The Journey of Health Digital Wholesalers in LMICs
Tools for scaling access to medicines in LMICs
Development aid is contracting sharply: official development assistance fell 23% in 2025, its steepest drop on record, with bilateral health aid projected to fall by up to a third against 2023 levels. As public financing retreats, reaching patients increasingly depends on the private providers most low-income patients already use: the pharmacies, drug shops and clinics that handle the majority of frontline care in many LMICs (67% of initial care-seeking in Nigeria, 74% in Indonesia, 85% in Pakistan).
Digital wholesalers are well placed to strengthen this frontline: by supplying these outlets reliably and equipping them with services from inventory management to training and basic diagnostics, they can lift both the availability of quality medicines and the standard of care.
That promise is hard to deliver, because the foundation itself is hard. Getting the right medicines reliably to thousands of scattered outlets, at a competitive price and on time, is already demanding, and few ventures have mastered it. Ventures most often stall not for lack of ambition, but because they take on too much too early: inventory before availability, credit before stable operations, new geographies before profitability. The cost is wasted capital and exhausted teams.
The Sanofi Impact Fund, combining patient capital, sector network and portfolio access, has invested in these ventures for over four years, with Hystra as operating partner.
Combining extensive experience with portfolio ventures, which have shared their data and their day-to-day challenges throughout, and exchanges with Sanofi supply chain leaders, Sanofi and Hystra have built two connected tools to help ventures sequence their growth: a map of the journey these businesses go through as they scale, and a field diagnostic that locates a venture on it and sets out its priorities, in order.
The Journey of Health Digital Wholesalers in LMICs sets out performance targets across every part of the business model at three sequential stages of maturity:
Phase 1: Build your foundation. Win over your first loyal customers and earn a “right to play”: a working client interface, a focused product range, competitive prices, and an acceptable level of service. The goal is repeat use, not scale.
Phase 2: Nail it, then scale it. Become the supplier customers cannot do without. First “nail it” by mastering core SKUs, hitting high availability, delivering on-time-in-full and deepening share of wallet. Then “scale it” to new geographies and segments without losing service quality.
Phase 3: Grow beyond drug supply. Transform pharmacies into healthcare destinations through value-added services, such as vendor-managed inventory, patient diagnostics and care, or accredited training.
We have already used the journey twice with Sanofi Impact Fund's portfolio companies, asking top management to rate themselves against each stage. Its value goes beyond the score: it aligns investor, company and management on the maturity of the business, which is a prerequisite to agreeing on strategy, often by surfacing disagreement no one knew was there.
To go further, we have built a Diagnostic Tool that can be run over a few days of field visit. The method is deliberately light: it looks for the signals that expose the real constraints, rather than auditing everything. It enables for example to identify client satisfaction issues by shadowing a sales agent, or tied up capital based on a quick (but systematic) warehouse visit.
Both tools work as a facilitated exercise, not a self-serve download. The framework shows the shape of the journey, but the true value sits in the voice-over provided and the debate it opens with a management team.
Get involved
These are work-in-progress materials, developed jointly by the Sanofi Impact Fund and Hystra, and we expect them to keep evolving as we learn from more ventures and co-investors. If you are one of these innovative entrepreneurs tackling last-mile access challenges, we'd love to take you through the journey, and share the diagnostic tool. Reach out to François, Guillaume or Alice at Hystra, or to the Sanofi Impact Fund team to connect.
Developed by Hystra with the Sanofi Impact Fund. © Sanofi Impact Fund - shared for discussion; please do not reproduce without attribution.