Africa’s struggle to make essential medicines affordable is not simply a problem of inadequate pharmaceutical production, as a new report suggests that fragmented markets, weak procurement systems, unpredictable demand and differing regulatory requirements are making it difficult for drug manufacturers to scale supply and bring medicines to more patients.
The findings of the report by the Access to Medicine Foundation, are significant for Africa’s growing pharmaceutical market, where demand for medicines is rising at the same time as governments and investors push for greater local production.
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The report examined eight multinational and regional generic medicine manufacturers: Aspen Pharmacare, Cipla, Emzor Pharmaceutical Industries, EVA Pharma, Hikma Pharmaceuticals, Sothema, Universal Corporation and Viatris — and found that companies are already adapting their businesses to Africa’s changing healthcare needs.
However, the report suggests that manufacturers cannot solve the continent’s medicine access problem on their own.
“Companies cannot succeed in isolation. Coordinated action between stakeholders will be essential to ensuring affordable, life-saving medicines can reach patients consistently, sustainably and at scale,” Claudia Martínez, director of research at the Access to Medicine Foundation, said, during a webinar on Tuesday.
Generic medicines are central to Africa’s medicine supply because they typically offer lower-cost alternatives to branded drugs. Globally, generic manufacturers produce about 80 percent of medicines by volume, making them particularly important to countries where healthcare budgets and household incomes remain constrained.
Yet the report found that the economics of selling medicines across Africa remain difficult.
Many African pharmaceutical markets operate independently, with different regulatory requirements, procurement processes and purchasing systems. For manufacturers, this can mean producing for several small markets rather than one larger, predictable regional market.
That fragmentation can discourage companies from investing in new production capacity because manufacturers cannot always predict how much medicine will be purchased, when orders will arrive or whether products approved in one market can easily be sold in another.
The result is a paradox: Africa needs more affordable medicines, but the market conditions needed to make large-scale production commercially sustainable remain underdeveloped.
The problem is becoming more urgent as Africa’s disease burden changes.
While infectious diseases and maternal health conditions remain major concerns, non-communicable diseases such as diabetes, cardiovascular disease and cancer are becoming an increasingly important part of the continent’s healthcare burden.
The report says only about one in two people living with type 1 diabetes in Africa has reliable access to insulin, while fragmented procurement continues to restrict access to cardiovascular medicines in many countries.
Without stronger intervention, non-communicable diseases could become the leading cause of mortality in sub-Saharan Africa within the next five years.
This is creating a new pharmaceutical demand that requires manufacturers to invest in medicines for long-term and continuous treatment rather than focusing mainly on episodic treatment of infectious diseases.
Several generic manufacturers are already expanding into areas such as cardiovascular disease and diabetes while maintaining portfolios for infectious diseases and maternal health.
But the report says companies still face significant commercial and technical barriers when entering some therapeutic areas. Complex manufacturing requirements, uncertain demand and fragmented markets can make investments difficult to justify.
To manage supply risks, manufacturers are increasingly diversifying their sources of raw materials, investing in local production of active pharmaceutical ingredients where possible and pursuing long-term agreements for finished medicines.
Some are also using partnerships to transfer technology, strengthen regulatory capabilities and build local manufacturing capacity.
The shift is important because Africa’s pharmaceutical future is increasingly being framed around local production rather than continued dependence on imports.
But the report cautions that partnerships will need to go beyond simply distributing medicines or selling products. Sustainable partnerships will require technology transfer, regulatory support, investment and the development of local companies capable of expanding their own production and product portfolios.
For Nigeria, Africa’s largest pharmaceutical market and one of the continent’s major manufacturing bases, the findings point to both an opportunity and a warning.
Greater regional integration and regulatory harmonisation could allow Nigerian manufacturers to reach larger markets and make investments in production more commercially attractive.
But if manufacturers continue to face fragmented procurement and different regulatory requirements across countries, the potential scale of Nigeria’s pharmaceutical industry could remain constrained.
The report therefore shifts part of the responsibility for medicine affordability away from manufacturers alone and towards governments, regulators, procurement agencies, development finance institutions and global health organisations.
It identifies eight areas for action, including improving visibility of future medicine demand, making medicine supply more affordable and predictable, coordinating procurement, harmonising regulatory practices, reducing market fragmentation, directing capital to areas where it is most needed and cutting regulatory bottlenecks.
The underlying message is that Africa may not necessarily need to wait for a dramatic increase in the number of pharmaceutical companies before medicine access improves.
Instead, governments could make existing manufacturers more capable of investing, producing and distributing at scale by creating a more predictable market.
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Better-coordinated procurement, for instance, could give manufacturers clearer signals about future demand. Regulatory harmonisation could reduce the cost and time involved in entering multiple African markets. Longer-term purchasing commitments could give companies greater confidence to invest in new production lines.
That could ultimately create a cycle in which larger and more predictable markets attract investment, increased production improves supply, and greater competition helps put downward pressure on medicine prices.
The Access to Medicine Foundation’s findings therefore point to a deeper problem in Africa’s medicine crisis: the continent’s pharmaceutical challenge is increasingly about how the market works, not simply how many medicines are being manufactured.
As demand rises and the burden of chronic diseases accelerates, fixing that market structure could determine whether Africa converts its growing pharmaceutical manufacturing capacity into reliable, affordable access for patients.
