Fortifying essential medicines supply chains in Sub-Saharan Africa - the curious cases of Kenya and Uganda

Universal Health Coverage (UHC) is the cornerstone of global health policy. Sustainable Development Goal 3.8 ensures access to safe, effective, quality and affordable medicines and vaccines. Sub-Saharan African (SSA) countries continue to face persistent challenges in achieving and maintaining essential medicines supply. National Medicines Policies (NMPs) that strengthen access to essential medicines are critical for UHC. In this scoping review, we take stock of the literature on essential medicines supply chains in SSA and analyze the unique, related provisions in the Kenyan and Ugandan NMPs, countries whose national essential medicines lists (EMLs) align with the WHO's Model List and have adopted reforms specific to medicines supply chains. Comprehensive hand and electronic searches were conducted on the Kenyan and Ugandan government websites to identify recent national medicines policies and laws. PubMed and Google Scholar searches also retrieved relevant research studies. Our review highlights three key features of Kenya's and Uganda's NMPs: 1) development of evidence-based national EMLs, aligned with the WHO's Model List, to guide essential medicines selection, procurement, and resource allocation; 2) devolution of central government authority for essential medicines to local counties; and 3) support and investment in domestic pharmaceutical manufacturing to minimize reliance on essential medicines imports and increase product availability. We discuss how these distinct policies can serve as models for other resource-constrained countries to build resilient, sustainable supply chains, strengthen access to essential medicines, and move closer to UHC.