Why financing, market shaping, and supply chains must come together to secure sustainable access in low-and middle-income countries
Access to essential medicines and other health products is fundamental to achieving Universal Health Coverage (UHC) and improving population health. But recent shifts in global financing — including the reduction of donor support — have exposed the fragility of many domestic systems, resulting in stockpiling, shortages, and inequitable access to life-saving commodities.
Results for Development’s (R4D) recent analytic work revealed that these challenges stem not only from insufficient funding, but from deep systemic disconnects. Without addressing these underlying system weaknesses, simply allocating more funds or trying to ringfence funds with budget lines will not ensure that essential medicines reach those who need them.
Ensuring sustainable, equitable access to essential health commodities requires governments to act across multiple, interconnected domains. They must:
- Set priorities for which services and products to fund
- Forecast needs based on population health and demand
- Shape markets to ensure quality products are available at fair prices
- Allocate resources effectively within budgets
- Align payment and pricing systems so that financial flows support reliable supply
- Ensure funds flow smoothly through financing arrangements to reach product suppliers and health care providers
- Procure and distribute products efficiently to the point of care
When any one of these links breaks down, it can cause cascading effects across the system — resulting in stockouts, inefficiencies, and high out-of-pocket costs.
R4D’s Integrated Approach: Bridging Health Financing, Market Shaping and Supply Chain
R4D has long been a leader in both health financing and market shaping, two fields that have often evolved separately. Recognizing the need for a new, integrated perspective, R4D has brought these areas together to understand how their interactions and linkages to supply chains can make or break access to essential commodities.
This intersectional approach was at the heart of R4D’s multi-country rapid assessment, conducted in Ghana, Ethiopia, Nigeria, and Tanzania with support from the Gates Foundation. The assessments mapped the critical connections between health financing, market shaping, and supply chain functions and policies — and highlighted where critical misalignments lead to inefficiencies and gaps that undermine access, but also where there are promising practices that can be built on and shared.
Four country-specific briefs, one overview brief and a full report, can be found below:
- Overview Brief — Building Integrated Systems for Financing Essential Medicines and Other Health Products: From Silos to Systems (4 Pages)
- Summary Report — A mapping of domestic systems for financing essential medicines and other health products (33 Pages)
- Ghana Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (15 Pages)
- Ethiopia Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (16 Pages)
- Nigeria Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (17 Pages)
- Tanzania Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (16 Pages)
