Essential medicines out of reach: a cross-sectional study of community-level access in Eastern Uganda

Access to essential medicines is a critical indicator of a country’s commitment to public health, yet significant barriers persist in sub-Saharan Africa. In Eastern Uganda, most studies have focused on pharmaceutical supply chain-related factors that limit access to essential medicines, while community and patient-related factors, which are also major contributors, have been largely neglected. To assess the extent and determinants of access to essential medicines at the community level in Eastern Uganda, using a multidimensional WHO-aligned framework. This was a household-based, cross-sectional survey conducted in the rural and urban communities of the Kibuku, Kapchorwa, and Mbale districts of Eastern Uganda, between February and April 2025. The household representatives were selected using multi-stage sampling. Access to essential medicines was defined using the five-point tool, comprising; availability, affordability, acceptability, accessibility, and accommodation/adequacy. Full access necessitated accomplishing all five criteria for the most recent episode of acute illness. Descriptive statistics were conducted to summarize participant characteristics, and bivariate and multivariable logistic regression to identify independent predictors of medicine access. Only 8.55% of households reported access to essential medicines. Key challenges included frequent medicine stock-outs (72.52%) and high costs (68.92%). Participants engaged in informal employment were significantly less likely to access medicines (aOR: 0.24, 95% CI: 0.10–0.57, p = 0.001), as were those seeking care at public hospitals (aOR: 0.30, 95% CI: 0.11–0.86, p = 0.026) and households with a member living with a chronic disease (aOR: 0.37, 95% CI: 0.17–0.85, p = 0.019). Nearly half (44.03%) of the households had medicines stored at home including analgesics (39.6%), Antimalarials (20.6%), and Antibiotics (20.1%). Comprehensive access to essential medicine at the community level is critically low in Eastern Uganda. Addressing affordability, availability in public facilities, and support for households with chronic illness is critical in order to advance equity in medicine access.