Availability and affordability of essential medicines in African low- and middle-income countries: a systematic review and meta-analysis (2014-2025)
Abstract
BACKGROUND: Access to essential medicines remains a critical challenge in African Low- and Middle-Income Countries (LMICs), directly impacting the achievement of Universal Health Coverage (UHC) and health-related Sustainable Development Goals (SDGs). METHODS: I conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. Six databases (PubMed/MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and African Journals Online) were searched from January 2014 to December 2025. Quantitative studies reporting on availability and/or affordability of WHO essential medicines in African LMICs were included. To ensure methodological rigor despite single authorship, independent verification was sought for screening and data extraction through consultation with a colleague, and all processes were documented transparently. Random effects meta-analysis was conducted, with subgroup analyses by sector, therapeutic category, region, and time period. RESULTS: From 5,127 identified records, 52 studies met inclusion criteria, representing 34 African LMICs. Meta-analysis revealed pooled public sector availability of 48.1% (95% CI: 42.5–53.7; I²=86.7%), significantly below the WHO target of 80%. Private sector availability was higher at 70.3% (95% CI: 64.1–76.5; I²=83.2%). Marked therapeutic disparities existed: communicable disease medicines showed 59.1% availability compared to 37.4% for non-communicable disease medicines in public sectors. Affordability analysis…
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