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Background. Access to safe, effective, quality and affordable essential medicines has become a key agenda at national and international levels following the adoption of the Sustainable Development Goals (SDG). This agenda is especially important in African countries where numerous studies have found high levels of medicine unavailability and unaffordability. In 2003, the World Health Organization (WHO)/ Health Action International (HAI) published a manual for assessing medicine availability and affordability. To date, there has not been a systematic study appraising medicine affordability and availability studies in the Africa region that identifies the methodologies and measures used to measure and monitor progress. Methods. We conducted a systematic scoping review of studies assessing medicine availability or affordability conducted in the WHO Africa region in the years 2009-2021. Results. 244 articles met our eligibility criteria. A majority (87%) of the articles reported descriptive studies, while 11% reported interventional studies. More than two-thirds (68%) reported studies conducted in four countries in eastern Africa. The most commonly studied medicines were antiparasitic and anti-bacterial medicines. The most commonly used measures of medicine availability were whether a medicine was in stock on the date of a survey, whether stockouts occurred during a particular period, whether a medicine was on a stock list, amount of stock available, respondent self-reported availability and prescription refill data. Of the 59 articles that included affordability measures, 39 compared the price of the medicine to the daily wage of the lowest paid government worker. Other affordability measures were patient self-reported affordability, capacity to pay based on individual income and expenses, and comparing medicines prices with a population-level income standard (such as minimum wage, poverty line, or per capita income). Conclusion. Our results indicate substantial adoption of the medicine availability and affordability assessment methodology recommended by WHO/HAI, but also revealed a promising set of alternative methods and measures. Our review also indicated a need for greater focus on medicines for certain non-communicable diseases, including anti-neoplastics, greater geographic diversity in the countries where these studies are conducted, and more interventional studies to identify interventions for improving access to medicines in the region. |
