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Improving the Financing of Supply Chains

March 26, 2025

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Supply chains are crucial to the performance of all health services and to achieving universal health coverage policy objectives. However, in many countries, the financing of health supply chains can be slow, unpredictable, fragmented, inflexible, dependent on donors and inefficient. As a result, many people suffer from limited and unreliable access to essential medicines and diagnostics: for example, only between 8 and 41 percent of health facilities in various low- and lower-middle-income countries had a core set of relevant essential medicines available and affordable on a sustainable basis in the decade up to 2019. And a study of low- and middle-income countries found that stockout levels of health centres increased from 7.79 percent in the period from 2006 to 2015 to 14.28 percent from 2016 to 2021.

When medicines are not available in the public sector, and not covered by pooled public finance, patient care is interrupted, and their health suffers. This often results in high out-of-pocket expenditure. Globally, one billion people spend at least 10 percent of their family budget on healthcare—and in Africa alone out-of-pocket payments push 150 million people into or deeper into poverty. The financing of supply chains is therefore a vital determinant of five health system objectives: health impact, financial protection, responsiveness, efficiency, and equity.

In response, the Center for Global Development (CGD) convened a working group to bring together experts and policymakers from the health financing and supply chain fields to identify and address the most pressing issues stemming from poor supply chain financing. This two-year working group will produce independent analysis and research on the vital intersection between health financing and supply chain policy, including country case studies. This will lead to policy recommendations at the national, regional, and global levels, including on best practice and investment strategies for relevant global agencies and major donors such as the World Health Organization, World Bank, Gavi, and the Global Fund. It will culminate in the production of a novel conceptual framework that integrates insights and secures buy-in from both disciplines. This will enable better health system reforms, resulting in more reliable and better financed access to primary healthcare and essential commodities in low- and middle-income countries.

Published work

Working group members:

  • Pete Baker, Center for Global Development (chair)
  • Jatu Abdulai, National Medical Supplies Agency, Sierra Leone
  • Ravi Anupindi, University of Michigan
  • Jennifer Asman, UNICEF
  • Mamessile Assih, Togo Central Purchasing Agency for Essential and Generic Medicines
  • Iain Barton, Health4Development
  • Rachel Bonnifield, Center for Global Development
  • Cheryl Cashin, Results for Development
  • Michael Chaitkin, Gates Foundation
  • Kalipso Chalkidou, World Health Organization
  • Yasmin Chandani, InSupply
  • Abdulkadir Gelgelo, Ethiopian Pharmaceutical Supply Service
  • Javier Guzman, Inter-American Development Bank
  • Harimat Hendarwan, Indonesia National Research and Innovation Agency
  • Philipp E. Kalpaxis, Asian Development Bank
  • Edward Llewellyn, Global Financing Facility
  • Boniface Mbuthia, Amref Health Africa
  • Marasi Mwencha, Global Fund
  • Mila Nepomnyashchiy, Independent consultant
  • Anooj Pattnaik, Health Systems Insight
  • Manuj Purwar, Uttar Pradesh Technical Support Unit
  • Nirmala Ravishankar, Gates Foundation
  • Adolfo Rubinstein, Institute of Clinical Effectiveness and Health Policy
  • Prashant Yadav, Council on Foreign Relations

Research staff

Katherine Klemperer, Center for Global Development

With thanks to Africa Resource Centre for their contributions in 2025.

Topics

Global Health