After Aid: The Commercial Architecture That African Public Health Actually Needs

Abstract: The retreat of donor-funded global health programs is not a temporary crisis but a structural shift with permanent implications for how essential health products reach low- and middle-income populations in Africa. This paper argues that the appropriate response is not to rebuild the aid model on its former terms but to establish the commercial market infrastructure that has always been missing: independent market intelligence, commercially sustainable access programs, and better-integrated procurement and financing mechanisms. We propose a three-part framework — create new entities where the market has failed and retrofitting is structurally impossible; consolidate and evolve existing actors where raw materials already exist; leave certain functions to governments and advocates where commercial solutions are inappropriate.

The paper concludes with an argument for urgency: the governance and market design decisions being made now will determine whether Africa builds self-sustaining health markets or simply replaces one dependency with another

Full text coming soon.