Posted by It is Saturday afternoon, and I find myself in the heart of Lomé, the capital of Togo, at the Akodessewa fetish market. It is said to be the largest fetish market in the world, and some call it the Walmart of voodoo in the region. The stalls are piled with animal parts, bone statues and herbs. But I am not in West Africa to pick up a new hobby. I am here to get a better understanding of both traditional medicine and the pharmaceutical industry.
I wrote that in December 2013. Much of what I saw then still holds, but the market around it has changed, in some ways for the better and in others for the worse.
The size of the prize
A large share of people in sub-Saharan Africa use traditional medicine, but the continent has long been pitched as the next big market for pharmaceutical companies. In 2013, IMS Health forecast that pharmaceutical spending in Africa would grow by 11% a year to reach US$30 billion by 2016.
The growth has been slower than promised. On a narrow definition of finished medicines, research firms put Africa’s pharmaceutical market at around US$28–29 billion in 2025. Afreximbank uses a wider measure and puts sales at about US$34 billion in 2024, rising to US$43 billion by 2029. Either way, the market is still substantial and growing, but it took a decade longer to arrive than the forecasts suggested.
The disease picture has shifted as expected. In 2013, Africa was the only continent where non-communicable diseases such as cancer, diabetes and heart disease were not the biggest cause of death, and the World Health Organization predicted a sharp rise. That shift is now well under way, alongside a continuing burden of malaria and other infectious diseases.
Africa is not one market
For most pharmaceutical companies, the challenge is still to target specific countries and regions. Africa is made up of very different countries, markets and stages of development. Chad has only about 60 km of paved road per million people, while Algeria and Namibia have more than 2,000 km.
History matters too. The pharmaceutical supply chain in francophone West Africa, in countries such as Mali, has traditionally been far less fragmented than in anglophone countries such as Ghana. Regional blocs like the East African Community and ECOWAS can reduce trade barriers, but in 2013 Africa was still a long way from anything like the European Medicines Agency.
That has started to change. The African Medicines Agency, created by an African Union treaty in 2019, opened its headquarters in Kigali and became operational in October 2025 under its first director-general, Dr Delese Mimi Darko, the former head of Ghana’s regulator. Around 31 countries have ratified the treaty so far. It will take years before a single registration works across the continent, but for the first time there is an institution built to make it happen.
Price, pack and product
With limited information on the ground, identifying market segments and forecasting demand is hard. To succeed, pharmaceutical companies need to think about price and product, and there is a lot to learn from traditional medicine and the consumer goods industry. That often means smaller pack sizes, such as sachets, and breaking bulk so that each unit is affordable.
Companies also need to study local customs and how medicines are actually taken. In some cases, pharmaceuticals are used alongside traditional medicine rather than instead of it. Packaging matters more than many companies realise. In Lagos’s Idumota market, I was told that the best-selling anti-inflammatory had the most vivid picture on the pack. “People want to see what the drug can do,” a pharmacy assistant told me.
Counterfeits and parallel imports
Counterfeit medicines were already a major concern in 2013, with drugs entering through poorly controlled borders. On the Nigeria–Benin border, “porters” were hired to carry pharmaceuticals across. Scratch codes and text-message checks, such as Nigeria’s, were an important line of defence.
The scale of the damage is now better understood. In 2023, the UN Office on Drugs and Crime estimated that falsified and substandard medicines kill almost half a million people in sub-Saharan Africa every year, including up to 267,000 deaths linked to bad antimalarials and around 169,000 children who die after being given substandard antibiotics for pneumonia. It also found that around 40% of the falsified and substandard products reported in the Sahel turned up inside the regulated supply chain, not just in street markets.
Companies also need to understand parallel imports: genuine products brought into a country without the brand owner’s permission. In Lagos, our team found the same well-known painkiller coming from three different countries. And the problem is not limited to pharmaceuticals. In any muti shop in South Africa you will find, alongside local ingredients, a range of mostly branded products from China and India, some of questionable benefit and quality.
Know how medicines really move
Pharmaceutical companies need to understand how products flow from the factory to the patient. African markets tend to be highly fragmented, with few large pharmacy chains. In some countries the barriers to opening a pharmacy are high; in Mali, I found a waiting list of pharmacists hoping for a licence. In Ghana, individual drug salesmen supply upcountry markets from vans.
In Nigeria, open markets such as Idumota in Lagos, Onitsha in Anambra and Ariaria in Aba have long been the backbone of distribution, supplying an estimated 80% of the country’s medicines. The government has been trying to move them into regulated Coordinated Wholesale Centres for years. Kano’s traders were finally relocated after a court ruling in 2024, and in February 2025 the regulator NAFDAC sealed the Idumota, Onitsha and Aba markets and destroyed truckloads of seized products. Most pharmaceutical companies would rather avoid informal networks altogether, but they still need to understand how these markets work and which outlets they reach, because that is where many of their products end up.
Partners, and who stays
Finding the right local partner is still one of the hardest parts of entering a market. Warehouses are often poorly designed, with little ventilation, yard management or equipment, and cold chain needs a backup plan, including generators. There are usually only a handful of distributors that meet a multinational’s standards, and the best of them may already work for a competitor.
In recent years, some multinationals have stepped back from running their own operations altogether. In 2023, GSK ended 51 years of direct operations in Nigeria and Sanofi followed, both handing their products to third-party distributors, after struggling with foreign exchange shortages and rising costs. Nigeria and other countries have responded by pushing for more local manufacturing, and the African Union aims for 60% of the continent’s vaccines and other health products to be made in Africa by 2040.
To reach both the private and public sectors, companies may need different partners. In some countries, NGOs handle last-mile logistics in hard-to-reach areas, as they did in South Sudan, and they often have good relationships with health workers, donors and government officials. Local partners are also essential for navigating regulation.
No voodoo business
With a growing middle class and a rising tide of chronic disease, Africa still holds real potential for pharmaceutical companies. But traditional medicine will keep growing alongside modern medicine, as it has in Asia, and the past decade has shown that the opportunity takes longer and costs more to reach than the forecasts suggest. Companies that take the time to understand each market, build long-term relationships and invest locally can still do well. And that is no voodoo business.
First published in How We Made It in Africa, December 2013. Updated October 2026.
