Essential Medicines at the National Level: The Global Asthma Network’s Essential Asthma Medicines Survey 2014

Abstract

Patients with asthma need uninterrupted supplies of affordable, quality-assured essential medicines. However, access in many low- and middle-income countries (LMICs) is limited. The World Health Organization (WHO) Non-Communicable Disease (NCD) Global Action Plan 2013–2020 sets an 80% target for essential NCD medicines’ availability. Poor access is partly due to medicines not being included on the national Essential Medicines Lists (EML) and/or National Reimbursement Lists (NRL) which guide the provision of free/subsidised medicines. We aimed to determine how many countries have essential asthma medicines on their EML and NRL, which essential asthma medicines, and whether surveys might monitor progress. A cross-sectional survey in 2013–2015 of Global Asthma Network principal investigators generated 111/120 (93%) responses—41 high-income countries and territories (HICs); 70 LMICs. Patients in HICs with NRL are best served (91% HICs included ICS (inhaled corticosteroids) and salbutamol). Patients in the 24 (34%) LMICs with no NRL and the 14 (30%) LMICs with an NRL, however no ICS are likely to have very poor access to affordable, quality-assured ICS. Many LMICs do not have essential asthma medicines on their EML or NRL. Technical guidance and advocacy for policy change is required. Improving access to these medicines will improve the health system’s capacity to address NCDs.

Nationwide survey of the availability and affordability of asthma and COPD medicines in Nigeria

“…ICS is cost-effective as it reduces exacerbations, emergency room visits, hospitalisation and impaired productivity, and its availability is considered fundamental to asthma care [36]. Limited availability of ICS-containing medicines is also a common problem in other LMIC of sub-Saharan Africa [27][28][29]. In Uganda, inhaled SABA was the most available medicine (75%) and ICS-containing medicines were only found in 45% of pharmacies with a profound lack (4%) in public sector pharmacies [27].…”

“…Unfortunately, these oral formulations are on the Nigerian EML which is clearly out of tune with the current recommendations. WHO and the GAN recommend the expansion or modification of the EML in LMIC to include medicines with good safety and efficacy profile [29]. The study by the GAN found that many sub‐Saharan countries did not have an ICS in their EML.…”

“…Asthma and COPD medicine availability and affordability particularly in LMIC are reportedly low [27][28][29][30]. The Global Asthma Network (GAN) reports that many LMICs lack updated EML, with very limited availability and affordability of the medicines on the WHO EML [29]. In Nigeria, the nationwide availability and affordability of asthma and COPD medicines are not known.…”

Global Asthma Network Phase I Surveillance: Geographical Coverage and Response Rates

“…Other centres have been unable to undertake Phase I at all because of unforeseen circumstances. Many centres in each of these categories have contributed to other published GAN surveys [ 10 , 11 , 12 , 13 ].…”

Implementing Single-Pill Combination Therapy for Hypertension: A Scoping Review of Key Health System Requirements in 30 Low- and Middle-Income Countries

“…We were able to access more recently updated national EMLs for China, the Philippines, Thailand and Vietnam through Resolve to Save Lives. There was no national EML that could be located for Turkey and research indicated its non-existence as of 2014 [23]. See Supplemental Digital Content 1 (SDC 1), which illustrates the data source for the most up to date national EMLs, national hypertension guidelines and availability of single-pill combination antihypertensives.…”