LAGOS, Nigeria — A new report is calling on governments and global health donors to investigate whether private pharmacies can be formally enlisted to expand access to HIV, tuberculosis and malaria care, as funding for public health systems tightens worldwide.
The report, titled “Private Pharmacies as a Delivery Channel for HIV, TB, and Malaria Care,” was published by healthcare consulting firm Salient Advisory and examines pharmacy-based care across 12 countries in Africa and Southeast Asia: the Democratic Republic of Congo, Ghana, Indonesia, Kenya, Mozambique, Nigeria, the Philippines, Rwanda, South Africa, Thailand, Uganda and Zambia.
Across those countries, an estimated 3.6 million people living with HIV are not yet receiving antiretroviral therapy, about 764,000 tuberculosis cases go unreported each year, and adherence to test-before-treat protocols for malaria remains low in several high-burden markets, the report found.
The report identifies roughly 188,000 licensed private pharmacy outlets operating across the 12 countries — including independent pharmacies, drug shops, pharmacy chains, digital platforms and software-enabled pharmacy networks — that collectively serve tens of millions of patients each month. In several of the countries studied, these pharmacies already serve as the first point of contact for 42% to 74% of tuberculosis patients and 41% to 60% of malaria patients, according to the report. Pharmacies are also an important access point for HIV patients who avoid public health facilities due to stigma or, in some countries, legal risk.
Most of the 12 countries already permit some pharmacy-based services under existing regulations, the report notes, with private pharmacies broadly allowed to provide HIV testing and referral, tuberculosis case-finding, and malaria diagnosis and treatment.
The report points to two existing programs as evidence that structured pharmacy engagement can produce measurable results. In South Africa, a pharmacy chain-based program for antiretroviral therapy pickup maintained viral suppression in 97% of patients after 12 months, a rate the report says is comparable to facility-based care. In Kenya, a randomized controlled trial testing a diagnosis-contingent reimbursement model produced a fourfold increase in uptake of malaria rapid diagnostic tests and cut treatment costs by 50% to 80% per patient.
Drawing on 2024 data on antiretroviral therapy initiations, tuberculosis notifications and malaria cases, along with results from those existing programs, the report estimates that structured pharmacy-channel engagement could support more than 650,000 additional antiretroviral therapy initiations, over 116,000 additional tuberculosis notifications, and rapid diagnostic test-confirmed malaria treatment for as many as 15.8 million patients. The report adds that pharmacies could also help support the rollout of new HIV prevention products, including generic lenacapavir and MK-8527, an investigational antiretroviral drug from Merck currently being studied as a potential pre-exposure prophylaxis treatment.
Abdullah Yusuf, an associate director at Salient Advisory, said the report’s findings make a case for governments and health institutions to take the pharmacy channel seriously. “The conditions we found — delivery gaps, channel presence, documented care-seeking, regulatory permissions, and proof points from programs already operating — amount to a case for taking the channel seriously, examining its potential market by market, disease by disease,” Yusuf said. “The question is where those conditions converge sufficiently to justify moving from evidence to action.”
Salient Advisory is calling on governments, donors and global health institutions to commission country-level investigations in markets where delivery gaps, pharmacy presence, patient demand, regulatory feasibility and financing options align, and to treat private pharmacies as a practical complement to public health systems rather than a secondary option.
The report was published June 24, 2026.
