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 high quality products are available at affordable 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 Ethiopia, Ghana, 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)
• Full Report — A mapping of domestic systems for financing essential medicines and other health products (33 Pages)
• Ethiopia Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (16 Pages)
• Ghana Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (15 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)

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Nyassatu currently serves as a senior program officer in Results for Development’s Market Shaping practice. In this role, she supports the management and implementation of projects, development of qualitative and quantitative analytics and fostering key partnerships with donor agencies and public and private stakeholders. Nyassatu supports projects that leverage market shaping and health financing approaches to help increase equitable access to products and services for women and girls.

She holds a doctor of medicine degree from Catholic University of Health and Allied Sciences (CUHAS) and she is currently pursuing her master’s degree in health informatics at the University of Dar-es Salaam.

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The major global health agencies — including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) — have put sustainability at the forefront of their strategies and investment policies, with sustainability referring to the maintenance of national responses to major health threats as donor funding declines or ends. While each global health agency has its own definition of sustainability for its programs and its sustainability planning, the dialogue on sustainability at the country level should be grounded in a systemwide view of domestic health financing and service delivery.

This guide provides suggested approaches and analytical tools for implementing the Global Fund’s Sustainability, Transition and Co-Financing (STC) Policy in High Impact Africa countries. It is meant to support structured dialogue to inform policy decisions that can help sustain progress on programs that address HIV/AIDS, tuberculosis and malaria as donor funding declines or ends, given the context of a country’s health financing system and reform plans.

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Fozia is a program officer and market shaping specialist at Results for Development (R4D). She is deeply engaged in phase two of the Ethiopia Market Shaping Capacity Improvement Program (EMSCIP) providing vital support to the EPSS. In this role, she is responsible for a range of critical supply chain functions including institutionalizing the market-shaping strategy, conducting market analysis, developing forecasting and supplier assessment tools, and mentoring/coaching EPSS personnel to implement these strategies effectively. Alongside this work, Fozia also engaged in the first phase of EMSCIP collaborating with Ethiopia’s Ministry of Health and delivering emergency supply chain training, developing a supply chain emergency guideline document, distribution protocols for pharmaceuticals and medical devices, donation protocols and working on the revitalization of the national emergency task force.

Fozia served as the Chief of Staff at the Ethiopian Pharmaceutical Supply Agency (EPSA) Director General Office. During her tenure, she played a pivotal role in supporting the Director General’s office, utilizing her exceptional organizational skills and leadership abilities to ensure smooth operations and effective decision-making.

She also served as the HIV/TB & Malaria Quantification and Market Shaping Team Leader at the EPSA. In this capacity, she demonstrated her expertise in quantification and market-shaping strategies for HIV, TB, and Malaria programs, contributing to efficient product availability and distribution.

Throughout her career, Fozia has held various positions at EPSA, including Warehouse Management & Inventory Management Officer III, Transit Officer I, Procurement Officer III, and Medical Equipment Surveillance Officer III. These roles have provided her with comprehensive knowledge and hands-on experience in supply chain management and pharmaceutical operations.

Fozia holds a master’s degree in logistics and supply chain management from Addis Ababa University and a bachelor’s degree in pharmacy.

Additional Resources

Analysis of laboratory logistics management information system for HIV/AIDS commodities in selected public health facilities in Ethiopia, Addis Ababa University, School of Commerce 2019

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Ms. Harris is a senior program officer in R4D’s Market Shaping practice where she provides programmatic and technical leadership for projects working to increase access to maternal and child wasting products, including multiple micronutrient supplementation.

Prior to joining R4D, Ms. Harris led a portfolio of projects introducing new and underutilized contraceptive methods in LMICs. Most notably, she supported the USAID-funded Expanding Effective Contraceptive Options (EECO) project, active in 10 countries in sub-Saharan Africa, South Asia and East Asia. In this role, Danielle contributed to thought leadership around the introduction of contraceptive and multi-purpose prevention technologies, product registration and women’s contraceptive preferences, resulting in several peer-reviewed publications and widely disseminated resources.

Earlier in her career, Ms. Harris managed multiple behavioral HIV research projects in South Africa focused on the intersection between HIV, alcohol use and gender roles. She also served as the project director for two randomized controlled trials engaging youth living with or at-risk of HIV in Los Angeles as part of the Adolescent Medicine Trials Network for HIV/AIDS.

Ms. Harris holds an MPH focused on community health and an MA in African Studies from the University of California, Los Angeles. She also holds a BA in International Studies and Spanish with a minor in African Studies from Virginia Tech. Danielle has intermediate proficiency in Spanish, working toward fluency.

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Prior to joining R4D, Ms. Gowda spent nearly nine years working at PATH International in both Washington, D.C. and Johannesburg, South Africa. During her time with PATH’s Market Dynamics program, she made significant contributions to projects across sexual and reproductive health, cervical cancer, malaria, diabetes, diagnostics, medical devices, product innovation, and human-centered design. She also worked for the Clinton Health Access Initiative in Ethiopia and Lesotho, leading an array of HIV and TB projects and working closely with the respective Ministries of Health. She began her career in health care consulting at Huron Consulting Group in Chicago, Illinois.

Throughout her career, Ms. Gowda has focused on expanding access to health commodities to individuals living in emerging markets. Her achievements include supporting successful product introductions, such as a self-injectable contraceptive method (DMPA-SC), an innovative bundle for diabetes commodities, a highly sensitive rapid diagnostic test aimed at malaria elimination, maternal health diagnostics and medical devices, and a micronutrient surveillance tool. She costed DMPA-SC introduction and scale-up plans for seven countries, and the implementation of these strategic plans played a critical role in shaping the market health and sustainability for this contraceptive method. She presented the methodology and lessons learned associated with this work at the 2022 International Conference for Family Planning.

In her role as the lead facilitator for the DMPA-SC Donor Consortium, Ms. Gowda drove consensus among five global donors (BMGF, CIFF, FCDO, UNFPA, USAID) to develop a roadmap to achieve market sustainability for the contraceptive.

More recently, Ms. Gowda oversaw efforts related to supply security and local manufacturing of diagnostics, primarily in sub-Saharan Africa. Her work helped to expand relationships with new development finance institutions, impact investors and donors.

Recognized for her leadership, Ms. Gowda was selected to be a member of the 2022 North America cohort in the WomenLift Health’s Leadership Journey, an initiative designed to support women through the challenges and opportunities of advancing to senior leadership positions in global health. She holds a Master of Science in Public Health from Johns Hopkins Bloomberg School of Public Health and a Bachelor of Business Administration from the University of Michigan’s Ross School of Business.

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