Political, economic and infrastructural factors affecting access to essential medicines in sub-Saharan Africa: A structural equation modeling approach

Two-thirds of the people in Sub-Saharan Africa lack access to essential medicines, and the region also bears a huge share of the global disease burden. Faced with inefficient health systems and poor economies, prescription medicines (essential medicines) remain the best option; a lifesaving issue. Despite broad literature discussion on factors that contribute to health sector outcomes that spans across a wide array of sectors, including political and economic factors, the literature is void of research that models the simultaneous effect of these cross sectoral factors on access and how they inter-relate.;To address this research gap, this dissertation study proposes a structural model, using the New Institutional Economics theory and a political-economy model (which includes an infrastructure dimension) as the theoretical foundation, to depict how these multi-sectoral factors collectively contribute to the level of access to essential medicines in Sub-Saharan Africa, and how these various factors interrelate in the process.;Economic factors are shown to affect access to medicines indirectly through political and infrastructural factors. Similarly, political factors are shown to affect "access" directly and indirectly through economic and infrastructural factors. Infrastructural factors are shown to be influenced by both political and economic factors to affect "access". These findings demonstrate that while a causal hierarchy can be established amongst the factors, no single factor exclusively predicts "access", validating the importance of taking an interdisciplinary, inter-sectoral approach to understand the access-to-essential medicines issue. Policy implications are later discussed.