Addressing fragmented pharmaceutical procurement in Africa and charting future directions: a narrative review

Fragmented national procurement systems weaken bargaining power, increase medicine prices, contribute to recurrent stock-outs, and deepen inequities in access to health commodities. This review aims to explore challenges of fragmented pharmaceutical procurement in Africa and assess opportunities for solidarity-based pooled procurement reforms. A narrative review methodology was employed. Peer-reviewed articles and grey literature published between 2016 and 2026 were identified through structured searches of electronic databases and institutional websites. A total of 142 records were initially identified, of which 32 articles were included in the final synthesis after screening. Evidence was synthesized thematically, focusing on pricing outcomes, supply stability, governance frameworks, regulatory harmonization, financing mechanisms, and political commitment. The review found that fragmented procurement contributes to higher medicine prices, supply instability, administrative duplication, weak market shaping, and vulnerability to external shocks. Evidence from African regional initiatives and international pooled procurement models demonstrates potential for cost reductions, improved negotiation leverage, and enhanced supply predictability. However, successful implementation depends on strong governance structures, legal alignment, predictable financing, regulatory harmonization, and sustained political will. Institutional capacity gaps and trust deficits remain significant barriers. Transitioning toward pooled procurement offers a strategic opportunity to improve pharmaceutical access and strengthen health security across Africa through coordinated reforms, reliable financing, and regional collaboration. supply stability.