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Description: In 2011, the World Health Organization published the World Medicines Situation Report that included the results of nine years of surveys from multiple WHO regions measuring affordability and availability of a basket of essential medicines using the WHO/Health Action International (HAI) survey methodology.(1) Prior versions of the World Medicines Situation Report had been published in 2004 and 1988. The 2011 report included the results of medicine availability and affordability surveys from 11 African countries. The surveys from the Africa region found substantial variability in the availability and affordability of essential medicines in the public and private sectors. See Figure 1.1, 1.4 and 1.6, included in the Annex, for key results from the 2011 report. An analysis of similar survey results was published by Cameron et al. in 2009.(2) Following the sustainable development goals declaration, access to medicines has become central to discussions around achievement of target 3.8. As such there is need to better understand the state of medicine availability and accessibility in the African region. As a starting point there is need for scoping review to provide information on existing evidence and gaps on access to medicines. A systematic scoping review is used to: identify the types of available evidence in a given field; clarify key concepts/ definitions in the literature; examine how research is conducted on a certain topic or field; identify key characteristics or factors related to a concept; and identify and analyze knowledge gaps.(3) This scoping review can provide useful information to policymakers in the region as they strategize to achieve SDG target 3.8. The SDG target 3.8 includes a component on universal access to safe, effective, quality, and affordable essential medicines and vaccines. In addition, the systematic scoping review shall identify methodological and empirical gaps in the current literature. The identified gaps will inform a more targeted policy and governance research that focusses on approaches to improve medicine availability and affordability in the African region. Therefore, we will conduct a systematic scoping literature review of medicine availability and affordability surveys and related studies conducted in the Africa region since 2009. We shall follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines where we shall define the review questions; identify, select and appraise the documents; abstract and synthesize data; and interpret the results.(4) The protocol will be registered on Open Science Framework (https://osf.io/). Inclusion Criteria • Analysis of medication availability or affordability • Qualitative or quantitative analysis • Geographic focus on countries in WHO African Region • English language • Published after 2008 Exclusion Criteria • Not available in below referenced databases • Not available in English • Assessments of availability/affordability of other types of health supplies/equipment/diagnostics Databases (1) Medline (PubMed) (2) EMBASE (3) WHO Global Index Medicus (4) Health Action International Medicine Prices, Availability, Affordability & Price Components Database, available at https://haiweb.org/what-we-do/price-availability-affordability/price-availability-data/ Study Selection. Three authors (JL, HN, and AK) will independently screen each identified record by title and abstract based on the above inclusion and exclusion criteria. JL will independently review all records and HN and AK will each review 50% of the responsive abstracts. Any disagreements on responsiveness will be resolved via discussion by the review authors. Irresolvable differences will be decided by a fourth author (AS). This will result in a list of potentially responsive articles for which the full text will be retrieved. Three authors (JL, HN, and AK) will independently review the full text of screened in articles based on the above inclusion and exclusion criteria. JL will review all screened full text articles and AK and HS will each review 50% of the screened full text articles. Any disagreements on responsiveness will be resolved via discussion by the three review authors and unresolvable differences will be decided by a third author (AS). This step will result in list of responsive studies. The selection process will be described using a PRISMA-ScR flow chart. Preliminary searches. We conducted a preliminary search to test the viability of our study and avoid empty search at advance stage study on PubMed, Embase and WHO Global Index Medicus. The yield per database is as presented in tables 1,2,3. Data Extraction. Reviewers will independently extract data from selected studies using a data extraction form in Excel. Extracted data will include study characteristics and outcome data. Where studies have multiple publications, we will collate multiple reports of the same under a single study ID with multiple references. We will contact the study investigators for further data on methods or results, as required. The following data will be recorded in the database for each study: authors, location, types of facilities assessed, types of medicines assessed, methodological approach, availability and affordability outcome measures. Critical Appraisal of Studies We will critically assess the quality of methods used for included studies. For each included study, we will rate the quality of methods used as low, high or unclear. We will use the AXIS tool to assess the quality of cross-sectional studies.(5) Analysis and Data Synthesis The results will be reviewed to determine ranges of medicine availability and affordability in the WHO Africa region in aggregate, by medication type and class, and by country. The analysis will include a description and comparison of methodological approaches (e.g., stock and pricing survey, patient survey, key informant interviews, focus group interviews) to assess medicine affordability and availability. The analysis will also include a comparison of definitions of medicine affordability and availability. A narrative discussion of differing methodological approaches and definitions and results tables will be prepared. Analysis of Groups or Subset Sub-analyses may be conducted of medicine availability/affordability by medication class if sufficient data is available. References 1. Cameron A, Ewen E, Auton M, Abegunde D. The World Medicines Situation 2011 - Medicines Prices, Availability and Affordability. . Geneva, Switzerland; 2011. 2. Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 2009;373(9659):240-9. 3. Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143. 4. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018;169(7):467-73. 5. Downes MJ, Brennan ML, Williams HC, Dean RS. Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open. 2016;6(12):e011458.