The policy, economic, and health system environments in which we operate
Sub-Saharan Africa: context
Sub-Saharan Africa’s economic growth increased to an estimated 4.5% in 2025; this growth is expected to fall to 4.3% in 2026. The region’s resilience cannot be taken for granted: overlapping monetary, financial, and fiscal vulnerabilities persist across many countries.
Inflation has eased in many countries, but unevenly. Rising debt-service costs are increasingly crowding out development spending, and a shift toward domestic borrowing is strengthening the sovereign-bank nexus. Meanwhile, aid flows are under pressure, and uncertainty around future development assistance is increasing. Several lower-income economies remain highly exposed to potential reductions in external funding, which could affect the delivery of essential services.
Together, these pressures are constraining governments’ ability to invest in health systems, putting progress toward universal health coverage (UHC) at risk and disproportionately affecting the most vulnerable people. These macroeconomic pressures are evident across PharmAccess’ programs.
Impact on PharmAccess' work
The Medical Credit Fund (MCF) continues to face volatile exchange rates as local currencies weaken. However, digital lending models have proven more resilient, giving healthcare providers faster and more flexible access to short-term financing than traditional banking channels can. In addition, social health insurance schemes are under strain. Delayed reimbursements are increasing financial pressure on providers and, in some cases, making them less willing to serve insured patients.
SafeCare is also impacted, as facilities facing financial constraints may deprioritize quality improvement and certification in favor of immediate operational costs such as salaries and supplies.
Uncertainty in external funding environments further complicates this landscape, affecting partnerships and the predictability of program financing. Without stable funding and sustained investment in quality, progress toward UHC remains fragile.
Political transitions, fiscal constraints, and shifting policy priorities across our core countries make adaptability essential. Each of the country contexts shapes how health systems evolve and how PharmAccess adapts its approach.
Ghana
In Ghana, recent policy measures have focused on strengthening the financial sustainability of the National Health Insurance Scheme (NHIS), including efforts to safeguard earmarked funding streams. Against a backdrop of remarkable progress in digital transformation, Ghana’s new government officially launched the Ghana Medical Trust Fund in April 2025 to reduce financial barriers in managing non-communicable diseases (NCDs). Economically, Ghana is still navigating a period of recovery and adjustment, and despite stabilization, households and businesses still face higher costs, and rural areas are disproportionately affected.
Kenya
In Kenya, the rollout of the Social Health Authority represents a major step toward universal health coverage (UHC), but implementation challenges, including provider payment delays, have created uncertainty for both facilities and patients.
Continued pressure on Kenya’s economic performance in 2025 is attributed to the depressed purchasing power underpinning weak wholesale and retail trade. Although economic indices show a trend to improvement, the cost of doing business remains high. The government continues to prioritize UHC, but this is hampered by inadequate funding and inefficient markets. Government health initiatives are rooted in the digitalization of health facilities, and a quality-of-care bill is at the initial parliamentary readings stage.
Nigeria
Nigeria’s large population face considerable socioeconomic and health challenges. Despite the need for services, macroeconomic instability continues to undermine health system financing, and hospitals have soaring operational costs, while unemployment and ‘brain drain’ stretch resources.
However, various initiatives aim to improve access to care. A new Power and Health Compact is prioritizing energy security for the health sector, and PharmAccess is represented on the national Implementation Committee. In addition, major policy and system reforms are helping work towards the national target of 44 million Nigerians to have health insurance by 2030. Nigeria’s digital momentum is also providing new opportunities to strengthen the health system.
United Republic of Tanzania
Tanzania’s path to UHC is entering an implementation phase: on the Mainland, full compliance with the Universal Health Insurance (UHI) law is expected in 2026. Financing reforms in the 2024/25 budget have ringfenced new revenues for the Universal Health Insurance Fund (UHIF). Meanwhile, Zanzibar continues to consolidate its UHI architecture and complementary ‘visitor insurance’ alongside a pro-poor Health Equity Fund design. Across both jurisdictions, enrolling in the informal sector remains a challenge, and delivery capacity will determine whether new entitlements translate into real care in 2026. Tanzania also held national elections in 2025, which may affect the pace and direction of health sector reforms.
India
Access to institutional care has improved substantially in India, but quality of care — particularly maternal and newborn care — remains variable. Although national accreditation systems and quality improvement initiatives have contributed to strengthening standards, many facilities still require support.
Our quality improvement program SafeCare was introduced in India to address persistent gaps in the quality of care in small and medium-sized healthcare facilities. This approach supports facilities in moving toward accreditation readiness while directly contributing to improved clinical outcomes.
