How our strategic objectives drive system change 1/3
In 2025, PharmAccess and its partners worked across all five fronts: expanding health insurance, strengthening care quality, piloting patient-controlled data models, mobilizing investment for health SMEs, and building the evidence base to inform policy. The sections below show what that looked like on the ground.
The following pages continue with the remaining strategic objectives.
Demand-side financing
Across Sub-Saharan Africa, out-of-pocket spending continues to expose millions of households to financial hardship and delayed care. In 2025, this challenge was sharpened by inflation, rising demand for chronic care, and reductions in external aid.
Growing access to health insurance and other pooled financing mechanisms is therefore essential for protecting households, improving equity, and strengthening resilience. PharmAccess and its partners help governments and private-sector actors build more affordable, transparent, and inclusive financing systems.
We support demand-side financing through digital health financing solutions, including health insurance and other pooled financing mechanisms, that reduce out-of-pocket spending and improve financial protection.
Expanding financial protection through health financing and insurance
Our work in 2025 concentrated on domestic resource mobilization, continued expansion of health insurance coverage, stronger alignment between disease-specific financing and broader universal health coverage (UHC) goals, and growing use of digital tools to improve insurance administration and accountability.
Bringing innovation to public insurance systems
In 2025, we continued to support the strengthening of social health insurance systems by helping governments and partners improve implementation, affordability, and operational effectiveness. This included technical assistance on scheme design, provider engagement, informal-sector enrolment, operational systems, and pathways for covering poor and vulnerable populations. Across countries, attention increasingly shifted from piloting isolated solutions to embedding them within public systems.
Ghana: stronger public insurance and new financing for chronic care
Ghana remains one of Africa’s best examples of public health insurance at scale. In 2025, the National Health Insurance Authority (NHIA) continued to position the National Health Insurance Scheme (NHIS) as a central platform for UHC expansion, alongside new efforts on free primary healthcare and financing for chronic and specialized care. This reinforced Ghana’s position as a country where health insurance is a core instrument for organizing and financing the health system.
NHIA reported active membership figures ranging from 18.5 million to just over 22 million during the year, indicating continued expansion. NHIA’s own analytics also highlighted persistent gaps in coverage, with women aged 60 and above among the best-covered groups, while men aged 18 to 59 remained less likely to be enrolled.
PharmAccess collaborated with NHIA on data analytics and how value-based care to inform national payment reform. To strengthen this foundation, NHIA established a Data Analytics Directorate to analyze utilization patterns and improve operational performance and patient care. Evidence from the ground is driving this shift: a remote monitoring program across 11 facilities improved blood pressure control from 39% to 60% within one year. PharmAccess and NHIA are now building on this result to develop payment mechanism for digital health consultations, translating clinical outcomes into a sustainable financing model. These efforts sit within the broader domestic financing reform agenda, with public financing discussions linking NHIS funding more explicitly to claims, medicines, and free primary healthcare, and the Ghana Medical Trust Fund for channeling resources toward chronic and specialized care.
Tanzania and Zanzibar: institutional health insurance reform
Zanzibar has demonstrated meaningful operational progress since launching health insurance in 2023. Within the last two years, approximately 21% of population has been enrolled. This growth is underpinned by strong identification infrastructure — 90% of the population holds a digital patient ID, with linkage to insurance enrollment creating a credible pathway to supporting scaling. However, coverage gains have been limited among poor and vulnerable groups due to limited awareness of how the insurance system works and fiscal constraints on the government.
To address this gap, PharmAccess’ MomCare and NCD approaches helped identify and enroll poor pregnant women and people living with non-communicable diseases into health insurance, with premiums financed by government, thus extending coverage to vulnerable groups.
In mainland Tanzania, progress remained limited in 2025, with greater emphasis on institutional and legislative alignment rather than on large-scale implementation. Enrollment in Tanzania’s health insurance scheme for informal workers — Improved Community Health Fund (iCHF) — fell sharply, from 1.6 million people in 2024 to 507,450 in 2025, as the government began transitioning toward a new national insurance scheme designed to cover all Tanzanians regardless of income status.
PharmAccess continued to provide technical support on affordable pathways for informal households. This included finalizing a report with Tanzania’s NIMR and the President’s Office that analyzed iCHF data to inform the design of the universal health insurance benefit package. Although major implementation breakthroughs were limited, these efforts remained important in laying the groundwork for a more coherent and sustainable UHC system.
Nigeria: deepening state health insurance implementation
In Nigeria, PharmAccess continued to support state health insurance implementation, with a strong focus on the informal sector. In 2025, efforts centered on expanding coverage, strengthening administration, and reinforcing the institutional systems needed to make schemes more effective. The National Health Insurance Authority reported that total lives covered in Nigeria rose to 21.7 million, up from 19.0 million in 2024.
In Lagos State, 2025 saw expansion in coverage and access to care health insurance coverage, which reached about 2.6 million people. Lagos State Health Management Agency (LASHMA) enrolled 1.4 million residents, while private health insurers (HMOs) covered an additional 1.2 million people. Despite this, limited subsidy for poor and vulnerable populations remains a major constraint to wider inclusion.
Provider engagement was a major focus for PharmAccess in 2025. LASHMA brought together more than 800 providers and stakeholders, helping strengthen the capacity of providers across the scheme. PharmAccess also advised Lagos State on the use of its digital portal to monitor private health insurer activities. Lagos continued to expand outreach beyond salaried groups. They used cooperative and community-based approaches to reach traders, artisans, and other informal-sector groups, while the state government moved to mandate enrollment for all public sector workers, backed by an Executive Order requiring all Lagos residents and workers to hold valid health insurance.
In Kwara, PharmAccess trained healthcare providers and the state health insurance agency in provider accreditation, data quality and reporting, and health management information systems. The focus was on consolidating the state health insurance scheme and strengthening institutional ownership. By year-end, enrolment had reached 100,940 — up nearly 58% from almost 64,000 in 2024 — driven entirely by the informal sector and financed primarily through domestic resources.
A major milestone was the Kwara State Government signing a memorandum of understanding with labor unions (including Nigerian Labour Congress and Trade Union Congress) to enroll all state workers into the state health insurance scheme. This formalized shared responsibilities and addressed earlier resistance to payroll-based enrolment.
Kwara also strengthened implementation by building provider capacity on digital tools for healthcare management. PharmAccess, working alongside UNICEF and UNFPA, further advised on integrating MNCH protocols into the insured provider network, bringing maternal, newborn, and child health services into the structured care pathway for enrolled populations. Despite these advances, coverage remains constrained in villages where access to quality healthcare is still limited.
Kenya: from transition to implementation
In 2025, Kenya moved from a turbulent transition to implementation of the new Social Health Authority (SHA). Around 23.3 million people were registered, though this figure reflects registrations rather than active health insurance users. Implementation remains constrained by major challenges, including government arrears to healthcare providers for services already delivered.
PharmAccess remained active in Kenya, especially in Kisumu County. Working with the Ministry of Health, PharmAccess and Delft Imaging supported service delivery improvements and strengthened digital health capacity in healthcare facilities. It also advanced safer maternal care through AI-enabled ultrasound and a digital maternity journey, while promoting SafeCare as a practical mechanism for integrating quality improvement into social health insurance.
Through its investment in CarePay, PharmAccess supports a digital platform connecting insurers, providers, and members — accelerating claims, improving transparency, and expanding access to quality care. In 2025, CarePay added two new insurer
clients in Kenya and, working with AAR, launched five new corporate and retail insurance products targeting underserved segments. One of these products is Project Uhuru — a Jubilee Health product enabling affordable cover via USSD, accessible through short codes without internet or a smartphone.
PharmAccess and CarePay's collaboration demonstrated that embedding coverage in existing financial and operational systems drives uptake more than standalone retail products. Building on this insight, CarePay enrolled 6,150 boda boda riders and informal taxi drivers by linking insurance to daily transactions and employment arrangements. The model has been extended to farmers and salaried staff.
The three-way collaboration between PharmAccess, CarePay, and AAR is advancing a data cooperative — a shared infrastructure that returns data ownership to patients, strengthens data sovereignty, and shifts care from being reactive to patient-centered.
Read an interview with AAR.
Strengthening quality of care delivery
More than 5 million people die in low- and middle-income countries every year because of poor quality of care — even more than the 3.6 million people who die due to a lack of access to care. Without quality care, universal health coverage (UHC) remains an empty promise.
We improve quality of care through SafeCare and related tools that make quality measurable, visible, and improvable for providers, payers, and governments.
SafeCare, because quality saves lives
By introducing SafeCare quality standards, healthcare facilities can create transparency, improve patient safety, increase efficiency, and build trust in the healthcare system. Transparency on quality and quality improvement can increase trust between all stakeholders across the sector and consequently increase public and private investments.
Our progress is enabled by three key drivers: the Quality Platform, strong partnerships, and a business-oriented mindset. Together, these elements drive scale, unlock new opportunities for growth, and ensure that more patients can access the safe, quality care they deserve.
Operating in a challenging financial context
2025 did not start well. In the first quarter, USAID programs in Zambia and Rwanda — both of which SafeCare supported — were abruptly terminated, together with global declining of donor funding. At the same time, demand for SafeCare increased among partners in new countries. In response, we expanded our geographic footprint by opening the SafeCare South & Southeast Asia office in Delhi.
Introducing Patient Journey Ratings
The increasing availability of data, driven by the wider adoption of health management information systems (HMIS) and more sophisticated claims tracking, has created an opportunity to strengthen SafeCare’s methodology: it is now possible to rate and measure the actual care patients receive. SafeCare is now moving towards a continuous, data-driven, outcome-based model for quality certification.
Patient Journey Ratings offer more granular insights into quality of care and whether that care led to improved outcomes. Did the mother’s journey end with a healthy baby and a safe recovery? Or did it end in postpartum hemorrhage, maternal or neonatal sepsis, birth asphyxia, or death? Journey Ratings make those outcomes visible and accountable, and they create pragmatic approaches towards improvement.
Implementing Patient Journey Ratings builds on the MomCare approach, using data to improve quality of care and create transparency for patients, providers, and payers.
Using data from facility HMIS, claims systems, and patient-reported outcome measures (PROMs), Patient Journey Ratings incorporate information like number of ANC visits, early ultrasound, and in-hospital delivery to assess the care pathways patients experience within health facilities. They provide a detailed, patient-centered view and actionable rating of the quality of care delivery, helping drive better, more complete and cost-effective care. Journey performance is incorporated into the quality improvement processes, concrete actions, and tailored recommendations, such as how to implement guidelines for post-partum hemorrhage or implement partograph monitoring for patients.
In 2025, we took our first concrete steps: Journey Ratings for maternity care were piloted across three facilities in Kenya. Providers worked directly with the tool and shared feedback. Their feedback also affirmed that facility teams are genuinely motivated to understand and improve the care they deliver, especially when seeing the direct impact better quality has on their patients.
As one of the key aims is to drive better, more cost-effective care, it is essential to connect providers and payers and equip them with the insights needed to actively improve quality of care. During testing of the rating tool and facility visits, this became very tangible. At one facility, a provider reflected on the ultrasound metric, noting that only a small number of mothers completed the recommended scans. He explained that many women are unable to follow through on these services due to cost constraints.
For this reason, we will further strengthen the Journey Rating to connect quality performance to financing, enabling demand-side incentives in partnership with insurance companies.
Progress in our core countries
In Ghana, SafeCare made strong progress in national scaling. The Christian Health Association of Ghana (CHAG) became the first network of faith-based facilities to make a financial commitment to quality improvement: in 2025, 45% of CHAG healthcare facilities paid for SafeCare services. As well as marking an important milestone toward sustainable institutionalization, this sets a compelling example for other countries. In the CHAG network, 250 assessments were conducted — 83% with an improved score and 67% achieving a higher level — and 54 new assessors were certified, bringing the total to 71.
SafeCare also initiated a strategic partnership with the Ghana Health Service. Following a successful pilot involving 134 facilities, a Memorandum of Understanding (MoU) was signed to support institutionalization and nationwide scale-up.
In Kenya, we continued to build our partnership with the Ministry of Health, providing technical feedback on the new Quality of Care Bill, which aims at linking quality directly to insurer empanelment. This would be a big step towards embedding quality in the healthcare ecosystem and a stimulus for wide focus on quality measurement and improvement. Additionally, we are designing a collaboration that brings together SafeCare and the Kenya Quality Model for Health (KQMH) in a strong, aligned quality approach. We strengthened healthcare quality systems and services, notably in Kisumu, where 307 self-assessments in 2025 provided the Ministry of Health with insights for informed decision-making.
In Nigeria, we signed a Memorandum of Understanding (MoU) with the National Tertiary Health Institutions Committee to implement SafeCare standards in 48 federal tertiary hospitals. SafeCare has been fully embedded in the primary healthcare system in Gombe State, covering all 114 public PHCs and strengthening routine quality improvement through existing government structures.
SafeCare is also a core technical partner to the National Health Insurance Authority (NHIA), supporting Nigeria’s largest strategic health purchaser to improve quality across its network of over 7,000 providers through staff training and the digitalization of accreditation and quality assurance tools. In 2025, assessments were done in 6,240 facilities.
“As the Federal Ministry of Health, we’re focused on enhancing access to quality healthcare for all Nigerians. We appreciate PharmAccess and SafeCare for their collaboration in support of the government’s own direction.” — Prof. Muhammad Ali Pate, Federal Ministry of Health Nigeria.
In Zanzibar, Tanzania, we worked with the government to reinforce the UHC model by consolidating centers of excellence, promoting peer learning, and driving system-wide quality improvement, while collaborating with partners to better use data and resources. On the mainland, we strengthened collaboration with the Private Hospitals Advisory Board to embed quality standards in the regulatory ecosystem and support the growth of self-paying facilities.
In India, the independent SafeCare entity for South and Southeast Asia was launched in April 2025, and the first SafeCare facilities were certified. An exploratory assessment was conducted for expansion into Nepal and Bangladesh in line with a growth model. We continued work to strengthen the Manyata for Mothers ecosystem: a quality improvement and certification initiative provided by the National Federation of Obstetric and Gynecological Societies of India (FOGSI). To improve maternal and newborn health, 841 assessments (501 Manyata assessment and 340 self-assessment) were conducted. We have also reached 47 facilities with onsite entry assessment in collaboration with the Consortium of Accredited Health Organisation (CAHO).
Expanding global partnerships
Since its inception, SafeCare has been active in 27 countries, working with 40 partners at more than 13,000 clinics; together, we reached more than 16 million patients in 2025. Almost two-thirds (62%) of the healthcare organizations that had a follow-up onsite assessment improved their quality scores in 2025, meaning millions more people are receiving safer, better care.
By building on the impact and experience gained in our core countries, we are well-positioned to expand our reach and deepen our effectiveness. We established several new partnerships in 2025. With Kampala Pharmaceutical Industry Ltd (KPI), we implemented SafeCare in 40 facilities in Kenya, Tanzania, Uganda, Pakistan, Afghanistan, and Syria — a new SafeCare country. We also worked with the Burundi Healthcare Federation at 29 facilities in Burundi. SafeCare has officially launched in Ethiopia in partnership with ABH partners, Ethiopia Healthcare Federation, and the Ministry of Health. The first facility in Somalia received a SafeCare certification, the assessment resulted in SafeCare Level 2.
Additionally, collaborating with key global stakeholders is a critical element of how we drive change and sustain momentum. By jointly advocating for focus on quality and continuing to innovate, we are able to make broader meaningful impact. A key consortium developed this year is our joint approach with the IFRC and the WHO for quality improvement in emergency settings, through which we will develop and implement a strategy in Somalia, Afghanistan and Sudan from 2026 on funding provided by the Postcode Loterij. Together with the IFC, we conducted a geospatial analysis linking the resilience of SafeCare facilities to weather-related risks, combining complementary data sources to better target investments in healthcare infrastructure. Building on this, we are working with Google to combine data sets and capabilities with our quality insights, developing predictive models that help healthcare providers prioritize where to act first.
At a global level, we contributed to the continent-wide PHC digital strategy by sharing our learnings on digitalization and quality mapping through an expert panel at Africa CDC. Through the Future of Hospitals and Health Systems (FHHS) initiative, a consortium led by the Geneva Sustainability Centre with AFD, AKDN and the Climate Action Accelerator, we served on the advisory board, drawing on our experience implementing SafeCare's green standards in low-resource settings to help translate data and insights into actionable guidance for healthcare providers on the path to more sustainable operations.
The Quality Platform: real-time, interactive, actionable data
The Quality Platform enables healthcare facilities to work on quality improvement digitally. Healthcare workers at participating organizations can use the Quality Platform for quality improvement. They get real-time information on their progress, as well as benchmarking data on other facilities’ performance to stimulate positive competition. To enhance contact moments, our chat function and push messages support frontline staff with direct feedback from our trained quality improvement advisors. Additionally, we are exploring how we can use AI to become smarter with more efficient and effective support. We are therefore piloting AI-enabled targeted messaging to our staff in the private sector in Kenya, with personalized messages to help facilities improve their quality faster.
In 2025, usage continued to increase to over 8,000 healthcare staff across 1,900 facilities using the platform, compared to 6,000 at 1,400 facilities in 2024. Users downloaded more than 70,000 guiding documents from the SafeCare library compared to 60,000 in 2024 and 14,000 in its inception year (2010).
Focus on critical aspects of quality care
In 2025, our capacity building was focused on quality processes that have the biggest direct impact on patient safety. One of these is infection prevention control, as mortality after infection is 22%.
To assess progress over time, we analyzed the 623 facilities that underwent an on-site assessment in 2025 and had previously completed at least one on-site assessment. For each facility, the first-ever on-site assessment was used as the baseline and the 2025 assessment served as the follow-up (endline).
Progress is shown in the table, which includes examples of performance improvement for standards that are labeled as critical and connected to the topic Infection, Prevention and Control (IPC).
Med4All: strengthening Ghana’s access to quality medicines
Healthcare providers in Ghana continue to face systemic barriers to reliable care: substandard medicines, fragmented procurement, and limited supply chain visibility drive up costs, cause stockouts, and ultimately impact patient outcomes, particularly in underserved communities. Med4All was built to change this, connecting healthcare providers with vetted suppliers through a digital procurement platform that leverages pooled demand to improve both affordability and quality.
An embedded financing mechanism launched in 2025 gives CHAG facilities access to affordable working capital. We saw a 39% reduction in medicine costs compared to open market prices, and 100% compliance with quality and regulatory standards. The number of health facilities served increased from 40 to 84 in 2025. Med4All delivered 14 million units of medicines totaling US$1 million in transactions, at a fulfilment rate of 83%.
However, these gains did not come without difficulty. Scaling the platform proved more complex than anticipated, with provider resistance to new procurement habits, liquidity
constraints, supplier-side market dynamics, and macroeconomic instability, creating headwinds various points. The transition from a donor-supported program to a sustainable social enterprise also demanded longer timelines and more adaptive thinking than originally planned.
The experience yielded important lessons. Behavior change in procurement is inseparable from financial feasibility; even motivated providers cannot adopt new models without accessible, structured financing. Adoption also depends far more on trust and alignment with facility cash flows than on price alone.
Acting on these insights, together with CHAG and financing partners we introduced more provider-friendly financing terms.
With over 1.5 million patients reached to date, Med4All stands at an inflection point, operationally stronger, institutionally better anchored, as a building block for growth.