.
The FAN is already beginning to address these gaps by providing catalytic funding for economic modelling for NCDs, and developing an NCD data registry to generate evidence that policymakers can use to understand the NCD burden and better advocate for more resources.
A collective opportunity for partnership between government and financing and supply chain stakeholders
Countries are increasingly being asked to take greater responsibility for financing medicines as external assistance declines. At the same time, resources available to support governments with the technical work of strengthening financing and supply chain systems are constrained.
This creates a collective action opportunity. Better forecasting, market intelligence, payment systems and data infrastructure can benefit governments, patients and the pharmaceutical market as a whole. Those benefits extend across companies, products and disease areas, which becomes a public good that will require concerted action by multiple stakeholders through platforms such as Access Accelerated, industry associations and partnerships with governments and technical organizations to support countries to build healthier pharmaceutical markets.
That support could focus on practical system capabilities including:
mapping funding flows;
linking forecasts to budgets;
identifying financing and cash-flow bottlenecks;
strengthening market and price intelligence;
improving medicine procurement capacity;
aligning provider payment with negotiated procurement prices;
connecting financing and supply-chain data;
connecting decision-makers across budget, health financing, supply-chain and clinical areas so countries can learn from one another.
Where the work goes next
Several avenues are in progress or under discussion:
Evidence generation. The assessment is informing a Gates Foundation–funded Center for Global Development working group on the interface between health financing and supply chains, with further papers forthcoming, including one on governance.
Data integration. Through a partnership with the Global Financing Facility, R4D is piloting a supply-chain data analytics module to integrate logistics data with other health information systems.
NCD-focused application through FAN. FAN regional country learning workshops could unpack these findings for NCDs and spotlight countries making progress.
As countries take greater ownership of financing their health systems, the next generation of supply-chain strengthening needs to look further upstream. Forecast demand must translate into adequate and timely funding. Medical stores need the information and purchasing power to negotiate effectively. Providers need payments that reflect the cost of the medicines they are expected to procure, and financing and supply-chain data need to come together so decision-makers can see where problems are occurring and respond.
Bringing together supply chain and health financing offers an opportunity to move beyond addressing symptoms such as medicine stockouts toward building stronger, country-owned systems that make scarce resources go further, create healthier pharmaceutical markets and improve reliable access to all essential medicines and health products.
