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

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