Contextualising access to essential medicines: Lessons learned from East and Southern Africa

Worldwide, more than 2 billion people lack access to medicines, leading to more than 10 million people dying needlessly as a result of this lack of access. Most of these deaths occur in Sub-Saharan Africa. To gain a deeper understanding of how barriers at different levels of the health system influence access in the region, and what lessons might be learned, this thesis focussed on three distinct cases: internationally controlled essential medicines (medicines listed on WHO’s Essential Medicines List and one of three international drug control conventions, such as morphine and phenobarbital), the treatment of snakebite envenoming, and commodities for sexual and reproductive health (SRH). Using these three cases, this thesis demonstrated that access to medicines remains a critical issue for the majority of people living in Sub-Saharan Africa. It shows that while access to essential medicines for specific care fields or diseases may be subject to topic-specific barriers, many of the barriers are transcendent and are the result of an interplay of conditions across the health system that affect all areas of access. By looking at the similarities between care fields and diseases, and not the dissimilarities, this thesis has shown that a system-wide approach is needed to strengthen health systems in the Sub-Saharan region. Such an approach should be targeted at individuals, households and the community, the delivery of health services, and governance at the health sector, national and international level. A complex issue such as this needs active involvement from all actors, including patients and communities, community- and faith leaders, healthcare workers, civil society, governments, researchers, and international actors.