The Impact of Pooled Procurement Mechanisms on Essential Medicine Prices and Availability in Sub Saharan Africa: A Systematic Review and Meta-Analysis

Background Pooled procurement mechanisms are increasingly implemented across Sub-Saharan Africa (SSA) to improve access to essential medicines. While theoretically promising for reducing prices and improving availability, quantitative evidence on their impact remains fragmented. This systematic review and meta-analysis synthesizes the evidence on the effect of pooled procurement on essential medicine prices and availability in SSA. Methods We conducted a systematic review following PRISMA 2020 guidelines, searching PubMed, Embase, Scopus, Cochrane CENTRAL, and WHO Global Index Medicus from inception to October 2025. Grey literature from World Bank, WHO, and major implementing partners was also searched. We included comparative studies reporting price (Median Price Ratio - MPR) or availability outcomes for essential medicines under pooled versus non-pooled procurement in SSA. Two reviewers independently screened studies, extracted data, and assessed risk of bias using ROBINS-I and Cochrane RoB 2.0 tools. Random-effects meta-analysis was performed using R version 4.3.2. The study was conducted from October 2025 to January 2026. Results From 1,624 screened records, 19 studies met inclusion criteria. Pooled procurement was associated with a significant reduction in medicine prices, with a pooled Mean Difference (MD) in MPR of -0.38 (95% CI: -0.48 to -0.28, p < 0.001; I²=81%). The pooled Odds Ratio (OR) for medicine availability was 2.67 (95% CI: 1.85 to 3.86, p < 0.001; I²=74%). Subgroup analyses revealed stronger effects for antiretrovirals (MD: -0.43) and vaccines (MD: -0.40) compared to antibiotics (MD: -0.22), and for global/donor pools (MD: -0.45) compared to national pools (MD: -0.25). Most studies (n = 12) had moderate risk of bias, primarily due to potential confounding. Conclusion Pooled procurement mechanisms in SSA are significantly associated with lower medicine prices and higher availability. However, substantial heterogeneity indicates context-dependent effectiveness. Policy implementation should consider medicine class, procurement model design, and local health system capacity to optimize benefits for universal health coverage.