Availability and affordability of essential medicines in African low- and middle-income countries: a systematic review and meta-analysis (2014–2025)

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). 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. 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 demonstrated that treatments for acute conditions required a median of 2.1 days’ wages (IQR: 1.5–3.2) in private sectors, while chronic disease treatments required 6.4 days’ wages (IQR: 4.3–9.1). Overall, 24.1% (95% CI: 20.3–27.9%) of households experienced catastrophic health expenditure from medicine purchases. Intervention analysis showed supply chain digitization improved availability by 31.7%, while social health insurance improved affordability by 32.6%. Essential medicines in African LMICs remain critically unavailable in public sectors and often unaffordable in private sectors, with significant geographical, therapeutic, and socioeconomic disparities. These findings underscore the urgent need for transformative system-wide reforms addressing supply chain resilience, sustainable financing mechanisms, regulatory harmonization, and equity-focused approaches to achieve essential medicine access for all populations.