Access to essential medicines and vaccines among hard-to-reach populations in Tanzania: evidence from a cross-sectional study of artisanal miners, fisherfolk, and pastoralists.

Abstract

Background: Despite global efforts to improve equitable access to healthcare, underserved and mobile populations in Sub-Saharan Africa continue to face major challenges in obtaining essential medicines and vaccines. In Tanzania, Artisanal miners, fisherfolk, and pastoralists face high disease burdens, mobility, and geographic isolation, yet evidence on their access to essential medicines and vaccines remains limited. This study examined access to essential medicines and vaccines among artisanal mining, fishing, and pastoralist populations in Tanzania.

Methods: A descriptive cross-sectional study was conducted in six selected districts of Manyara, Mara, and Geita regions, representing pastoralist, fisherfolk, and artisanal mining communities, respectively. A semi-structured questionnaire was administered to 280 conveniently sampled community participants and to 29 purposively selected pharmacists or drug dispensers. Data were analysed using descriptive statistics and chi-square tests with support of STATA software.

Results: Availability of essential medicines was limited, with 58.1% of participants reporting that they did not obtain all prescribed medicines during their most recent treatment episode. Vaccine availability was reported as always available by 65.0% of participants, while 24.6% were uncertain. Regarding affordability, 51.3% reported spending over TZS 10,000, 39.0% could not afford prescribed medicines. In terms of accessibility, 40.3% lived within 1-5 km of a health facility, and 62.8% lived within 1 km of a pharmacy or drug outlet. Acceptability indicators showed that 86.7% trusted healthcare providers and 81.7% adhered to treatment, while 59.3% lacked to the knowledge on identify counterfeit medicines. Overall, 92.0% reported improvement after treatment, and 31.0% of providers reported occasionally receiving complaints about the quality of the medicine.

Conclusions: While vaccine access appears well established, significant gaps remain in ensuring equitable access to essential medicines in these populations. Addressing supply chain inefficiencies, financial barriers, geographic constraints, and patient awareness, is critical for advancing equitable access and achieving universal health coverage.