Hamza Asumah, MD, MBA, MPH
The Brutal Truth About Hospital Sales Cycles
You’ve built a great product. Your pilot went well. The hospital CEO said “yes, we want this.”
And then…nothing. For 18 months.
Welcome to African hospital procurement. It’s not B2B. It’s not even B2G. It’s a multi-stakeholder, politically influenced, budget-constrained, donor-entangled decision-making process that resembles a Kafka novel more than a sales funnel.
Medicine procurement is undertaken through an open centralized tender system, with the National Department of Health entering into contracts on behalf of provinces. Your champion at the hospital? They don’t control the budget, don’t control procurement, and often don’t even control what gets purchased for their own department.
Why Pilots Stall (And How to Prevent It)
The pattern is depressingly consistent:
- You demo to clinicians. They love it.
- You run a 3-month pilot. It works.
- You wait for the purchase order. It never comes.
Here’s what actually happened:
The clinician doesn’t control procurement. Purchasing agents and other decision-makers have procurement objectives that must be met, focusing on cost savings while meeting criteria for medical equipment they need. The person who loves your product isn’t the person who buys it.
Budget cycles are rigid. Most public hospitals work on annual budgets set 6-12 months in advance. If your pilot completes in March and their budget was finalized in October, you’re waiting until next fiscal year—even if they want to buy today.
Buy-outs are painful. Buy-outs—the process used by hospitals to purchase medicines appearing on essential medicines lists but not on tender—face significant challenges. If your product isn’t on tender, procurement has to justify it. That’s bureaucracy few are willing to navigate.
Who Actually Makes Buying Decisions?
The org chart lies. Here’s who really matters:
1. Value Analysis Teams (VATs)
Value Analysis Teams can include hospital administrators like the hospital CEO, CFO, and CMO, as well as board members. These committees evaluate cost-effectiveness, not just clinical utility. Your champion clinician gets one voice at a table with finance, administration, and external stakeholders.
2. Procurement Officers
They control the actual process. Procurement officials can deliberately set requirements and purchase products that are not needed, primarily because the official has demanded or will receive a personal benefit from the supplier. That’s not just theory—it’s a documented risk in African healthcare procurement.
What this means: You need multiple champions. Clinical excellence isn’t enough. You need someone in procurement who understands your value, someone in finance who sees ROI, and an executive sponsor who cares enough to push through resistance.
3. Donor and Development Partners
Here’s the part nobody talks about: International donor agencies and governments engage in procurement partnerships, with donors sharing financial and technical resources while countries provide human resource and health system capacity.
If USAID, Global Fund, or Gates Foundation is funding the hospital’s priority programs, they often influence what gets purchased. This is why understanding donor priorities matters as much as understanding the hospital’s needs.
The Real Sales Cycle
Months 0-3: Relationship Building
- Identify multiple champions across clinical, finance, procurement
- Understand budget cycles and tender schedules
- Map decision-making authority (it’s never where you think)
Months 3-6: Pilot Execution
- Structure pilot to generate quantifiable ROI data
- Document cost savings, efficiency gains, patient outcomes
- Get written endorsements from multiple stakeholders
Months 6-12: Navigating Procurement
- Help procurement draft tender specifications (without writing them yourself)
- Provide complete documentation package proactively
- Identify budget source: operating budget, capital budget, or donor funding
Months 12-18: Actually Getting Paid
- Even after purchase approval, payment can lag 6-12 months
- Cash flow planning must account for this reality
- Some startups factor payment delays into pricing
Shortening the 18-36 Month Cycle
Strategy 1: Get on Tender Lists
After tenders are awarded by the National Department of Health to suppliers, provincial depots perform quantification and procurement on behalf of facilities. Being pre-approved on tender lists eliminates the biggest friction point.
How: Work with procurement associations, attend tender briefings, build relationships with central medical stores at provincial/national level.
Strategy 2: Donor Alignment
If your product addresses donor priorities (HIV, TB, maternal health, NCDs), partner with implementing organizations. Donors like USAID prompt governments to use health economic and ethical criteria in defining basic and hospital care packages.
Practical tactic: Get approved by UNICEF, WHO, or Global Fund supply mechanisms. Hospital procurement officers are far more comfortable buying products with multilateral backing.
Strategy 3: Value-Based Contracting
Shift from “buy this device” to “we’ll improve outcomes and you pay for results.” Several African markets are experimenting with risk-sharing models where payment is contingent on demonstrated savings or improved patient outcomes.
Example: Rather than selling diagnostic equipment upfront, offer it on consignment with payment per test. The hospital’s cash flow improves, their budget approval process simplifies, and you get paid as value is delivered.
What Actually Influences Buying
Research shows clear patterns:
Budget constraints, experiences from past procurement cycles, political and cultural support, and equity considerations all influence prioritization decisions.
This means:
- Price matters more than value in year one. Get cheaper initially, prove value, then reprice.
- Past vendor performance matters. If hospitals have been burned by failed implementations, they’ll be cautious.
- Political endorsement accelerates decisions. Products endorsed by Ministry of Health or professional associations move faster.
The Corruption Question
Let’s address it directly. Corruption in procurement wastes resources and potentially leads to dangerous products entering the health system, with the high volume and value of healthcare contracts making this a high corruption risk.
You will encounter procurement officers who hint at unofficial payments. Here’s the principled position that’s also commercially smart: Don’t.
Why? Because:
- It’s illegal and unethical
- It rarely solves the underlying procurement dysfunction
- It creates a business model you can’t scale or defend
- The competitive advantage goes to whoever pays the most, not who delivers the most value
Instead: Work with transparency initiatives, participate in open contracting platforms, and build a reputation for clean business practices. It’s slower initially, but it’s the only path to sustainable scale.
Case Study: What Works
Field Intelligence (Shelf Life product – Nigeria): Rather than selling directly to hospitals, they enabled community pharmacies with inventory financing. When hospitals needed reliable medicine supply, Shelf Life-powered pharmacies became the distribution channel. They bypassed hospital procurement entirely.
Helium Health (Nigeria/West Africa): Offered hospital management systems on SaaS subscription, priced low enough to fit operating budgets rather than requiring capital expenditure approval. This moved purchase decisions from procurement committees to department heads with discretionary budgets.
mPharma (Ghana/Kenya/others): Built managed care networks that hospitals could plug into rather than procuring individual products. The value proposition shifted from “buy our product” to “join our network and improve patient access.”
Your Action Plan
- Map decision-making before demoing. Understand budget cycle, tender status, donor relationships, and decision authority. This takes 2-3 months of research but saves 12-18 months of waiting.
- Structure pilots for procurement success. Generate the specific evidence procurement and finance need: cost per patient, efficiency gains, staff time savings. Clinical outcomes matter, but ROI decides procurement.
- Build champion networks, not single champions. You need at least one person in clinical, finance, procurement, and executive leadership actively advocating. Lose any one, and your deal stalls.
- Align with national priorities. Study the National Health Strategic Plan. Products that advance government priorities get faster approval.
- Consider alternative commercialization. Direct hospital sales isn’t the only path. Distribution partnerships, donor channels, and private provider networks often move faster.
The hospitals that move fastest are often the ones with the most pain and the least bureaucracy—typically faith-based hospitals, private hospitals, or public hospitals with strong leadership willing to champion innovation.
Public sector sales isn’t impossible. But success requires understanding that you’re not selling technology—you’re navigating institutional decision-making, budget constraints, and political dynamics.
The founders who win don’t have the best product. They have the best understanding of how decisions actually get made.
Dr. Hamza Asumah 
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