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<h3>Background and Importance</h3> Access to medicines remains a global challenge in low- and middle-income countries, with Sub-Saharan Africa (SSA) facing specific barriers. This issue is often examined through five key dimensions: availability, affordability, accessibility, acceptability, and quality of medicines. <h3>Aim and Objectives</h3> The PHARMAF study aimed to describe hospital pharmacists’ roles and assess key barriers to medicine access in SSA. <h3>Material and Methods</h3> Between January and May 2025, semi-structured interviews were conducted with hospital pharmacists. Data analysis used R (v4.5.0). Fisher’s exact test compared availability, affordability, accessibility, and quality variables by hospital type (university vs non-university) and country income level (low vs middle income). <h3>Results</h3> Twenty-four pharmacists from 14 countries (10 low- and 14 middle-income) participated. Availability of medicines emerged as a major concern. Essential medicines such as analgesics, anti-infectives, and anaesthetics were available in all hospitals (100%). However, anticancer medicines were available in only 43% (10/23), and oral antidiabetics in 74% (17/23). In 58% (14/24) of cases, respondents indicated certain medicines were unavailable in their country (with inconsistent responses from four countries), and 29% (7/24) reported shortages. Anticancer and anaesthesia-related drugs were the most cited as desired but unavailable. Regarding accessibility, the mean number of pharmacists per 100 beds was 2.0±3.3, non-medical pharmacy staff averaged 2.9±4.2 per 100 beds. Hospitalised patients often retrieved and paid for their own medicines from the hospital pharmacy. Affordability remained a key issue: 33% (8/24) reported medicines were inaccessible in their country due to high cost. Most hospitals 67% (16/24) required external patients to pay the full cost of treatment; only 25% (6/24) had any health system coverage. Quality control was mainly through visual inspection (88%, 21/24), with one pharmacist reporting spectrophotometric analysis. In all hospitals, there was a formal reception committee composed of a pharmacist and a finance representative to verify deliveries and prevent theft or mismanagement. Statistical analysis test showed no significant differences by hospital type or country income level regarding the availability, affordability, accessibility, and quality control variables presented above. <h3>Conclusion and Relevance</h3> Despite an adequate pharmacist-to-bed ratio, access to medicines remains limited across SSA, with affordability and availability being key concerns. Findings highlight the urgency of regionally adapted strategies to improve access to medicines. <h3>Conflict of Interest</h3> No conflict of interest