Health systems across Africa are facing a pivotal stress test, one triggered not by disease outbreaks, but by the sudden retreat of donor funding that has long underpinned essential services.
Sudden and significant reductions in donor funding from major partners such as the U.S. government and European institutions have left countries grappling with hard choices to make. Essential health programs, including those focused on HIV, malaria, tuberculosis and reproductive health, have experienced severe interruptions in service delivery.
The ripple effects have been swift and deeply felt. In our recent conversations with supply chain champions, individuals cited warehouse staffing gaps, medicine stockouts, system failures and a rise in emergency measures like patient medicine hoarding. In Mozambique, where PEPFAR accounts for over 80% of HIV prevention funding, recent freezes have resulted in documented ARV stockouts in at least eight health zones and a 45% drop in viral load testing in some provinces. In Liberia, health facilities reported medicine shortages, contraceptive stockouts and unpaid staff as the country struggled to fill gaps left by the sudden withdrawal of U.S. funding.
The sudden withdrawal of donor funding exposed the deep vulnerabilities of public health supply chains in Africa, revealing systems built on external support and vertical programs. Amid the upheaval, countries are not standing still. The wakeup call has sparked a mindset shift from dependency to resilience, as governments reimagine supply chains to be more integrated, self-reliant and sustainable. Governments across the continent are responding not with paralysis, but with innovation.
They are reimagining how public health supply chains function, not just to survive today’s disruptions, but to emerge stronger.
Fostering Collective Dialogue in a Time of Uncertainty
To facilitate cross-country learning and foster shared problem-solving, VillageReach convened a regional roundtable of supply chain leaders and government partners. The conversation brought together practitioners from Anglophone, Francophone and Lusophone countries, creating space for open reflection on how donor transitions are reshaping supply chain operations and what must come next.
What emerged was a picture that was both sobering and hopeful. While many described the initial donor cuts as a shock, they also shared early examples of adaptation, innovation and resilience.
The Consequences of a Funding Cliff
When donor-supported programs were scaled back, the consequences were swift and severe. Many countries found themselves cut off from critical infrastructure and personnel. In some cases, access to data systems used for forecasting and distribution disappeared overnight. Differentiated service delivery models that had efficiently served stable HIV patients through private pharmacies were suspended. Public health facilities, already under strain, saw sudden spikes in patient volume as care reverted to centralized systems.
The withdrawal of external funding also led to the disappearance of warehousing specialists, logistics teams and last-mile delivery contractors. This created an abrupt shock to the supply chain leading to immediate bottlenecks in storage and distribution. With little communication about commodity availability, panic spread among patients, triggering a wave of stockpiling that further strained fragile supply chains.
The Response: Doing More with Less
In the face of mounting challenges, several governments are proving that resilience is both possible and actionable. Their responses share a common thread: integration. Integration of data systems. Integration of ordering and distribution cycles. Integration of human resources. And in many cases, integration of public and private sector capacities.
In Kenya, the government acted quickly to consolidate fragmented data platforms into a new national system housed under the Kenya Medical Supplies Authority. This shift allowed for unified planning across HIV, TB, malaria and reproductive health programs, helping to reduce redundancies and improve visibility. Ordering and delivery cycles were merged to cut costs and avoid duplication, while health workers were cross trained to provide broader support across clinical and supply chain functions.
Mozambique, facing acute shortages of warehousing personnel and suspended private pharmacy-based delivery models, is advancing efforts to expand local pharmaceutical manufacturing. Though quality assurance and regulatory harmonization remain challenges, the move reflects a growing regional trend in nurturing homegrown production as a long-term solution to dependency on external commodity pipelines.
In Côte d’Ivoire, a semi-autonomous procurement and supply agency not bound by central treasury rules is enabling more agile contracting with private sector logistics providers. This has proven particularly valuable in maintaining last-mile delivery capacity during a time when flexibility and speed are more critical than ever.
These examples from Kenya, Mozambique and Côte d’Ivoire show that a strategic pivot from donor dependency toward systemic resilience is possible, challenging the notion that low-resource settings must remain reliant and instead illustrate how adaptive governance can reconfigure fragility into sustainability.
Toward a Stronger, Self-Reliant Future
Several emerging strategies that other governments and global health partners can learn from and build on include:
- System Integration: Combining vertical supply chains, data platforms and HR functions helps governments improve efficiency and reduce fragmentation.
- Digitization and Visibility: Investing in centralized, interoperable logistics management systems enables better decision-making and faster response times.
- Targeted Outsourcing: While not a one-size-fits-all solution, outsourcing select supply chain functions, particularly distribution, remains a viable strategy when done with clear oversight.
- Local Manufacturing: Strengthening regional production capacity can reduce lead times, improve emergency preparedness and generate economic co-benefits.
- Public Financing Mechanisms: Exploring how national insurance schemes can absorb commodity costs offers a pathway to long-term sustainability.
A Call for Coordinated Action
This moment demands more than reactive measures; it calls for bold, coordinated investment in systems that can withstand future shocks. As countries shift from crisis response to long-term strategy, they need more than funding; they need sustained technical partnership, policy coherence and platforms for shared learning. Donors and development partners must take cues from national priorities, supporting the institutional shifts already underway rather than imposing new, fragmented systems.
The roundtable hosted by VillageReach was the first in a series of conversations that create space for shared learning and regional coordination. What’s clear is that countries are not waiting for solutions; they are building them. But they cannot do it alone.
Now is the time to invest in approaches that outlast the present crisis. That means strengthening the architecture of public supply chains, expanding the role of private actors where appropriate and deepening country ownership across all levels. Most importantly, it means acknowledging that resilience is not built in moments of calm; it is forged in the wake of disruption.