Private Pharmacies as a Delivery Channel for HIV, TB, and Malaria Care: A Rapid Assessment of Opportunities across 12 Countries

Private pharmacies are often the first point of contact for HIV, TB, and malaria care, yet this reality is rarely reflected in how global health programs are designed and funded. As public-sector capacity faces increasing pressure and donor funding contracts, formalizing private pharmacy channels as structured points-of-care may present an opportunity to sustain and expand access to treatment. 

This rapid assessment,Private Pharmacies as a Delivery Channel for HIV, TB, and Malaria Care: A Rapid Assessment of Opportunities across 12 Countries in Africa and Southeast Asia, examines whether the conditions exist for private pharmacy channels to play a more structured role in the delivery of HIV, TB, and malaria care across 12 focus countries: the Democratic Republic of Congo, Ghana, Indonesia, Kenya, Mozambique, Nigeria, the Philippines, Rwanda, South Africa, Thailand, Uganda, and Zambia.  

6 key findings emerged: 

1. An estimated 3M+ people living with HIV are yet to initiate treatment; over 700K TB cases go unnotified; and malaria test-before-treat rates remain low. Pharmacies could contribute to closing all 3 gaps. 
2. Estimates suggest over 188K licensed private outlets operate across the 12 countries, comprising pharmacy chains, independent pharmacies, drug shops, digital pharmacies, pharmacy software platforms, and private health facilities. The infrastructure already exists. 
3. Patients already use private pharmacies for HIV, TB, and malaria care. Between 42–74% of TB patients and 41–60% of malaria patients across high-burden countries seek first-contact care through private channels. Engagement does not need to create demand; it needs to meet it. 
4. Engagement of private pharmacy providers in the 12 countries has generated measurable results, offering indicative lessons. For example, a pharmacy chain-based pick-up point program for antiretroviral therapy (ART) in South Africa achieved 97% viral suppression in people living with HIV at 12 months. Additionally, a diagnosis-contingent reimbursement model tested in a randomized controlled trial in Kenya delivered a 4x improvement in malaria rapid diagnostic test uptake. 
5. Pharmacy-based HIV, TB, and malaria services appear to be permitted in most countries; however, scopes of practice differ by disease area and country.  
6. Illustrative estimates suggest that structured private pharmacy engagement could support more than 600K additional ART initiations, over 100K additional TB notifications, and millions of RDT-confirmed malaria treatments across the focus countries. 

Findings indicate that enabling conditions for structured engagement appear to be present in varying degrees across the 12 countries. They do not suggest conditions are sufficient for immediate activation; rather, they make a case for country-level investigations into where delivery gaps, channel presence, patient demand, regulatory feasibility, financing pathways, and stakeholder alignment converge. 

To learn more, explore the full report for insights on delivery gaps amenable to pharmacy-based support, existing private pharmacy channels and care-seeking behavior, evidence of impact in engaging the channel, regulatory conditions, and the potential size of the opportunity to leverage the channel to fill access gaps.  

Project Team 

This work was led by Zillah Waminaje, Anton Kannemeyer, Abdullah Yusuf, Deji Ogunye, Oladunni Lawal, Dr. Tosin Oshinubi, and Mara Hansen Staples at Salient Advisory. Our gratitude goes to Dr. Peter Ehrenkranz of PDE Consulting, who provided invaluable expert guidance. 

This rapid assessment is based on work funded by the Gates Foundation and delivered in consultation with the Global Fund to Fight AIDS, Tuberculosis, and Malaria.