Fernandos Ongolly

Abstract

Access to medicines is a global challenge, impacting nations differently. Whereas high-income countries may face challenges such as high-pricing issues for essential drugs, lower-and middle-income countries may be affected by issues linked to socio- economic, cultural and opportunity cost-based factors to access these medicines.

This thesis examines the role of grassroots health activism and advocacy in accessing essential medicines at the crucial ‘last   from the telecommunications industry, the term ‘last mile’ refers to the final leg of supply chain delivery. Equally, this phase is the most critical stage of access to essential medicines for populations in need. Using HIV pre-exposure prophylaxis (PrEP) access as a case study, comparative qualitative research was conducted in Kenya and Ireland to explore the role that grassroots activists and advocates play in influencing access to medicines with a focus on understanding access patterns, barriers at the last mile, and how grassroots activism and advocacy influence access at the last mile. The analysis captures access to medicines issues in western and non-western settings grounded in two relational philosophical approaches: ethics of care and Ubuntu (An African relational philosophy). Based on these approaches, grassroots activism is discussed in this thesis as form of care in response to access to medicines needs, focusing on the community, solidarity, reciprocity, collective responsibility, and inclusivity in access. Additionally, as the research that contributed to this thesis took place during the COVID-19 pandemic, this thesis also highlights how the last mile in the supply chain of medicines is affected during a crisis and how crisis stimulates grassroots innovations to address new needs for accessing essential medicines at the last mile. Overall, this thesis brings to light new insights in access to medicines especially with its focus at the last mile and its comparative approach.