Posted by Sceptics have long argued that corporate social responsibility was mostly a way of throwing money at a problem in exchange for a glossy brochure and a photo for the annual report. Whether or not that was fair, the better partnerships between companies, donors and governments have moved well beyond that. Today the most useful thing a company brings is often not its money but what it knows how to do.
A good partnership also does not need a large organisation or a famous name behind it. Some of the best opportunities are local, and those tend to last longer because they are less exposed to shifts in politics or donor priorities.
Why this matters more now
When I first wrote about this in 2022, private sector partnerships in health logistics were a useful extra. Since 2025 they have become part of how the system has to work.
The cuts to USAID removed one of the biggest funders of health supply chains in Africa. In March 2025 it was confirmed that 83% of USAID programmes would end. The US has since moved away from its large central supply contract, signing bilateral health agreements with recipient governments and relying mostly on private logistics firms to distribute supplies.
Governments have had to adapt quickly. Nigeria’s national health supply chain strategy now uses a managed outsourcing model, bringing private third-party logistics providers into its zonal hubs. In Côte d’Ivoire, a semi-autonomous procurement and supply agency can contract private logistics providers more flexibly than a ministry bound by treasury rules. The question is no longer whether the private sector should be involved, but how to do it well.
What multinationals bring to the table
The first thing is connections. Beyond any funding, a multinational can bring together other companies, NGOs, bilateral donors, foundations and universities. Coca-Cola’s Project Last Mile is the best-known example. It brought together the Global Fund, USAID, PEPFAR, the Gates Foundation and early partners such as Yale, and at its peak worked with ministries of health in more than a dozen African countries. It has since shut down in most of those countries and now focuses on supporting small ventures. That is a reminder that even the best-known partnerships depend on the donors behind them.
The second is fit. Not every company suits every problem, but value comes when companies stick to what they are good at: Coca-Cola in distribution and marketing, DHL in supply management and cold chain, IBM in technology.
The third, and often the most valuable, is local knowledge. A multinational’s local operation knows the trading conditions, the real cost of things and how to get work done with limited resources. International project teams can learn a great deal from that. On our transport management project in South Sudan, AB InBev’s local team gave us practical insight into the difficulties of importing vehicles and the challenge of finding qualified technicians in the country.
Companies can also choose how deeply to engage. Some sit on advisory boards or lend technical advisers. Others embed staff in project teams, share resources, or appoint someone to link the project team with the local operation.
Where multinationals fall short
Multinationals are not superheroes, and they run into many of the same problems as humanitarian logistics organisations. None has written the definitive guide to the last mile in Africa. Some have succeeded in specific areas, such as Coca-Cola’s micro-distribution model, but most companies do not operate in the rural areas where NGOs work. They sell through intermediary distributors, so their own view of the supply chain often stops at the distributor’s warehouse. And many run their African business from regional commercial centres, with little presence on the ground.
When partnerships go wrong
It is also worth being honest about the record. Many public-private partnerships in health have failed, and some have done real damage.
Lesotho’s Queen ’Mamohato Memorial Hospital was meant to be the model. It opened in 2011 under an 18-year partnership with a consortium led by South Africa’s Netcare, with the World Bank’s IFC as adviser, and it was the first deal of its kind in a low-income country. Clinical results improved, but the cost swallowed the health budget. Oxfam put it at half of all health spending; even the World Bank’s own figures showed around a third. In 2021 the government ended the contract early, saying it was consuming nearly half the health budget, and Netcare then claimed M1.6 billion for outstanding services.
Kenya’s Managed Equipment Services scheme went wrong in a different way. In 2015 the government signed contracts with five international suppliers to lease specialist equipment such as CT scanners and theatre kit to all 47 counties, in a deal worth around Sh63 billion. Auditors later found that procurement rules had been broken, counties had been pushed into accepting equipment they had not asked for, and some were paying for machines that had never arrived. A Kenyan think tank concluded that the scheme had not delivered value for money.
The pattern in these failures is familiar: long, expensive contracts, a ministry that could not monitor them properly, and little room to adjust when costs rose. These were mostly big financing and construction deals, which are a different animal from a company lending its people and know-how. But they are a warning. A partnership that locks a ministry into payments it cannot afford, or that nobody on the government side can properly manage, does more harm than good.
In my own work on health supply chain partnerships in Tanzania, Kenya and Côte d’Ivoire, the failures I saw were usually less dramatic but more common. The scope was too narrow, and the donors were nervous about scaling up. A project would set up a carefully protected pilot, with extra funding, extra staff and extra attention, that worked well inside its own little garden. But it was never built to survive outside it. When the pilot ended, there was no budget, no ownership and no plan to take it to the rest of the system, and things quietly went back to how they were.
Where they can add real value
Demand planning and procurement is one. As health systems move from emergency response to long-term planning, and now have to do more with less donor money, they need to forecast demand and buy well. Companies that operate in unpredictable markets have hard-won experience here.
Routing and network design is another. Basic information such as routes to health facilities is often not available in structured form, and a well-designed distribution network pays off for years. Companies also understand how to work with distribution partners in the last mile.
Transport management is a third. Scheduling and vehicle maintenance are still weak points in many health systems. Riders for Health has made this its core business for decades and still runs fleet programmes in Lesotho, The Gambia, Malawi and Nigeria, but the gap is far bigger than one organisation can fill. Companies can also share what they know about using third-party logistics providers and negotiating local transport rates, which matters more now that governments are outsourcing more of their distribution.
The last is incentives. Companies know how to use incentives to lift productivity. Public health systems often have no real incentive scheme at all, and there is growing interest in what can be borrowed from business.
What companies get out of it
Most employees want to give something back, and local staff in particular take real pride in solving problems in their own communities. Companies that let them do this become more attractive places to work.
There is also a lot to learn. NGOs have often been ahead of business in trying out mobile technology in difficult settings, and few multinationals truly understand rural distribution. Their people learn by working on hard problems in tough environments.
Finally, there is a real opportunity to share infrastructure. In rural areas, where it is hard for anyone to justify the cost of warehouses, vehicles or cold chain alone, the right partnership can make it work for both sides.
The bottom line
With donor money shrinking, African health systems will lean more on private logistics, whether through outsourcing, partnerships or shared infrastructure. Multinationals will not solve the last mile on their own. But when they bring their people, their local knowledge and their operating discipline, rather than just a cheque, they can make a real difference.
First published in April 2022. Updated November 2026.
