Availability of essential medicines for non-communicable diseases: a scoping review of challenges and opportunities

Given the critical role of medicines in reducing the burden of non-communicable diseases (NCDs), we analysed factors that hinder the availability of quality medicines for managing NCDs at the point of service delivery, with a particular focus on low-income and middle-income countries.

In this scoping review, literature published in PubMed, Embase, Web of Science, the World Bank eLibrary and the WHO's Institutional Repository for Information Sharing (WHO IRIS) was collected (January 2009-May 2025). Literature was excluded if it did not specifically address NCD medicines, discussed global rather than national determinants of availability only, failed to detail supply chain inefficiencies or exclusively reported on other dimensions of access (ie, pricing/affordability, trial access, regulatory access). From cross-sectional assessments of medicine availability, mean availability was extracted, and from quantitative, interventional studies, details on the intervention and its effectiveness on NCD medicine availability were extracted. From the remaining studies, descriptions of barriers and recommendations or empirically proven interventions to improve availability were extracted and mapped according to the pharmaceutical value chain (PVC).

Our review of 3348 records identified 83 eligible studies. The mean availability of NCD medicines reported in cross-sectional surveys was suboptimal (<80%) in 39 of 46 surveyed countries. We found barriers to available NCD medicines across all components of the PVC. Deficiencies in governance, financing, the health workforce, health information systems and service delivery underscore the interlinkage of various health system building blocks and stakeholders in determining availability. Nonetheless, most barriers pertained to supply chain inefficiencies, followed by challenges in regulatory systems and quality monitoring.

The evidence highlights the need for political commitment to NCDs, broad stakeholder involvement, integrated stock management systems and increased human resources to make NCD medicines more available to patients worldwide.