Commentary Contributed by Isaac Agbugblah and Ernest Boamah, Mursi Biosciences 

January 16, 2026 | Africa remains one of the most important yet underleveraged regions in global drug development. The continent carries a substantial share of disease burden but contributes only a small fraction of clinical trial activity. This imbalance is not driven by scientific limitations or lack of patient interest. It reflects structural constraints that traditional site centric trial models have failed to overcome at scale. When viewed through the lens of day-to-day execution, a consistent pattern emerges. Decentralized patient engagement and remote trial operations are not a future aspiration. They are increasingly the most practical and commercially viable path to accelerating research across the continent.    

Scientific capacity across Africa continues to strengthen, with institutions increasingly equipped to support high quality research. Operational reach, not patient willingness, is the binding constraint. In many markets, participants must travel long distances and commit an entire day to attend a study visit. For working adults and rural populations, that burden suppresses enrollment and disrupts follow up. These realities indicate there is less of a lack of readiness and more of the need for trial models that reduce dependence on physical proximity while maintaining appropriate oversight and data integrity. 

Across much of the continent, healthcare engagement is already organized around distributed and mobile driven systems. Communication, service access, and care navigation occur primarily through phones. Digital health platforms supported by governments, NGOs, and private partners enable population scale engagement. Community health workers provide continuity between households and clinical facilities, while logistics networks manage last mile delivery in complex environments. Home based care is routinely used for immunization, infectious disease programs, and chronic disease management. In this context, decentralization is not a departure from existing practice but an extension of it. While these components do not yet form a complete decentralized research ecosystem, they represent the foundational infrastructure on which one can be built. 

Decentralization directly addresses the two largest operational risks in African trials, enrollment, and retention. When participants are no longer required to travel hours for routine visits, the eligible pool expands. When follow-up is supported through teleconsultation, community-based sample collection, and home-based safety checks, participants remain engaged. These outcomes mirror how daily life and care delivery already operate across the continent. Importantly, decentralization also reshapes who can participate. Populations historically excluded from research become reachable through local touchpoints, strengthening the representativeness and scientific value of trial data while supporting more robust global submissions. 

A commercially viable model brings several core elements into a single operating system. It relies on mobile first data capture that performs reliably under variable network conditions. It uses community-based sample collection to reduce travel burden. Home health services support medication delivery, adherence, and routine safety monitoring. Field coordinators anchor patient relationships and ensure operational continuity. Direct-to-patient logistics maintain supply integrity. Real time dashboards provide sponsors with visibility into enrollment, safety, and compliance. Early regulatory engagement ensures alignment around remote consent, teleconsultation, and data governance. Integrated effectively, these elements create a decentralized framework that strengthens existing systems rather than attempting to replace them. 

Momentum in African clinical research will increasingly depend on how studies are structured from inception. Many protocols still reflect assumptions rooted in healthcare systems with dense facility networks, creating avoidable friction around enrollment, travel, and follow up. Embedding decentralization into core trial architecture produces a different outcome. When designed intentionally, it expands reach, accelerates execution, and improves consistency across diverse environments. Over time, this approach also deepens collaboration with local institutions that are already positioned to support modern research delivery. 

Decentralized approaches streamline operations by reducing reliance on large, fixed sites and shifting activity closer to patients. They often shorten enrollment timelines, support continuity across follow-up, and broaden the diversity of contributing data. From a strategic standpoint, these operational efficiencies translate into clearer growth pathways. For global organizations pursuing long term expansion, Africa represents a compelling opportunity defined by a young population and rising demand for accessible healthcare. 

Africa does not benefit from incremental adjustments to models designed for fundamentally different healthcare environments. What delivers impact is an operating strategy aligned with how care, technology, and logistics already function across the continent. Decentralization enables scale without waiting for large infrastructure expansion, increase flexibility for patients, and open new avenues for collaboration with local partners.    

The signals are clear. Institutions are ready. Patients engage when participation is designed around their reality. Organizations that act now will shape how research is conducted over the next decade, establish durable presence in one of the most strategically important growth regions in global health, and build competitive advantage through models that are more inclusive and better aligned with Africa’s operating landscape. 

Isaac Buertey Agbugblah, a clinical researcher, is committed to advancing equitable healthcare solutions in Africa. Formerly a Research Assistant at the University of Health and Allied Sciences in Ghana, he now serves as a Research Associate at Mursi Biosciences. Isaac is dedicated to pioneering innovative solutions in clinical biomarker development. He can be reached at isaac.agbugblah@mursibiosciences.com. 

Dr. Ernest Boamah, a clinical scientist, is committed to advancing clinical drug development in Africa. Having previously held key roles in Translational Development across multiple pharmaceutical companies, he now serves as the Laboratory Director at Mursi Biosciences. His passion for health equity fuels his efforts to shape Africa's healthcare future. He can be reached at ernest.boamah@mursibiosciences.com.