While countries have made progress strengthening supply chain operations, persistent challenges such as fragmented funding flows, opaque procurement processes, and weak accountability continue to undermine system performance and create access barriers. Authority over supply chain financing functions is typically split across ministries of health and finance, procurement agencies, insurance schemes, and donors with little formal coordination or accountability for results. These challenges are not technical or logistical but are inherently governance problems.
This paper draws on experience from six countries—Canada, Chile, Ethiopia, Ghana, Indonesia, and Thailand—spanning a range of income levels and health system structures, to identify five elements of effective supply chain financing governance: aligned legal, regulatory and policy frameworks; effective formal coordination mechanisms; mechanisms to ensure transparency; performance-based accountability; and adaptive learning and evidence-informed decision-making. Together, these elements help align financing, procurement, and service delivery to achieve better outcomes.
We find that consolidating funding sources and supply chain financing functions can reduce fragmentation, but consolidation alone does not guarantee better outcomes, and few countries have managed to achieve it. Countries can use the five governance elements to counter the effects of fragmentation even without merging funding streams, provided enabling conditions are in place, particularly strong public financial management and reliable payment systems. To achieve equitable access, however, supply chain financing governance improvements have to take place in the context of equitable coverage, which ultimately determines who gets access to more affordable and available medicines.
The overall finding is that every country, regardless of where it starts, can take practical steps to improve governance and better align supply chain financing. The country experiences suggest a progress pathway that may inform the sequencing of these steps. However, sustained gains in affordability, availability, and equitable access to medicines, will also require investments in public financial management, expanded and equitable coverage, and well-designed incentives for providers and patients.
