Blog | From HIV to NCD+: Leveraging 25 Years of Supply Chain Leadership to Strengthen Chronic and Mental Health Care Access in Africa
February 15, 2026
For more than 25 years, Medical Access has partnered with Ministries of Health, development partners, and implementing organizations to strengthen public health supply chains across Uganda and sub-Saharan Africa. Founded in 1998 under the UNAIDS Drug Access Initiative, the organization played a foundational role in enabling early access to antiretroviral therapy (ART) in Uganda at a time when treatment costs exceeded US$6,000 per patient per year and availability was extremely limited.
Today, Africa faces a new inflection point. As epidemiological patterns shift, Medical Access is strategically expanding its mandate through its NCD+ Access Strategy (2025–2030), applying proven infectious disease supply chain capabilities to improve access to non-communicable diseases (NCDs), chronic conditions, and mental health services.
The Burden of Non-Communicable and Chronic Diseases in Africa: Trends, Transitions, and Priority Conditions
Sub-Saharan Africa is undergoing one of the fastest epidemiological transitions globally. NCDs now account for approximately 37–40% of all deaths in the region, with a disproportionately high share occurring prematurely before age 70. Cardiovascular diseases alone represent the leading cause of NCD mortality, followed by cancer, diabetes, and chronic respiratory diseases. Chronic kidney disease is rising sharply, particularly in populations with hypertension, diabetes, and HIV. Sickle cell disease remains highly prevalent in parts of East and West Africa, with significant paediatric mortality.
Mental health disorders further compound this burden. Depression and anxiety disorders are among the leading causes of years lived with disability globally, and in sub-Saharan Africa they are highly comorbid with HIV, cardiovascular disease, diabetes, and cancer. Untreated depression has been shown to reduce adherence to ART, insulin therapy, and antihypertensive regimens—directly worsening outcomes across multiple chronic conditions.
In Uganda for example, NCDs account for more than one-third of all deaths. At the same time, over 1.2 million individuals remain on ART, and as this population ages, multimorbidity is increasing. The convergence of HIV and chronic diseases—including hypertension, diabetes, CKD, malignancies, and depression—requires integrated, lifelong care systems capable of ensuring uninterrupted access to medicines, diagnostics, and monitoring services.
Unlike acute infections, chronic and mental health conditions demand sustained medicine supply, long-term patient follow-up, decentralized diagnostics, and interoperable data systems. The transition from episodic to lifelong care represents a fundamental health systems transformation.
Critical Gaps and System-Level Needs Limiting NCD+ Access
The literature consistently identifies several structural barriers to NCD and mental health scale-up in low- and middle-income African countries.
Medicine availability remains inconsistent across primary and secondary facilities. Essential NCD medicines including insulin, antihypertensives, statins, inhaled corticosteroids, oncology generics, and dialysis consumables are frequently out of stock. Psychotropic medicines such as antidepressants and antipsychotics are even less consistently available at primary care level.
Affordability presents a major barrier. In some contexts, chronic patients pay up to US$97 per month for medicines—levels that constitute catastrophic health expenditure for many households. Out-of-pocket spending remains significant, particularly where pooled procurement and price negotiation mechanisms are underdeveloped.
Diagnostic capacity gaps persist. Access to HbA1c testing, lipid profiling, renal function testing, oncology pathology, and mental health screening tools is uneven and often centralized in tertiary facilities. Radiotherapy capacity across sub-Saharan Africa remains severely limited relative to projected cancer incidence.
Supply chain fragmentation further undermines reliability. Parallel procurement channels, inconsistent quantification methodologies, and limited integration between clinical data and logistics systems create stock imbalances. Without predictive analytics and end-to-end visibility, chronic medicine programs face recurring stockouts.
Workforce shortages compound these challenges. Africa is projected to face a deficit of approximately 1.5 million health workers by 2030. The mental health workforce gap is particularly severe, with psychiatrist-to-population ratios among the lowest globally.
These system weaknesses mirror the constraints that once limited HIV treatment scale-up. They are fundamentally supply chain, procurement, financing, and digital integration challenges.
Medical Access Capabilities and Experience: A Proven Platform for NCD+ Systems Strengthening
Medical Access’ 25-year track record provides a strong foundation for addressing these structural barriers. Since inception, the organization has:
Supported uninterrupted treatment for over 30% of Uganda’s HIV patients
Procured over US$610 million in health commodities
Generated more than US$87 million in documented savings
Supported reduction of first-line HIV treatment costs from approximately US$6,400 per patient annually in 1999 to below US$70 under managed procurement models
Delivered more than 223,000 facility orders
Transported over 5,000 metric tons of commodities across 5.2 million accident-free kilometres
These outcomes were achieved through disciplined forecasting, pooled procurement, supplier negotiation, cold-chain management, digital inventory systems, fleet optimization, and rigorous performance monitoring.
The Medical Access NCD+ Access Strategy (2025–2030) extends these core competencies to chronic and mental health commodities. The same procurement strategies that drove ARV cost reductions can be applied to insulin, antihypertensives, oncology generics, renal medicines, and essential psychotropics. The same warehousing and cold-chain infrastructure used for HIV and TB commodities can safeguard insulin and temperature-sensitive products. The same traceability systems can enhance oversight of oncology and controlled psychotropic medicines.
Medical Access’ experience integrating supply chain management with national programs positions it to support Ministries of Health in transitioning from vertical infectious disease platforms to integrated chronic care supply systems.
Medical Access Technical Approaches and Digital Methodologies for NCD+ Access
Global guidance emphasizes standardized treatment protocols linked to essential medicine availability, interoperable digital systems, task-sharing supported by reliable logistics, and data-driven forecasting. Medical Access’ operational model aligns directly with these recommendations. The organization has deployed:
End-to-end e-procurement systems reducing cycle times and improving transparency
Digital warehouse management platforms
GS1 barcoding and traceability solutions supporting pharmacovigilance
Electronic Proof of Delivery (ePOD) systems enhancing accountability
Cloud-based temperature monitoring for cold-chain integrity
Fleet optimization tools improving last-mile performance
Supply Chain Control Tower dashboards enabling predictive analytics
These tools are directly applicable to NCD+ programming. For example:
Predictive analytics can improve demand forecasting for hypertension and diabetes medicines, reducing both stockouts and overstocking. Traceability systems can mitigate the risk of substandard and falsified oncology or psychotropic medicines. Integrated dashboards can align facility consumption data with national procurement planning, ensuring chronic medicine continuity.
Medical Access is also exploring pooled procurement models and private-sector partnerships aimed at improving affordability for chronic and mental health medicines. Integration with national eLMIS platforms and DHIS2 systems will support data harmonization between clinical and logistics streams.
These approaches reflect global best practice in supply chain modernization and digital health interoperability.
Expected Impact of the NCD+ Expansion
The HIV response in Uganda demonstrated that supply chain reform can translate into profound public health impact. Between 2004 and 2025, Medical Access through strengthened procurement and distribution systems contributed to preventing an estimated 600,000 HIV-related deaths and 500,000 new infections.
The NCD+ strategy seeks to replicate this systemic transformation for chronic and mental health conditions. Over the next five years, Medical Access aims to contribute to:
· Improved availability of essential NCD and psychotropic medicines across supported facilities
· Reduced procurement costs through pooled purchasing and supplier negotiation
· Strengthened forecasting and quantification systems for diabetes, cardiovascular, oncology, CKD, SCD, and mental health commodities
· Enhanced last-mile delivery reliability
· Reduced out-of-pocket expenditure burdens
· Support for national universal health coverage implementation
The epidemiological transition requires supply chains that are predictive, digitized, integrated, affordable, and patient-centered. It requires systems capable of delivering lifelong therapy without interruption.
Medical Access views the NCD+ program not as a departure from its mission, but as the logical extension of 25 years of health systems strengthening. The infrastructure, digital platforms, procurement expertise, and national partnerships that enabled HIV treatment scale-up now form the foundation for expanding equitable access to chronic and mental health care across Uganda and sub-Saharan Africa.
We welcome collaboration with Ministries of Health, bilateral and multilateral funders, philanthropic partners, technical agencies, manufacturers, and implementing organizations committed to strengthening NCD and mental health systems. After 25 years of delivering hope in HIV, we are committed to delivering resilient, sustainable access for chronic and mental health care.