Assessment of pricing, availability, and affordability of essential medicines in a resource-limited setting

Background Access to essential medicine is a worldwide issue, driven by high prices, low affordability and limited availability. Under funded health systems, weak local production, poor supply chain governance, and discriminatory policies are the main hurdles. Low and middle-income countries are continuously making efforts to improve healthcare services. To evaluate the extent to which the intended objectives have been met, the present study undertakes an investigation into the pricing, availability, and affordability of selected essential medicines in Pakistan.Methods A survey of 50 essential medicines, including 14 from the global core list and 36 selected from the national essential medicine list, was carried out from November 2025 to February 2026, using an adaptation of WHO/HAI methodology in five geographical areas of Pakistan. Data were acquired from 9 pharmacies of government hospitals and 18 retail pharmacies of the private sector. Prices were evaluated on the basis of the Median Price Ratio (MPR); affordability was determined by estimating how many days a minimum salaried employee of the government must spend to buy the prescribed regimen.Results In the public sector mean availability was 12.65% (IB), 36.2% (LPG) and in private sector it was 45.7% (IB) and 55.2% (LPG). In private retail pharmacies, 13.61% were stocked with oncology medicines. Median price ratios in the private sector varied between 0.11–6.85 for LPG and 0.17–23.37 for IB. Median price ratio of 12 medicines (out of 36 calculated for MPR) was approximately similar between LPG and IB. However, prices for cardiovascular and antidiabetic medicines increased.Conclusion Availability of LPGs has improved in the private sector. Median price ratios have decreased over time, but medicines are still unaffordable, especially for diabetes, viral, fungal and bacterial infectious diseases.