<b>Health system-related barriers affecting access to and adherence to antidiabetic medications among adult patients at Gombe General Hospital. A cross-sectional study.</b>

Background: Health system factors such as drug availability, service delivery, and patient–provider interaction influence consistent use of antidiabetic medications. This study aims to assess the health system-related barriers affecting access to and adherence to antidiabetic medications among adult patients at Gombe General Hospital.  Methodology:  A descriptive cross-sectional study was conducted among 36 adult diabetic patients attending the hospital's diabetes clinic. Data were collected using structured, interviewer-administered questionnaires. Data were analyzed using descriptive statistics with Microsoft Excel.  Results: The majority of respondents were female (72.2%) and elderly, with half of the participants aged 60 years and above. A significant proportion had a low level of formal education, with 91.6% having only primary-level education or none at all. The majority (94.4%) reported a monthly income of 300,000 UGX or less, indicating a low socioeconomic status. The most prevalent challenge was drug stock-outs, experienced by 80.6% of patients, directly impacting the reliability of medication supply. The high cost of medication was also a major barrier, affecting 75% of respondents. Long distances to the facility and long waiting times were significant challenges for 41.7% and 33.3% of patients, respectively. Provides a nuanced view of the health system's performance. The interpersonal factors were excellent, with all patients finding health workers supportive.  Conclusion: Health system barriers, particularly drug stock-outs, high medication costs, and access challenges, significantly affect consistent utilization of antidiabetic medications despite positive patient–provider relationships.  Recommendation: Strengthening medicine supply chains and reducing patient costs, alongside improving service accessibility, is necessary to enhance sustained adherence to treatment.