Health System Investment Readiness for Pharmaceutical Innovation in Africa: A Multi-Country Diagnostic Framework for Health Programme Design and Investment Prioritization in High-Burden Malaria Settings
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Health system readiness for pharmaceutical innovation is a prerequisite for realising the human capital returns of biomedical progress. In malaria, a disease responsible for USD 12 billion in annual productivity losses and a 1.3% annual GDP drag across sub-Saharan Africa, two transformative innovations are approaching regulatory approval: ganaplacide-lumefantrine, the first novel-mechanism antimalarial in 25 years, and Coartem Baby, the first antimalarial indicated for newborns under 5 kilograms. Whether these innovations translate into reduced child mortality, improved labour force productivity, and human capital accumulation depends not on the science, which is settled, but on the health system architecture of the countries that must receive them.
This paper introduces the Africa Readiness Index, the first published multi-country diagnostic framework assessing health system investment readiness for next-generation antimalarial introduction across ten high-burden sub-Saharan African countries. Across ten countries representing 68% of global malaria burden, the mean ARI score is 11.8 out of 25. No country achieves full readiness. The highest-burden countries score lowest -a structural inversion that defines the investment gap. Ghana leads with 17 and Kenya with 16. Nigeria, carrying 31.9% of global malaria deaths, scores 13. DRC scores 8. Niger scores 7.
REVISION NOTE (May 2026): This paper has been updated to incorporate the 2025 bilateral aid restructuring as a validation of the domestic financing gap argument, updated WHO World Malaria Report 2025 data (610,000 deaths; 282 million cases in 2024), the December 2025 World Bank-Global Fund USD 2 billion joint MOU, and cross-references to the companion paper 'When Donors Leave, Fake Artemisinins Arrive' which documents the resistance amplification consequences of the financing gap this paper identifies.