How our strategic objectives drive system change 3/3
The following sections highlight how PharmAccess advanced the remaining strategic objectives in 2025.
Mobilizing investments in the health sector
Healthcare providers need capital to grow and improve the quality of care they provide. They struggle to obtain financing from banks since they are relatively small, and they have limited collateral and credit history. In addition, banks have little knowledge of the health sector, and they have difficulty assessing credit risk for these SMEs.
MCF aims to bridge this gap by providing loans and technical assistance to health SMEs to increase access to improved healthcare in Sub-Saharan Africa. MCF’s flexible loans are mostly supported by digital channels, with special attention to women entrepreneurs. The loans are combined with technical assistance to help SMEs grow and improve their quality of care.
Through the Medical Credit Fund (MCF), we expand access to credit by mobilizing investment for healthcare providers where traditional lenders are unwilling or unable to serve the sector.
More loans, women entrepreneurs and digital lending
MCF’s objective directly addresses one of the core issues in achieving PharmAccess’ goal of universal healthcare: the lack of investments in the health sector. Without capital, health SMEs cannot improve the quality of their services, expand services, or build trust with patients. This reinforces the vicious cycle of low supply, poor quality, and low demand.
By providing accessible, flexible, and increasingly digital loans combined with technical assistance, MCF enables healthcare providers to strengthen and grow their services. This improves the availability and quality of care, and consequently encourages patients to seek care earlier, and helps rebuild trust in the healthcare system. This objective thus helps in addressing the vicious cycle: better financing leads to better care, which increases demand and trust, ultimately supporting more inclusive and sustainable healthcare systems in Africa.
In 2025, MCF disbursed a record of 1,754 loans across four countries, the highest ever in a single year, contributing to a total of over 12,500 loans and more than EUR 200 million disbursed since inception. The total outstanding loan portfolio grew by 33% in 2025, reaching EUR 18 million. For the first time, 32.5% of loans went to women entrepreneurs — a new high.
In Uganda, the portfolio grew from 5 to 14 large term loans totaling EUR 5 million in 2025. And in Nigeria, MCF started a pilot with fintech partner Paga to develop a digital loan product
The biggest financial need in the sector is working capital; this accounted for 75% of the total disbursed volume in 2025. To cater for this need, MCF has developed digital loans. Digital lending automates many loan processes and requires no collateral, which makes clients’ onboarding fast and easy, making the product very attractive to especially smaller healthcare providers in more remote areas. In 2025, more than 1,700 of the disbursed loans were digital.
The majority of these (1,600 digital loans) were in Kenya. Following the transition from the National Hospital Insurance Scheme to the new Social Health Authority in Kenya, there is increased demand for short-term liquidity. Working capital provided through digital loans allows providers to bridge payment delays, pay staff, and maintain medicine stocks without requiring traditional collateral.
Building on the success of MCF’s digital loan product in Kenya, we launched a similar solution in Tanzania in 2025: Afya Mkopo. In partnership with Vodacom and with support from the Gates
Foundation, we developed a digital loan product tailored for health SMEs in Tanzania. It requires no collateral and offers simple access and repayments via M-Pesa. We disbursed over 100 loans in the first year, reaching more than 75 health businesses.
Although we had launched a similar product in Ghana in 2024, unfortunately there was limited uptake. While the mobile money usage has been on the rise in the past years, transaction charges from our fintech partner were less attractive for our clients than the mobile money solutions they were already using. This led us to pause the digital loan project and reassess our approach. However, overall, a stable macro environment led to more stability in MCFs portfolio in Ghana, where almost half of MCF’s term loans were disbursed in 2025.
In Uganda, the portfolio grew from 5 to 14 large term loans totaling EUR 5 million in 2025. And in Nigeria, MCF started a pilot with fintech partner Paga to develop a digital loan product.
A new approach to technical assistance
To reduce reliance on donor funding, MCF began moving toward a more sustainable approach in which clients increasingly contribute to the cost of technical assistance (TA) services. At the same time, SafeCare shifted to a decentralized delivery model, engaging licensed partners and external assessors to deliver services. While baseline assessments remain mandatory for borrowers with term loans and can be financed through the loan, follow-up TA is no longer centrally managed by MCF; it is now delivered through SafeCare’s partner network in a direct engagement between the TA provider and the borrower, improving scalability and cost efficiency.
In 2026, we plan to scale the digital loan product and develop new types of digital loan products in existing markets and introduce digital loans in new markets. At the same time, MCF will remain committed to TA, to strengthening the resilience and quality of care of its clients and to support clients who are not yet bankable to transition to bank financing.
These activities lead to healthcare providers strengthening and grow their services, which improves the availability and quality of care, and consequently encourages patients to seek care earlier, helping rebuild trust in the healthcare system.
“With MCF, access to funding is straightforward, with no heavy documentation, and their team arranges so much for us. Because of this support, we’ve taken over our fifth facility and continue to grow.” — Lameck O. Mokua of Westy Chemist, Kenya
Scientific evidence and advocacy
Policy reform is driven by practical evidence on what works, what is affordable, what can be implemented at scale, and what kinds of partnerships can produce results. This need is especially acute in Sub-Saharan Africa, where health systems face rising demand, constrained public budgets, and growing pressure to reduce aid dependency.
PharmAccess works to generate and translate evidence that can inform policy, improve decision-making, and create the enabling environment for stronger health financing and service delivery. This means not only conducting and supporting research, but also helping governments, insurers, providers, patient groups, and development partners use evidence to shape practical solutions.
We invest in advocacy and research by generating scientific and operational evidence, using it to shape policy, and helping partners scale successful models.
Progress on adopting and scaling digitalization
In 2025, we received important accreditation from World Health Organization Regional Office for Africa (WHO AFRO), creating new opportunities to contribute to regional digital health discussions. We also remained active in continental and global platforms, including the Africa CDC Primary Health Care Digitalization Committee, the Africa CDC Health Data Governance Working Group, and the UHC2030 Coalition. Working with Transform Health and other partners, we helped shape a regional perspective on health data governance, while continuing to build the African Digital Health Network (ADHN) to promote inclusive digital solutions.
This agenda became more urgent as concerns grew over bilateral health data arrangements between the United States and African countries, raising questions about data protection, public accountability, and sovereignty. These concerns were voiced publicly in a recent publication in Devex, where we argued that citizens’ health data should not become a bargaining chip in development cooperation.
At the country level, by 2025, the Zanzibar’s Matibabu Card had become the universal patient identifier for the health system. Recognition through the WSIS 2025 e-Health Award, received by the government of Zanzibar through the Ministry of Health in partnership with us, underscored how digital systems can strengthen patient identification, service tracking, continuity of care, and evidence-based policymaking. Ghana’s NHIA reaching finalist status in the same award process highlighted the growing visibility of digitally enabled public insurance reform.
Mobilizing local financing and resources for health
In 2025, the financing debate became more urgent. Governments were under pressure to protect access while external support became less predictable. PharmAccess used evidence and advocacy to support more sustainable and locally anchored financing options.
Ghana provided one of the clearest examples, where the government increased budget allocation to NHIS by 66% — from GH¢5.9 billion in 2024 to GH¢9.8 billion 2025. The government also introduced the Ghana Medical Trust Fund to finance chronic care. This showed a stronger shift toward domestic financing and more explicit recognition that chronic care can no longer remain peripheral to health financing reform. Research helped strengthen this agenda. In Ghana, studies identified why NCD patients are lost to follow-up and which patients are most at risk, providing a stronger basis for patient-centered chronic care pathways. Early findings also showed substantial willingness to pay for NCD care among patients in the study, helping inform future financing design.
In Nigeria, the Basic Health Care Provision Fund (BHCPF) rose from ₦125.7 billion in 2024 to ₦298.4 billion in 2025, a 137% increase, contributing to financing care for poor and vulnerable households. As a federal matching mechanism, the BHCPF supports state health budgets for poor households within health insurance schemes. Against this backdrop, PharmAccess’ advocacy for integrated funding flows remained relevant. In Kwara, Lagos and three other states, Global Fund-supported enrolment of people living with HIV into health insurance continued to demonstrate how disease-specific funding can support broader financial protection, while in Kwara, UNICEF- and UNFPA-supported capacity building helped align maternal, newborn, and child health priorities more closely with the state insurance platform.
In 2025, Zanzibar combined mandatory visitor insurance with the Zanzibar Health Services Fund to strengthen health financing, with government reporting average monthly collections of about US$1 million from visitor insurance. Through the Health Equity Fund, it also began paying health insurance premiums for poor pregnant women and people living with non-communicable diseases. In Kisumu County, public facilities continued to deliver care, but delays in implementing Kenya’s Social Health Authority (SHA) slowed the shift toward insurance-based financing. Likewise, on mainland Tanzania, delays in introducing universal health insurance stopped poor households from benefiting from government-supported coverage.
Institutionalizing quality improvement and patient-centered healthcare
Several institutional gains marked progress in 2025. PharmAccess signed an agreement with the Healthcare Federation of Ghana to advance quality improvement. In Kenya, the Ministry of Health formalized collaboration with SafeCare and we gave input for the new Quality Healthcare and Patient Safety Bill. SafeCare formalized relations with Africa CDC and is supporting the regional body’s strategy for pandemic preparedness and primary healthcare digitalization through the Primary Care Digitalization Committee.
PharmAccess also promoted stronger patient participation in policy processes. Ahead of the UN High-Level Meeting on NCDs, we supported calls for governments to integrate patient voices more deliberately into the UHC agenda and coordinated the responses of Dutch organizations and private sector for the Dutch government.
Leveraging development cooperation for investment
PharmAccess engaged Dutch and international institutions to position strengthening health systems as an investable opportunity, linking development cooperation more directly to market development. This included engagement with the G20/G7 Health Partnership and the Africa Health Ministers Forum, helping place Africa’s UHC priorities within broader debates on economic resilience and investment.
PharmAccess also worked with the Dutch embassies to connect health priorities to trade and investment opportunities, including through the Ghana Netherlands Business & Culture Council. We also contributed to Dutch-Kenyan expert meetings through Combi-track on health and the Taskforce for Health Care. Our Advocacy Director joined the World Bank Technical Advisory Group on Financing NCDs, and our CEO served on the advisory board of EPiHC, the IFC/World Bank initiative on ethical principles in healthcare.
In March 2025, Dutch Minister Reinette Klever visited PharmAccess, CarePay, and partners in Kenya to see how Dutch-backed innovations can translate development cooperation into investment and market growth. We also collaborated with Invest International and Delft Imaging to work on Kisumu County’s maternal health initiative.
Research that helps strengthen healthcare systems
In 2025, PharmAccess’ body of work strengthened the evidence base for advocacy on digital transformation, domestic resource mobilization, quality improvement, patient participation, and public-private collaboration. Throughout this report, you can read about the studies we published in 2025.
