# Access to Essential Medicines in Low- and Middle-Income Countries: A Systematic Review of Barriers and Facilitators

## TL;DR

This paper reviews barriers and facilitators to accessing essential medicines in low- and middle-income countries, focusing on availability, affordability, and proper use.

## Contribution

The study systematically compiles evidence on barriers and facilitators to essential medicine access in LMICs, emphasizing policy implications.

## Key findings

- Barriers like public sector stock-outs and high private sector prices were more frequently reported than facilitators.
- A national essential medicines list was identified as a key facilitator for improving access.
- Policies favoring generic drugs and addressing public-private disparities are crucial for equitable access.

## Abstract

To conduct a systematic review to analyze the barriers and facilitators related to accessing essential medicines in low- and middle-income countries (LMICs).

We searched PubMed, SciELO, LILACS, and Web of Science for studies published between 2002 and 2025. Studies were included if they were peer-reviewed, written in English or Spanish, and reported data on barriers or facilitators across three dimensions: availability, affordability, and adequate use.

From 1010 identified records, 36 studies were included. Most were quantitative (n = 26), followed by qualitative (n = 8) and mixed-methods (n = 2) designs. Barriers (n = 34 studies) were reported more frequently than facilitators (n = 25), particularly for availability and affordability. Key barriers included public sector stock-outs and high prices in the private sector. A key facilitator was the presence of a national essential medicines list.

Our analysis compiles evidence on barriers and facilitators affecting access to essential medicines in LMICs. Policies favoring generic drug procurement and public–private sector disparities highlight the complexity of ensuring equitable access.