Access to essential medicines and other health products is fundamental to achieving Universal Health Coverage (UHC) and improving population health. But recent shifts in global financing — including the reduction of donor support — have exposed the fragility of many domestic systems, resulting in stockpiling, shortages, and inequitable access to life-saving commodities.

Results for Development’s (R4D) recent analytic work revealed that these challenges stem not only from insufficient funding, but from deep systemic disconnects. Without addressing these underlying system weaknesses, simply allocating more funds or trying to ringfence funds with budget lines will not ensure that essential medicines reach those who need them.

Ensuring sustainable, equitable access to essential health commodities requires governments to act across multiple, interconnected domains. They must:

• Set priorities for which services and products to fund
• Forecast needs based on population health and demand
• Shape markets to ensure high quality products are available at affordable prices
• Allocate resources effectively within budgets
• Align payment and pricing systems so that financial flows support reliable supply
• Ensure funds flow smoothly through financing arrangements to reach product suppliers and health care providers
• Procure and distribute products efficiently to the point of care

When any one of these links breaks down, it can cause cascading effects across the system — resulting in stockouts, inefficiencies, and high out-of-pocket costs.

R4D’s Integrated Approach: Bridging Health Financing, Market Shaping and Supply Chain

R4D has long been a leader in both health financing and market shaping, two fields that have often evolved separately. Recognizing the need for a new, integrated perspective, R4D has brought these areas together to understand how their interactions and linkages to supply chains can make or break access to essential commodities.

This intersectional approach was at the heart of R4D’s multi-country rapid assessment, conducted in Ethiopia, Ghana, Nigeria and Tanzania with support from the Gates Foundation. The assessments mapped the critical connections between health financing, market shaping, and supply chain functions and policies — and highlighted where critical misalignments lead to inefficiencies and gaps that undermine access, but also where there are promising practices that can be built on and shared.

Four country-specific briefs, one overview brief and a full report, can be found below:

• Overview Brief — Building Integrated Systems for Financing Essential Medicines and Other Health Products: From Silos to Systems (4 Pages)
• Full Report — A mapping of domestic systems for financing essential medicines and other health products (33 Pages)
• Ethiopia Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (16 Pages)
• Ghana Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (15 Pages)
• Nigeria Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (17 Pages)
• Tanzania Brief — Opportunities to align supply chain, market shaping and health financing functions and policies (16 Pages)

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At Results for Development (R4D), Jeremiah is a senior program associate in the Market Shaping Practice where he provides both technical and programmatic support on the Improving Access to RMNCAH-N Procurement and Distribution Channel (Access PDC) project, as well as the Maternal and Child Wasting (MCW) and Multiple Micronutrient Supplement (MMS) projects to identify and address bottlenecks in scaling up access to reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH-N) commodities in Nigeria and other low- and middle-income countries.

Throughout his career, Jeremiah has focused on contributing to improving access to essential health commodities at service delivery channels through trainings and supportive supervision of pharmacy focal staff across primary and secondary health facilities. He also contributed to developing training materials and supported in revising the 2023 Sokoto state essential medicines list. At R4D he contributed to analyzing states’ nutrition commodity procurement data which informed key messages on financing nutrition commodities in Nigeria.

Before joining R4D, Jeremiah worked with The Palladium Group as a facility management and logistics advisor on the USAID-Integrated Health Project where he supported over 220+ primary health care facilities in improving facility and financial management of the Basic Health Care Provision Fund, and accountability of the Drug Revolving Fund for sustainable access to essential health commodities in Sokoto State, Nigeria. He also worked with the Society for Family Health in north-central Nigeria as a demand creation representative where he contributed to scaling-up access to reproductive health commodities.

Jeremiah holds a bachelor’s degree in pharmacy from the University of Nigeria and is pursuing a master’s in public health at Ahmadu Bello University. He speaks fluent English, Igbo and Hausa languages.

Publications

• In Vivo Investigation of the Aqueous Methanol Extracts of Leaves of Millettia aboensis (Hook. F.) Baker (Fabaceae) for Anti-Inflammatory Potentials: doi.org/10.26538/tjnpr/v5i9.6 | Tropical Journal of Natural Product Research (TJNPR)

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The major global health agencies — including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) — have put sustainability at the forefront of their strategies and investment policies, with sustainability referring to the maintenance of national responses to major health threats as donor funding declines or ends. While each global health agency has its own definition of sustainability for its programs and its sustainability planning, the dialogue on sustainability at the country level should be grounded in a systemwide view of domestic health financing and service delivery.

This guide provides suggested approaches and analytical tools for implementing the Global Fund’s Sustainability, Transition and Co-Financing (STC) Policy in High Impact Africa countries. It is meant to support structured dialogue to inform policy decisions that can help sustain progress on programs that address HIV/AIDS, tuberculosis and malaria as donor funding declines or ends, given the context of a country’s health financing system and reform plans.

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Prior to joining R4D, Ms. Gowda spent nearly nine years working at PATH International in both Washington, D.C. and Johannesburg, South Africa. During her time with PATH’s Market Dynamics program, she made significant contributions to projects across sexual and reproductive health, cervical cancer, malaria, diabetes, diagnostics, medical devices, product innovation, and human-centered design. She also worked for the Clinton Health Access Initiative in Ethiopia and Lesotho, leading an array of HIV and TB projects and working closely with the respective Ministries of Health. She began her career in health care consulting at Huron Consulting Group in Chicago, Illinois.

Throughout her career, Ms. Gowda has focused on expanding access to health commodities to individuals living in emerging markets. Her achievements include supporting successful product introductions, such as a self-injectable contraceptive method (DMPA-SC), an innovative bundle for diabetes commodities, a highly sensitive rapid diagnostic test aimed at malaria elimination, maternal health diagnostics and medical devices, and a micronutrient surveillance tool. She costed DMPA-SC introduction and scale-up plans for seven countries, and the implementation of these strategic plans played a critical role in shaping the market health and sustainability for this contraceptive method. She presented the methodology and lessons learned associated with this work at the 2022 International Conference for Family Planning.

In her role as the lead facilitator for the DMPA-SC Donor Consortium, Ms. Gowda drove consensus among five global donors (BMGF, CIFF, FCDO, UNFPA, USAID) to develop a roadmap to achieve market sustainability for the contraceptive.

More recently, Ms. Gowda oversaw efforts related to supply security and local manufacturing of diagnostics, primarily in sub-Saharan Africa. Her work helped to expand relationships with new development finance institutions, impact investors and donors.

Recognized for her leadership, Ms. Gowda was selected to be a member of the 2022 North America cohort in the WomenLift Health’s Leadership Journey, an initiative designed to support women through the challenges and opportunities of advancing to senior leadership positions in global health. She holds a Master of Science in Public Health from Johns Hopkins Bloomberg School of Public Health and a Bachelor of Business Administration from the University of Michigan’s Ross School of Business.

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Mu’azu is a senior program officer in R4D’s Market Shaping practice where he provides strategic and programmatic leadership in managing market shaping projects in Nigeria. He leads in transforming markets for maternal, newborn and child health medicines and devices, by identifying underlying market challenges and opportunities to create advocacy and market-shaping roadmaps to introduce and scale-up lifesaving commodities for the health and wellbeing of women and children. Mu’azu further manages both new and existing key internal and external partnerships at the national and sub-national levels.

Before joining R4D, Mu’azu worked with and managed Global Funds- and USAID-funded projects strengthening primary health care systems and establishing durable community partnerships for the reduction of maternal newborn and child mortality in Nigeria by addressing barriers to access and use of health care services through social and behavior change. He previously contributed to the introduction and the scale-up of chlorhexidine (a low dose antiseptic) to prevent newborn death by preventing umbilical cord infection, and misoprostol for the prevention of postpartum hemorrhage in Nigeria.

He currently served on the advisory board of Lafiya Nigeria, and had previously served in the same capacity at Family Empowerment Media (FEM).

Mu’azu holds an MPA in development practice from Columbia University, a master’s degree in international studies and a bachelor’s degree in history from Usmanu Dan Fodio University Sokoto. He speaks English and Hausa fluently and is currently learning Arabic and French. 

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Monte is a senior fellow at Results for Development (R4D), where he supports market development and mixed health systems initiatives aimed at increasing access to products and services in public and private sectors. He contributes to quality of technical inputs, strategy development, partner and donor liaison, thought leadership and programmatic design efforts.

Prior to R4D, Monte was chief of party for USAID Transform WASH at Population Services International (PSI) Ethiopia, where he led market development efforts that resulted in sales by business partners of more than 70,000 sanitation products and services to household customers across the country. He also served as country representative for PSI in Pakistan and Kenya and deputy regional representative in Central America, as HIV and marketing technical advisor in Cambodia, and as country director for Equal Access International in Cambodia. His background spans multiple health areas including HIV, family planning and reproductive health, water and sanitation, maternal and child health, malaria, TB and cervical cancer. In other experience, Monte worked as a media producer for Spark Media in Washington, DC, as vice president of international programs at Alight (formerly the American Refugee Committee), and as a senior program officer for the National Democratic Institute where he managed democratic development programs in Nepal, Haiti and West Africa.

Monte holds two master’s degrees, one in international economics and development from the Johns Hopkins University’s School of Advanced International Studies (SAIS) and a second in communications (film & video) from American University, both in Washington, DC. He also earned a BA in journalism and French from the University of Wisconsin – Madison. He speaks English and is also proficient in French, Spanish and Nepali.

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John is a senior program officer at R4D in Abuja, Nigeria, where he plays an integral role in technical and project management aspects of The Bill & Melinda Gates Foundation (BMGF)-funded health financing technical assistance project. He supports the technical assistance efforts to the Government of Nigeria on health care financing policy development and implementation at the federal and state levels by engaging key stakeholders in joint policy dialogue, generating evidence to inform health financing design options, and helping to develop implementation “know-how” to support the roll-out of health financing reforms at the state level towards the attainment of universal health coverage.

Throughout his career in public health, John has focused on working with stakeholders and co-creating evidence-based solutions towards addressing complex health issues. He supported the convening of a national dialogue to address critical human resources for health production gaps for primary health care (PHC) service delivery focusing on pre-service health training institutions and other high-level national and state forums. He has also written abstract papers presented at international conferences.

Before joining R4D, John had worked in various USAID and GFATM Health Systems Strengthening and technical assistance projects where he supported a landscape assessment and political economy analysis leading to implementation of public sector governance and budgetary reforms for improved delivery of PHC services at the sub-national level. He led the development of novel LGA oversight plans, domestication of state budget manual to the LGA level, development of operational and domestic resource mobilization plans, private sector engagement strategy document, development of Akwa Ibom Human Resource for Health Strategic Plan, and capacity building of health care providers across various public health programs including HIV/AIDS and malaria.

John previously supported the conceptualization, design, pilot, and implementation of Community-based Health Insurance Scheme in Akwa Ibom state as a key step towards PHC systems strengthening, improved financial protection, access, and coverage for the poor and vulnerable groups in the state. He led efforts at strengthening downstream supply-and demand-side interventions to improve access to the subsidized WHO-prequalified ACTs for the treatment of malaria working with private facilities under the GFATM’s private sector co-payment mechanism which significantly led to crowding out of monotherapies for treatment of malaria in Nigeria.

John is a graduate member of the Nigerian Institute of Management. He holds a Master of Science degree in Public Health with a specialization in Health Systems, Policy and Management from the University of Nigeria, Nsukka; an MPH in Public Health from Federal University of Technology Owerri and a Bachelor of Science degree in Microbiology from Nnamdi Azikiwe University, Awka. He also holds a postgraduate diploma in Global Health Procurement and Supply Chain Management from Empower School of Health, India. He is fluent in English and Ibo languages.

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