Fixing the health last mile: A short-term win for long-term impact

Africa continues to carry a disproportionately large share of the world’s disease burden, accounting for nearly 95% of global malaria cases and two-thirds (66%) of all people living with HIV. This pattern holds across many other endemic conditions, a burden continually made heavier by health systems that are often fragmented, underfunded, or lacking the staffing and technical capacity needed to function reliably. Governments and health agencies recognise these challenges and are working diligently to change this trajectory, doing all they can to improve access to essential health products, invest in local manufacturing, and strengthen systems for the long term. The Africa Centres for Disease Control and Prevention (Africa CDC), for instance, has set an ambitious goal to achieve 60% vaccine self-sufficiency by 2040, a target echoed by other regional partners. But while those long-term ambitions take shape, there’s a more immediate step that could make a tangible difference today: fixing last-mile delivery. 

The fragmentation in last-mile delivery has been a longstanding weak link, often at the expense of already scarce resources. The ongoing Mpox outbreak has made this painfully clear. Just between September and October of 2025, more than 2,000 new cases have emerged across Congo, Liberia, Kenya, and Ghana alone, further adding to the devastating total of over 34,800 cases reported in the past year. While limited vaccine supply played a significant role—Africa was projected to receive only about 10% of required doses by the end of 2024—it was compounded by logistical challenges that impacted those who needed them most. Vaccines are to be transported under strict cold-chain conditions, maintained at temperatures as low as –130°F until administration. In the Democratic Republic of the Congo, for example, deliveries to vulnerable communities were delayed due to logistical bottlenecks, rendering many vaccines unusable by the time they reached the final mile of delivery.

This story is not unique to Mpox. Across the continent, audits and assessments have repeatedly highlighted the same obstacles: procurement delays, weak transport networks, and chronic stock-outs. In Uganda, most health facilities reported running out of essential medicines at least once within six months. In Ethiopia, transport management scored poorly in humanitarian logistics reviews, with delays and weak infrastructure identified as major barriers. The Africa CDC also notes that fragmented logistics and limited access to real-time data continue to slow the delivery of essential health products. 

What makes this even more disheartening is that much of what’s needed to fix the problem already exists. Africa has skilled logistics providers: cold-chain specialists, third- and fourth-party logistics operators, regional transporters, and a growing network of tech-driven startups using real-time tracking to prevent shortages. The talent and the technology are on the continent, yet the problem persists. From years of working on solutions for these deadly diseases, it is apparent that the real challenge here is the coordination of all available resources. The available logistics providers often operate in isolation, unseen by the governments, NGOs, and manufacturers that need them most. As a result, contracts frequently and repeatedly go to a handful of international firms, while capable local providers, who have more knowledge of the lay of the land, remain underused in large numbers. This massively drives up costs and, more dangerously, causes delivery delays.

In mature markets, a simple online search can surface dozens of qualified logistics partners. In much of Africa, however, the case is not the same. Additionally, no centralised directory of logistics providers exists—or didn’t, until recently. Thankfully, the launch of the Logistics Marketplace begins to change that. Funded by the Global Fund in partnership with the Gates Foundation, it is a first-of-its-kind Global Good platform that centralises logistics providers and streamlines procurement for health delivery. Governments, global health partners, humanitarian agencies, and manufacturers/distributors can now find, assess, and engage capable providers with greater efficiency, and it’s free for qualified users.

The launch of this platform marks a revolutionary step, a practical solution that begins to stitch together a fragmented landscape. But its true power lies in what it can enable. Technology and infrastructure are only as effective as the systems that connect and sustain them. To truly solve Africa’s delivery challenge, we must build on this foundation and create an ecosystem that works in real time, adapts in crisis, and lasts beyond donor cycles.

Once coordination is in place, the next challenge is evolution, turning information into intelligence and connection into capability. Africa’s health logistics cannot remain reactive; they must become predictive, flexible, and locally driven.

Across the continent, innovation is already pointing the way. Optimisation solutions, digital inventory systems, and cold-chain tracking tools have long moved from being experiments to proven models. The task now is integration, ensuring these tools don’t exist on the periphery of national systems but become embedded within them. Because when data from private platforms feed directly into public dashboards, countries gain the ability to anticipate shortages before they happen, not just respond to them after. Since the Logistics Marketplace acts as the central convergence point for logistics providers and suppliers across Africa and other growth regions, the data it generates is invaluable for national supply chain managers and public health decision makers.

We must also recognise that even the most connected system depends on people who can keep it running. Cold-chain technicians, warehouse managers, and data specialists form the human thread that ties technology to results. Many of them work with limited resources but thrive in keeping products and communities protected. Consistently investing in their skills and stability should then become an area of focus and not an afterthought.

For the longest time, Africa’s health story has been told through the lens of crisis, but it can also be one of possibility. While change will not come overnight, it can, however, begin with what’s already within reach. Strengthening logistics and distribution systems is a practical, short-term win – one that ensures the resources already available reach people efficiently and lay the groundwork for resilient, self-sustaining health systems.