Access to essential medicines is a persistent public health challenge in low-resource settings. Zambia faces systemic barriers affecting the availability, affordability, and appropriate use of medicines within its healthcare system. A consolidated analysis is needed to inform policy. This systematic review synthesises evidence on the challenges of medicinal access and delivery in Zambia. Its objective is to identify and categorise key barriers across the pharmaceutical supply chain, from procurement to patient use. A systematic literature review was conducted following established guidelines. Multiple academic databases and grey literature sources were searched. Studies were screened against predefined criteria, with data extracted and analysed thematically. The synthesis identified several interconnected barriers. Severe stock-outs of essential medicines at primary care facilities were a dominant theme. Financial constraints, fragmented supply chain logistics, and human resource limitations were also consistently reported as major impediments to reliable access and delivery. Medicinal access and delivery in Zambia are hindered by a complex set of systemic challenges embedded within the pharmaceutical supply chain and broader health system. Multifaceted and sustained interventions are required for meaningful improvement. Priorities include strengthening national supply chain logistics and management information systems, and securing increased, predictable health financing. Future research should evaluate the impact of specific policy interventions, such as decentralised procurement models, on medicine availability. Zambia, access to medicines, drug supply chain, essential medicines, health systems, pharmaceutical policy, systematic review This review provides a comprehensive, synthesised evidence base on medicinal access challenges in Zambia, which can guide future policy development and strategic investment in the health sector.