Comparison of essential medicines lists in 137 countries

Abstract

Objective To compare the medicines included in national essential medicines lists with the World Health Organization’s (WHO’s) Model list of essential medicines , and assess the extent to which countries’ characteristics, such as WHO region, size and health care expenditure, account for the differences. Methods We searched the WHO’s Essential Medicines and Health Products Information Portal for national essential medicines lists. We compared each national list of essential medicines with both the 2017 WHO model list and other national lists. We used linear regression to determine whether differences were dependent on WHO Region, population size, life expectancy, infant mortality, gross domestic product and health-care expenditure. Findings We identified 137 national lists of essential medicines that collectively included 2068 unique medicines. Each national list contained between 44 and 983 medicines (median 310: interquartile range, IQR: 269 to 422). The number of differences between each country’s essential medicines list and WHO’s model list ranged from 93 to 815 (median: 296; IQR: 265 to 381). Linear regression showed that only WHO region and health-care expenditure were significantly associated with the number of differences (adjusted R 2 : 0.33; P < 0.05). Most medicines (1248; 60%) were listed by no more than 10% (14) of countries. Conclusion The substantial differences between national lists of essential medicines are only partly explained by differences in country characteristics and thus may not be related to different priority needs. This information helps to identify opportunities to improve essential medicines lists.

A comparison of national essential medicines lists in the Americas

“…We included NEMLs from 138 countries: 31 in the Americas (89% of the 35 PAHO Member States) and 107 outside of the Americas (15). PAHO Member States that did not have an NEML in the online WHO NEMLs repository were the Bahamas, Canada, Guatemala, and the United States of America.…”

“…The number of medicines on the individual lists from the Americas lists ranged from 197 to 704 (median: 361; interquartile range (IQR): 290 to 456) ( Table 1). In comparison, the values for other world regions were: Africa, 64 to 702 (median: 298; IQR: 248 to 347); Eastern Mediterranean, 200 to 964 (median: 462; IQR: 278 to 623); Europe, 181 to 980 (median: 398; IQR: 285 to 601); Southeast Asia, 44 to 546 (median: 291; IQR: 230 to 343); and Western Pacific, 177 to 742 (median: 249; IQR: 215 to 295) (15).…”

“…When more than one NEML was found for a country, the most recent was used. Detailed explanation of these methods is described elsewhere (15). The original database was updated with an NEML from Panama, and with other minor corrections.…”

“…Medicine bases and their salts were combined (e.g., promethazine hydrochloride and promethazine), as well as different compounds of the same vitamin or mineral (e.g., ferrous fumarate and ferrous sulfate). Detailed methods for the creation of the database, including data extraction, are described elsewhere (15).…”

“…We determined the number of differences between each country's NEML and the WHO Model List, including both the number of medicines on the WHO Model List but not on the NEML and the number of medicines on the NEML but not on the WHO Model List (15). At the time of our study, the WHO Model List had 415 medicines on it.…”