Health Access for universal distribution of life saving drugs in South Africa

Abstract

Access to essential medicines is a critical determinant of health equity and a prerequisite for achieving Universal Health Coverage (UHC). In South Africa, progressive policy instruments such as the Essential Medicines List (EML), Standard Treatment Guidelines (STGs), and decentralised initiatives like the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme have been introduced. However, equitable access remains constrained by systemic inefficiencies and user- side barriers. This study adopts a qualitative, literature-based approach guided by the Levesque conceptual framework to examine how access is conceptualised and operationalised within the public health sector. Findings reveal persistent provincial disparities in medicine availability, recurrent stockouts, limited adoption of digital inventory systems, and user-level challenges including health literacy gaps, indirect costs, and reduced engagement with care. Comparative insights from low- and middle- income countries highlight the effectiveness of decentralised procurement, community-based delivery, and public-private partnerships in improving access. Policy recommendations include institutionalising Health Technology Assessment (HTA), investing in digital supply chain infrastructure, expanding community delivery models, and mitigating user-side burdens through targeted interventions. The study concludes that sustainable improvements in access require an integrated, equity-driven approach that strengthens system responsiveness while enhancing user agency.