Dissecting PASHeF II (2024): a roadmap — and why local R&D & manufacturing of medical devices is the engine for equitable, cost-effective surgical care in Africa

Afrimed
Sep 27, 2024
7 min read

Abstract: The Pan-African Surgical Healthcare Forum (PASHeF) II in Kigali (Sept 2024) consolidated country commitments and produced a continent-level roadmap that explicitly links political leadership, financing, surgical system planning (NSOAPs), monitoring, and partnerships as the pillars of improved surgical access. This article unpacks that roadmap, shows where local research & development (R&D) and domestic manufacturing of medical devices plug into each pillar, and presents evidence and case studies that local device capacity improves affordability, supply resilience, maintenance and whole-life costs — all necessary to make surgery accessible, safe and sustainable. Key high-level references used below: the PASHeF consensus & 2024 forum reporting, WHO/AFRO frameworks for local production, the Lancet Commission on Global Surgery and follow-on ROI analyses, and regional manufacturing roadmaps (NEPAD/AUDA).

1. PASHeF II (2024) — what the roadmap actually says (short synthesis)

PASHeF grew out of a country-led, Africa-based consensus process (inaugural forum 2023) and convened ministry technocrats, clinicians, researchers, donors and industry in Kigali in 2024 to convert the 50-point continental consensus into an actionable roadmap. Key, repeatedly emphasized elements were: (a) political commitment and leadership at ministerial/AU levels, (b) sustainable financing and procurement reform, (c) integration of surgical priorities into NSOAPs and national health strategies, (d) monitoring, evaluation and a continental policy-monitoring secretariat, and (e) multi-sector partnerships (public/private, academic, industry) with community engagement. The forum explicitly framed implementation (not just policy wording) as the central problem to solve.

Why that matters. Policy + money + metrics + partnerships = an operational system. But policies will only change patients’ lives if the health system has reliable equipment, consumables, and the capacity to maintain them — and that’s where local R&D and manufacturing enter as an operational priority in the roadmap.

2. Where local R&D & manufacturing sit inside the PASHeF pillars

Below I map each major PASHeF pillar to the specific value that local R&D and manufacturing deliver.

2.1 Leadership, governance & NSOAP alignment

PASHeF calls for surgical priorities to be built into NSOAPs and national budgets. Local device policy gives ministries concrete levers (industrial policy, procurement rules, regulation) to make equipment availability a deliverable in NSOAP operational plans. NSOAPs already include “infrastructure & equipment” as a domain — linking national planning to a domestic supply pipeline reduces dependency risks.

2.2 Financing & procurement reform

Centralised procurement often buys lowest-upfront-price imports without accounting for installation, consumables, maintenance or spare parts. Locally made devices can reduce total cost of ownership (faster servicing, local warranties, cheaper parts) and enable pooled regional procurement models aligned with PASHeF’s financing commitments. WHO/AFRO and NEPAD regional roadmaps recommend public-private partnerships and regional hubs to scale manufacturing and lower unit costs.

2.3 Workforce & clinical engineering capacity

Clinical engineers and biomedical technicians are essential for device uptime. Local R&D + local manufacture reinforces training pipelines: design teams are co-located with repair workshops and training programs, creating a virtuous loop between device design for local contexts and the maintenance workforce called for by PASHeF. Evidence from country case studies shows that strengthening in-country clinical engineering dramatically improves sterile processing and device uptime — directly reducing surgical cancellations and complications.

2.4 Supply-chain resilience & emergency preparedness

PASHeF emphasises sustainability and community resilience. The COVID-19 era exposed fragile international supply chains for oxygen, PPE and ventilators; locally produced oxygen and oxygen equipment projects in Africa (regional oxygen manufacturing investments) demonstrate how local capacity improves emergency surgical and peri-operative care. Local manufacture shortens lead times and insulates health systems from export restrictions.

2.5 Research, innovation & measurement

PASHeF called for improved monitoring systems and research networks. Local R&D increases the pipeline of context-appropriate technologies (low-power, maintainable, affordable) and creates locally generated evidence (clinical trials, HTA) to inform procurement and scaling. The continent needs more device trials and regulatory capacity; building R&D offerings into PASHeF’s science agenda helps fill that gap.

3. Evidence that local production improves equity & cost-effectiveness (selected studies)

Economics of investing in surgical systems. The Lancet Commission on Global Surgery showed that scaling surgical care is not only health-effective but economically justified; subsequent cost-effectiveness/ROI work found very large societal returns for investments in surgical care (examples: >10:1 societal ROI in some analyses). This makes the argument that investing in local device ecosystems (as an upstream enabler of surgical scale-up) is economically rational.
WHO & AFRO policy evidence. WHO AFRO’s 2024 framework to strengthen local production sets targets and shows that building local manufacturing capacity for medicines, vaccines and health technologies increases availability and affordability and can capture a greater share of the market locally — a mechanism that PASHeF can leverage for devices needed in surgery.
Case studies: oxygen & ventilator responses. The Unitaid/partners oxygen initiatives and multiple university-led ventilator projects during COVID demonstrated that local manufacture (or regional scaling) can rapidly increase access to critical surgical/anaesthesia supports and reduce dependence on volatile imports. These initiatives are explicit models for PASHeF roadmap actions on emergency preparedness/oxygen security.
Procurement & whole-life cost research. Studies of medical equipment procurement in African settings show that procurement decisions rarely consider maintenance and lifecycle costs — a market failure that local manufacture and local servicing can correct by making maintenance & spares accessible and by aligning incentives for durable design. Align PASHeF procurement reform goals here.
Localisation studies & roadmaps. Empirical reports (IEJ LoMMiA, NEPAD priority products) identify concrete policy instruments — tax incentives, skills development, public procurement set-asides and regional hubs — that increase local production viability. These are programmatic levers PASHeF can adopt.

4. Concrete examples & cross-references (how it plays out on the ground)

Rwanda/UGHE & PASHeF hosting: the forum itself is hosted from Kigali and tied to local research networks (UGHE) — a model for country ownership and research-to-policy translation. PASHeF’s consensus was produced with technocrats and researchers collaborating — precisely the environment needed to incubate device R&D partnerships.
Oxygen regional manufacturing (East Africa): Unitaid/CHAI/MedAccess investments to expand liquid oxygen production show how local manufacturing solves a direct surgical bottleneck (oxygen for anaesthesia, critical care) and reduces peri-operative mortality risks. PASHeF can formalize oxygen manufacturing as a continental priority and connect it to NSOAPs.
Kenya and early medtech clusters: country case-studies (Kenya, South Africa) show private sector interest and nascent clusters for medical equipment; with supportive procurement rules and finance they can scale to supply neighbouring countries under AfCFTA/regional hub models referenced in NEPAD’s roadmap.

5. Policy actions PASHeF should prioritize (operational, evidence-based)

Embed device manufacturing targets in NSOAPs: Add metrics for local production share, spare-parts availability and mean time-to-repair into the NSOAP M&E frameworks. (Links PASHeF roadmap to operational indicators).
Public procurement reform: Move from lowest-capital-price to total cost of ownership scoring; include local manufacturer scoring in tenders and dedicate pilot procurement pools to locally made devices. (WHO procurement guidance & country procurement studies).
Regional manufacturing hubs + financing: Leverage NEPAD/AUDA’s priority-product roadmap to create specialty hubs (oxygen, consumables, sterile processing equipment, simple laparoscopic sets) with concessional financing and technical assistance.
Strengthen regulation & standards: Invest in national/regional regulatory harmonization (African Medicines Agency model + device standards) so locally made devices can move across borders. PASHeF’s secretariat should coordinate device regulatory capacity building.
Build the clinical-engineering pipeline: Fund university-industry apprenticeships, certification curricula for biomedical technicians, and in-service training to ensure devices stay functional — directly tied to PASHeF’s workforce and quality pillars.
Fund translational R&D & trials: Provide grants for device adaptation studies, safety/efficacy trials in African settings, and HTA to inform purchasing decisions. PASHeF’s research agenda should include device evaluation targets.

6. Measuring success — suggested indicators (aligned with PASHeF and NSOAPs)

Percentage of essential surgical devices with local supply of spare parts within 72 hours.
Device uptime % for operating theatres (target >90%).
Proportion of hospital procurement budget awarded to domestically manufactured/assembled devices.
Number of certified biomedical technicians per 100 hospital beds.
ROI and catastrophic expenditure reductions for surgical patients (tracked via household surveys).These metrics translate PASHeF’s high-level commitments into measurable operational targets and can be monitored by the proposed PASHeF secretariat and national NSOAP dashboards.

7. Risks & mitigations

Risk: Pretend-manufacturing where “local content” is superficial (final assembly only) and not resilient.Mitigation: Phased targets (parts localisation; skills transfer), enforceable local content rules, and technical assistance. (NEPAD & WHO frameworks provide templates.)
Risk: Public procurement slow payments harm SMEs.Mitigation: Escrow / advance payment mechanisms, contract security, and vendor finance support (public-private credit lines). (Seen in SA masterplan drafts and IEJ analyses.)
Risk: Regulatory gaps create unsafe devices.Mitigation: Invest in regulation and conformity assessment capacity as an early priority (WHO/AFRO guidance).

Conclusion

PASHeF II’s roadmap is a clear call for implementation. To turn commitments into operating theatres with functioning equipment, the forum’s policy agenda must make local R&D and manufacturing of medical devices a first-order operational objective. Doing so reduces costs over time, increases supply resilience, creates jobs and skills, and — crucially — brings surgery closer to the rural, poor and underserved communities PASHeF was convened to serve. The international evidence and regional roadmaps are aligned: make devices local, make maintenance local, and make procurement and policy support both. The return — in lives saved, disability averted, and economic productivity regained — is substantial.

References:

Alayande BT, Seyi-Olajide JO, Fenta BA, et al. The Pan-African Surgical Healthcare Forum: An African qualitative consensus propagating continental national surgical healthcare policies and plans. PLOS Global Public Health. 2024. PLOS
PASHeF (forum pages / reports) — University of Global Health Equity coverage & PASHeF website. University of Global Health Equity+1
WHO Regional Office for Africa. Framework for strengthening local production of medicines, vaccines and other health technologies in the WHO African Region. 2024. WHO | Regional Office for Africa
Meara JG et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015. The Lancet
Nicholson CP et al. Cost-effectiveness / ROI analyses for surgical care (PLOS Global Public Health). 2024. PLOS
NEPAD / AU: 24 Priority Medical Products and Road-map for Regional Manufacturing in Africa. (regional manufacturing priorities). AfricanLII
Unitaid / CHAI / MedAccess regional oxygen manufacturing initiative (East Africa). Clinton Health Access Initiative
WHO. Towards improving access to medical devices through local production: case studies. 2016. World Health Organization Apps
IEJ LoMMiA project: Localisation of Medical Manufacturing in Africa (case studies including Kenya). 2022. Institute For Economic Justice
Peters AW et al. Developing NSOAPs: framework and country experiences. (NSOAP literature). PMC+1
Cuncannon A et al. Sterile processing in LMICs: implications for safe surgery and infection control. 2020. PMC