Access to equitable medicines in a resourceconstrained environment. A mixed-methods study from rural Zimbabwe

Abstract

Inequitable access to essential medicines persists in rural areas due to systemic distribution failures, creating critical evidence gaps for addressing health disparities. In Zimbabwe, where more than 61% of the population resides in rural areas, the determinants of access to medicine remains poorly understood. This study aimed to determine the factors affecting access to medicines in subsistence markets in Zimbabwe. The study was guided by a conceptual framework based on the WHO’s dimensions of healthcare access. Amixed methods study was conducted in four rural districts in Zimbabwe using data collected from January 2024 to June 2024. Quantitative data collected from residents, healthcare providers and community leaders were analyzed using linear regression, while thematic analysis was used to analyze qualitative information. Geographical accessibility (13% effect, p < 0.05), adequacy (7% effect, p < 0.1), and affordability (5% effect, p < 0.1) significantly improved access to medicine. Household head education showed a minor positive impact. Qualitative analysis revealed four main themes, financial barriers (poverty, lack of insurance, catastrophic costs), geographic accessibility, supply chain failures, and quality of care. Findings confirm that geographical access, affordability, and adequacy are critical levers for improving medicine access in rural Zimbabwe, aligning with studies in similar resource-constrained settings. Policymakers should focus on improving medicine access, prioritizing rural populations as they form the national majority. Healthcare facilities should implement strategies to reduce geographical barriers and improve medicine availability. Future research should conduct cross-country comparative analyses. This study provides integrated evidence to advance Universal Health Coverage in rural contexts.