A proposed analytical framework for qualitative evaluation of access to medicines from a health systems perspective

Abstract Objective Despite global recognition that access to medicines is shaped by various interacting processes within a health system, a suitable analytical framework for identifying barriers and facilitators from a system’s perspective was needed. We propose a framework specifically designed to find drivers to access to medicines from a country’s health system perspective. This framework could enable the systematic evaluation of access across countries, disease areas and populations and facilitate targeted policy development. This framework is the byproduct of a larger study on the barriers and facilitators to childhood oncology medicines in South Africa. Results Eight core (pharmaceutical) functional processes were identified from existing frameworks: (I) medicine regulation , (II) public financing and pricing , (III) selection , (IV) reimbursement , (V) procurement and supply , (VI) healthcare delivery , (VII) dispensing and (VIII) use . National contextual components included policy and legislation and health information systems . To emphasize the interlinkage of processes, the proposed framework was structured as a pharmaceutical value chain. This framework focusses on national processes that are within a country’s control as opposed to global factors, and functional mechanisms versus a country’s performance or policy objectives. Further refinement and validation of the framework following application in other contexts is encouraged.