Annual Report

A changing context for global health

COVID-19 underlined the lifesaving power of scientific and medical innovation. It also brought into sharp focus the extent and consequences of unequal access to healthcare.


2020 Highlights

A health and economic catastrophe

On 11 March 2020, the World Health Organization (WHO) declared the SARS-CoV-2 virus (COVID-19) a pandemic. By then, an estimated 114,000 people had already been infected and almost 4,300 had lost their lives. The WHO estimated that by the end of 2020 there had been 83 million COVID-19 cases and the infection had claimed 1.8 million lives. COVID-19 also threatens to undo decades of progress against other diseases.

How we responded

  1. We agreed our first procurement guarantee. In July 2020 we announced a $50 million guarantee to support UNICEF’s procurement of essential COVID-19 supplies.
  2. We assessed opportunities for guarantees to support emerging COVID-19 products. We brought our expertise to discussions on how to incentivise at-risk production of not-yet-approved products.
  3. We remained focused on rigour, remotely. When international travel stopped, we quickly reimagined how we monitor our existing guarantees and conduct diligence on new opportunities.
  4. We became a hybrid working organisation. After shifting seamlessly to home working in March 2020, we took the decision to become a fully hybrid working organisation from 2021.
  5. We developed a new strategy for a new era. Our new strategy gives us a wider range of tools and expands the range of diseases we focus on and where we work in the healthcare value chain.

Financing the future

Progress towards every Sustainable Development Goal has been adversely affected by COVID-19, not least Goal 3, which focuses on human health. In this difficult environment, it is more important than ever to maximise the impact of every dollar invested in global health.

Our tools reduce the risks all sides face in uncertain markets, enabling manufacturers to bring their products to new territories and reach more people while securing lower ceiling prices and stable supplies for procurers.

Development impact

These results estimate the total impact achieved through the guarantee and related activities undertaken by partners, including MedAccess. No deductions have been made for impact that may have occurred without a guarantee, although MedAccess does calculate this for investment decision making purposes. For more on our methodology see our website.

From the Board Chair and the CEO

“Our guarantees give suppliers and procurers confidence to act, enabling them to reach more patients with more healthcare products at lower prices.”
“I expect innovative finance and market shaping organisations have an increasingly important role to play in ensuring that people do not miss out on healthcare.”

Partnering for impact

Discover how our three guarantees are increasing access to healthcare.


Expanding access to viral load testing

Volume guarantee
Aim Reduce the price of viral load testing for HIV, hepatitis B and hepatitis C, and diagnostic testing for human papillomavirus (HPV).
Guarantee Partners Hologic | CHAI
Impact to date 2.5 million tests procured leading to improved clinical outcomes for at least 445,000 people.

Reducing the price of next-generation mosquito nets

Volume guarantee
Aim Reduce the price of and accelerate access to next-generation mosquito nets in malaria-endemic countries.
Guarantee Partners BASF | The Bill & Melinda Gates Foundation
Impact to date 11.9 million next-generation mosquito nets distributed, averting 6.7 million cases of malaria.

Increasing access to essential COVID-19 supplies

Procurement guarantee
Aim Secure and distribute vital COVID-19 supplies in LMICs.
Guarantee Partners UNICEF
Impact to date COVID-19 supplies delivered in 55 LMICs and non-COVID supplies delivered in 26 LMICs.

How we work

We help companies reach more people with life-changing healthcare products

Our approach focuses on deploying the appropriate financial product for the market, for our partners and ultimately for patients. We select high-quality partnerships and apply rigorous standards of due diligence when underwriting guarantees and analysing the potential impact of these guarantees.

We work with civil society, healthcare providers, policymakers, suppliers, donors and procurers, who are all committed to increasing equitable access to healthcare.

We scope opportunities through active monitoring of developments and trends in healthcare and innovative financing. This includes:

The healthcare financing landscape
Disease burden trends
Innovations in the pharmaceutical, diagnostics, and devices industries
Shifts in the market dynamics of specific healthcare products

Stakeholders across the healthcare ecosystem play a vital role in ensuring MedAccess guarantees ultimately deliver the intended development impact.

Read more

Our financial products

What is a volume guarantee?

The objective of a volume guarantee is to increase supply and lower prices while taking on risks that manufacturers face when entering new markets.

How a volume guarantee works

Financial flows
Potential financial flows
Product flows

Healthcare market inefficiencies

Uncertainties such as poor data, uncertain demand, unreliable funding and unpredictable regulation can make markets appear risky for manufacturers.
Procurers face higher costs in fragmented and uncertain markets. In some cases, manufacturers may decide not to register, sell or distribute their product at all.
Healthcare providers can only provide products if they are available and affordable. Doctors are reluctant to prescribe products when supply is uncertain as stockouts can have a significant effect on patients’ health.
Patients are unable to access the medical products they need when they need them. In some cases it can take years, or even decades, for healthcare products to reach people in Africa and Asia

Healthy markets

Short-term benefits
Opportunities to reach more people with healthcare products. Cost savings from production optimisation.
Long-term benefits
Economies of scale achieved through long-term planning. Greater incentives to make products available for diseases that typically affect people in LMICs.
Short-term benefits
Financial savings that can be used to procure larger volumes of products under volume guarantee or reinvested into other healthcare priorities.
Long-term benefits
Long term affordability and supply security as volume guarantees demonstrate demand in the market, making it more likely that other suppliers will join.
Short-term benefits
Stable access to innovative, quality-assured healthcare products.
Long-term benefits
Healthier and more economically active populations. Protection from price spikes when moving to domestic financing.
Short-term benefits
Accelerated access to innovative products that save lives and improve health.
Long-term benefits
Improved long-term health outcomes and greater empowerment on health decision-making. Reduced risk of economic hardship through punitive healthcare costs.that other suppliers will join.

What is a procurement guarantee?

The objective of a procurement guarantee is to enable procurers to accelerate and increase high-volume procurement so that supplies reach those who need them more quickly.

Development impact:
The heart of our mission

Our mission is to increase access to affordable healthcare. We measure the impact of our work using a Development Impact Framework comprising three indicators:


We estimate the impact of each opportunity against three indicators by comparing the expected outcomes against a counterfactual situation, where we are not involved. This ensures we only capture the additional impact generated by a MedAccess guarantee.

Our framework is based on four principles:

Balancing rigour and pragmatism, making careful, evidence-based assumptions where required.
Focusing on the direct outcomes resulting from our involvement, rather than the impacts that follow.
Focusing on our contribution to the change, rather than attribution, as we always work in partnerships.
Accompanying quantitative data with qualitative evidence.

Our values

Everything we do at MedAccess is underpinned by our five core values. Individually and collectively, we strive to live by our values every day.

We are mission-driven

We make decisions based on the development impact that MedAccess can achieve.

We go further than expected in the pursuit of our mission.

We actively seek out knowledge on emerging trends and ideas in health and social finance.

We are humble

We recognise the remarkable achievements by others in the global health space over the past 20 years and we seek to learn from their experiences.

We actively solicit feedback on our work.

We always seek to champion the work of our partners and others committed to improving lives and livelihoods around the world.

We are relentless about rigour

We base our decision on the highest quality data available.

We are continuously curious; asking questions and challenging assumptions to deepen our understanding.

We review and refine our work to ensure we deliver the best possible outcomes.

We embrace scrutiny

We are open, honest and transparent in all areas of our business.

We are fully accountable, as individuals and as a team, for our decisions.

When we make mistakes, we acknowledge and learn from them quickly.

We build trust

We value and nurture positive relationships at all levels.

We keep our word and follow through on our commitments internally and externally.

We recognise people as individuals and invest time in their emotional wellbeing.


Financial report

“In 2020, MedAccess displayed a resilient performance in a challenging environment. Our balance sheet remained robust, supporting the growth in scale and scope of our guarantee portfolio enabling us to continue serving our partnerships and creating meaningful impact.”

Dr. Michelle Teo,
Chief Investment Officer

Financial highlights

Our year-end net guarantee exposure was $58.4 million (2019: $26.5 million), reflecting the addition of the $50.0 million procurement guarantee and the discharge of $18.0 million of commitments over 2020.

Operating costs increased 72% to $7.2 million in 2020 (2019: $4.2 million), reflecting the growth in the business and continued investment to support the delivery of the Company’s strategic objectives.

Find out more

Download our 2020 Annual Report