Sustainable access to affordable, quality medicines is an important component of health care but in many African countries it continues to be limited. Commonly reported problems include poor supply chain management, pilfering of stock, insufficient human resources and limited financing resulting in chronic stock-outs. This study aims to gain a better understanding of some of the different ways in which private sector pharmaceutical supply and distribution channels are organized in Africa. To gain a broad perspective, this study focuses on three very different country contexts: Ghana, Mali, and Malawi. These countries represent significant geographic, economic, social and historical differences. The countries in the study come from English and French-speaking Africa; West and South-east Africa; have close ties with European sources vs. links with other African and Indian pharmaceutical supply chains; draw upon common law vs. civil law legal traditions and regulatory frameworks; are dependent upon imports vs. local manufacturing capacity; and rely upon various levels of public and private health care services. The focus of the study is medicines; it does not address reactive or pharmaceutical devices. Interviews were conducted over 1-2 week missions in each of the three countries participating in the study. The project was conducted between July and October 2009. Data were drawn from interviews with actors at each level of the private sector pharmaceutical supply and distribution chain and from secondary sources.