Based on our fieldwork in Ghana, this study examines the marketing strategies of Chinese artemisinin-based antimalarial drugs (ACTs) within Ghana’s dual public-private pharmaceutical market. Key findings reveal that Ghana’s health insurance system and fragmented market structure often lead to inefficiencies where “bad drugs drive out good ones”, and donated medicines risk being commodified. Chinese pharmaceutical firms succeed through deep localization—leveraging local pharmacy graduates’ alumni networks to build trust and promote star products like artesunate, creating a “long-tail” effect for other drugs. The research illustrates how pharmaceutical marketing intertwines science, social networks and commercial interests, challenging the simplistic dichotomy of drugs as either pure commodities or altruistic gifts. These insights can offer practical implications for market entry strategies in Africa and highlight governance challenges in last-mile drug distribution.