The operationalisation of Zimbabwe’s participation in the Pfizer Accord for a Healthier World is expected to strengthen the National Pharmaceutical Company of Zimbabwe (NatPharm)’s capacity to procure, store and distribute essential medicines, while improving access to quality-assured and innovative treatments in public health facilities. Under the partnership, Pfizer will supply its medicines and vaccines on a not-for-profit basis, alongside technical support aimed at improving supply chain systems. NatPharm managing director MR NEWMAN MADZIKWA spoke to our Senior Health Reporter RUMBIDZAYI ZINYUKE about the expected benefits of the partnership, how it will help address medicine shortages and what Zimbabweans can expect from the arrangement.
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Q: Following the operationalisation of the Pfizer Accord for a Healthier World, what specific benefits does NatPharm expect to derive from the partnership, particularly in strengthening its mandate to ensure the uninterrupted supply of essential medicines and vaccines to public health facilities?
A: NatPharm’s mandate is to procure, store and distribute medicines and medical supplies to public health facilities so that patients find what they have been prescribed. The accord supports that mandate in two important ways, by giving NatPharm a direct, lower-cost source of quality-assured products and by bringing technical support to the systems we use to move those products.
Firstly, it provides a reliable source of medicines directly from the originator manufacturer on not-for-profit terms. This reduces dependence on intermediaries and spot purchases, shortens the supply chain for these products and minimises the risk of substandard or falsified medicines entering the system.
Secondly, it offers better value for the public health budget. Not-for-profit pricing means that every dollar allocated to NatPharm can purchase more treatment courses, particularly for high-cost oncology, specialist anti-infective and vaccine products that have previously been difficult to procure at scale.
The arrangement also provides more predictable pricing, allowing us to forecast and budget with greater confidence while reducing exposure to global market price volatility. It opens access to innovative and newer patented therapies, as well as future Pfizer products, which might otherwise reach Zimbabwe’s public health sector late or not at all.
Another important benefit is capacity building in our core supply chain functions. Pfizer’s support in demand planning and cold chain management, together with Government’s investment in NatPharm’s procurement, forecasting, warehousing and distribution capacity will strengthen systems that serve all medicines, not just those supplied under the accord.
We also expect coordinated engagement with the Medicines Control Authority of Zimbabwe (MCAZ) to facilitate the registration of identified products while maintaining regulatory standards. This should reduce delays between identifying a need and making the products available.
Taken together, these benefits will strengthen our ability to maintain continuous supplies. However, it is important to emphasise that the accord covers Pfizer products only. Uninterrupted availability across the full Essential Drugs List and Standard Treatment Guidelines (EDLIZ) will continue to depend on adequate and timely Government funding, other suppliers, local manufacturers and partner-funded programmes.
Q: The Health minister indicated that medicine availability in public health facilities stands at approximately 54 percent against a national target of 80 percent. How will the Pfizer partnership help NatPharm contribute towards closing this gap, and what improvements in medicine availability can realistically be expected?
A: The 26-percentage-point gap between current availability and the national target is influenced by several factors, including limited and irregular funding for procurement, long lead times, forecasting inaccuracies, stock imbalances between facilities and distribution constraints. The accord can help address some of these challenges, although it should be viewed as one contributor to improving medicine availability rather than a stand-alone solution.
Where medicines on the national essential medicines list are Pfizer products, procuring them at not-for-profit prices will allow NatPharm to purchase larger quantities within the same budget allocation, improving their availability in public health facilities.
The savings realised on these products could also be redirected towards procuring other essential medicines, extending the benefits beyond Pfizer’s portfolio, provided the savings are retained within the medicines budget.
There are also expected system-wide efficiency gains. Improvements in forecasting, inventory control and distribution will benefit the broader supply chain. Better demand planning will help reduce both stockouts and expiries, while improved stock visibility will make it easier to identify facilities with excess stock and those experiencing shortages.
Coordinated work with MCAZ should also shorten the time between identifying priority products and making them available through NatPharm. In terms of realistic expectations, the most immediate improvements should be seen in the availability of specific accord products once they have been registered, procured and distributed.
However, because Pfizer supplies only part of the essential medicines basket, the partnership alone cannot be expected to move national medicine availability from 54 percent to 80 percent. We anticipate steady, year-on-year improvements if the accord is supported by sustained Government financing, effective use of the savings and continued investment in supply chain improvements.
We believe the implementation road map should, therefore, have separate targets for the availability of accord products at facility level and NatPharm’s contribution to overall tracer-medicine availability. This will allow progress to be measured and attributed accurately.
Q: What categories of medicines, vaccines and health technologies are expected to come through the accord, and how will NatPharm work with the Ministry of Health, Pfizer and other relevant institutions to identify priority products based on Zimbabwe’s disease burden and medicine needs?
A: The accord offers Pfizer’s full portfolio of approximately 500 patented and off-patent products across more than 20 therapeutic areas, many of which are included on the World Health Organisation Model List of Essential Medicines.
For Zimbabwe, the priority areas highlighted during the signing of the agreement and the operationalisation workshop include infectious diseases, vaccines, oncology, cardiovascular and neurological conditions, as well as inflammatory and other chronic diseases.
Under infectious diseases, the portfolio includes anti-infectives such as antibiotics and anti-fungals, which are also relevant to the management of antimicrobial resistance in hospitals.
The vaccine component will provide opportunities to access Pfizer vaccines that align with national immunisation priorities, subject to the country’s Expanded Programme on Immunisation policies and existing Gavi-supported arrangements.
Oncology is another important area, given the limited availability of cancer treatments in the public sector. The accord could improve access to these medicines, while cardiovascular, neurological and other chronic-condition medicines will help address the growing burden of non-communicable diseases.
There are also specialist therapies for inflammatory and immunological conditions.
However, the fact that the full portfolio is available does not mean that every product will automatically be introduced into Zimbabwe. The actual selection will be determined by the country’s health needs and priorities. Some products that are not already in common use in the public sector may also require supporting health technologies, including diagnostics, cold chain equipment and clinical protocols, before they can be safely introduced.
The Ministry of Health and Child Care will lead the product selection process to ensure that the identified medicines are aligned with national disease priorities, EDLIZ and approved treatment guidelines.
We will also work with MCAZ to establish the registration status of the products and facilitate the registration of priority medicines.
Ultimately, prioritisation should consider disease burden, clinical need, potential cost savings, the health system’s capacity to use the products and the sustainability of funding beyond the initial procurement.
Q: Beyond making medicines available at not-for-profit prices, what specific technical and operational support could Pfizer provide to strengthen NatPharm’s procurement, forecasting, warehousing, inventory management and distribution systems?
A: The health system-strengthening component of the accord is just as important to NatPharm as the pricing benefits. Pfizer has considerable experience in pharmaceutical logistics and quality management, and its Global Health Team model and capacity-building programmes provide opportunities for us to strengthen our operations.
In procurement, we would seek support in developing clear ordering, contracting and payment procedures for accord products, as well as predictable supply agreements, joint supply planning and order scheduling.
Forecasting and quantification are equally important. Training in demand planning and forecasting methods, together with tools that combine consumption, disease burden and service delivery data, would help us make more accurate procurement decisions and monitor the supply pipeline.
In warehousing, technical guidance on good storage and distribution practice would help improve warehouse layouts, storage processes, temperature mapping and monitoring.
Cold chain management is another critical area, particularly for vaccines and biologics. Support could include training on the management of cold rooms, refrigeration systems and temperature-controlled transport, as well as the use of temperature data loggers and appropriate procedures for managing temperature excursions.
On inventory management, we would benefit from stronger stock control systems, improved first-expiry-first-out practices, expiry risk management and regular stock reconciliation. Better use of data would also allow us to rebalance stock between facilities and reduce wastage.
We would also want to strengthen data visibility by integrating accord products into existing national information systems to ensure end-to-end tracking, rather than establishing parallel systems.
Other areas include support with product documentation for MCAZ registration, pharmacovigilance, quality management systems and training for supply chain personnel. Working with the ministry, there would also be opportunities to train prescribers and dispensers on the appropriate use of newly introduced medicines.
Our position is that this support should be delivered through NatPharm’s existing systems and personnel and aligned with ongoing improvement initiatives. This will ensure that the benefits are institutionalised and strengthen the supply chain for the entire range of medicines handled by NatPharm.
Q: One of the challenges in medicine supply is ensuring that products move efficiently from central warehouses to hospitals and clinics, including those in remote areas. How will NatPharm leverage this partnership to strengthen last-mile distribution and ensure equitable access across the country?
A: Equitable access means ensuring that medicines reach rural and remote health facilities as reliably as they reach central hospitals.
NatPharm distributes medicines from its central and regional branch warehouses to provincial, district and primary-level facilities. However, some of the challenges we face include transport capacity, fuel and operating costs, road conditions and limited real-time visibility of stock levels at facility level.
Through the partnership, we intend to integrate accord products into our existing national distribution network so that they move along the same routes and schedules as other essential medicines. This will avoid creating parallel delivery systems that could fragment the last-mile supply chain.
We also see opportunities to apply distribution and route-planning expertise to improve delivery schedules from regional branches, consolidate loads and reduce the cost of deliveries.
Extending cold chain capacity will be particularly important for vaccines and other temperature-sensitive products. This will require appropriate storage and temperature-controlled transport at regional and district levels to ensure that products reach remote facilities in good condition.
Another important area is improving stock visibility at facility level. Resupply decisions should be informed by actual consumption and available stock so that we can identify and respond to shortages before they become serious stockouts.
We will also need to monitor delivery performance and medicine availability by province and district to identify disparities and ensure that remote communities are not disadvantaged.
However, distribution alone does not guarantee access. Health workers must also be equipped to prescribe, dispense, administer and monitor new treatments appropriately. Specialist products such as oncology medicines may initially be concentrated in facilities with the necessary diagnostic and clinical capacity, with access expanded as that capacity improves.
Q: Given that the accord operates on a not-for-profit pricing model rather than a donation arrangement, how will NatPharm and the Government finance the procurement of these medicines, and what mechanisms will be put in place to ensure their continuous availability beyond initial implementation?
A: As the minister has emphasised, not-for-profit pricing does not mean that medicines are free. Zimbabwe will still pay for every product procured under the accord. Therefore, the arrangement will only deliver the intended benefits if procurement is adequately funded and payments are made on time.
The primary source of funding will be Government budget allocations through the Ministry of Health and Child Care for medicines and medical supplies. Domestic resources, including the health levy and other funds earmarked for health, can also contribute.
Partner and programme funding may be used where accord products fall within the scope of donor-supported programmes and the respective partners agree to procure through the arrangement.
Cost recovery from health facilities under NatPharm’s existing ordering arrangements may also apply where appropriate. To ensure continuity beyond the initial orders, we would recommend that the implementation road map provide for a dedicated or ring-fenced budget allocation for accord procurement, informed by multi-year quantification.
This would help prevent interruptions caused by delays in funding.
There is a need for multi-year supply planning, with clear ordering cycles, lead times and minimum and maximum stock levels for each product. Savings realised through not-for-profit pricing should also be retained within the medicines budget to help expand coverage of other essential medicines.
Most importantly, accord products must be integrated into national procurement and supply systems so that they are planned, budgeted and monitored like any other essential medicine, rather than treated as a time-limited project.
Q: Looking ahead, what measurable changes should Zimbabweans expect from this partnership over the next few years in terms of medicine availability, supply chain efficiency and access to innovative treatments, and how will NatPharm measure its contribution to these outcomes?
A: The ultimate measure of the partnership’s success is whether a patient, wherever they are in Zimbabwe, can obtain the right medicine at the right time and at an affordable cost.
Over the coming years, Zimbabweans should expect improved availability of selected accord products in public health facilities, reducing the need for patients to purchase prescribed medicines from private pharmacies.
We also expect steady progress towards the national target of at least 80 percent availability of essential medicines as the savings from the partnership and improvements in supply chain efficiency begin to take effect.
Another important outcome should be improved access to innovative treatments, particularly for cancer and other non-communicable diseases, which have previously been difficult to access or unaffordable in the public sector.
On the operational side, we expect a more efficient supply chain characterised by fewer stockouts, reduced expiry and wastage, and more reliable deliveries, including to remote facilities.
