Essential medicines for emergency care in Africa

Abstract

ObjectivesEssential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications. The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury.MethodsWe undertook a multi-step consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final in-person consensus process.ResultsThe final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential, and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (e.g. district hospitals), and an additional 78 for advanced facilities (e.g. tertiary centres).ConclusionThe 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation, and will be a useful tool for practical expansion of emergency care delivery in Africa.

Antibiotic resistance in hospital-acquired ESKAPE-E infections in low- and lower-middle-income countries: a systematic review and meta-analysis

“…The over-the-counter availability of carbapenems and surge in its consumption has been documented for India, Pakistan and Egypt [ 4 , 33 ]. While data on carbapenem consumption is very scarce in WHO Africa, available evidence suggests that access and use of carbapenems is very low for various reasons including its absence over-the-counter, and on the essential medicine list of many African countries before 2020 [ 31 , 34 , 35 ]. Other factors like underestimation due to limited diagnostic stewardship and surveillance as well as varying infection prevention and control (IPC) capacity, may also contribute to the differences observed within L-LMICs and when compared to HICs [ 36 ].…”

Dexamethasone: Therapeutic potential, risks, and future projection during COVID-19 pandemic

“…Over the last decade, corticosteroids (CS) have emerged as steroidal medicine to reduce inflammation in various disorders, including rheumatoid arthritis, systemic lupus erythematosus, asthma, and certain cancers by mimicking anti-inflammatory hormones produced by the body ( Health, N.I.o., 2017 ; Bethesda, 2012 ; Rhen, T. and Cidlowski, J.A., 2005 ). Since 1977, dexamethasone listed on the world health organization (WHO) Model List of Essential Medicines in multiple formulations and presently available in most countries at reasonable cost and off-patent ( Broccoli, M.C. et al, 2018 ).…”

Measuring Medicine Prices and Availability of Commonly used Essential Medicines using WHO/HAI Methodology in Hyderabad, India

“…[1][2][3] Essential medicines are those which satisfy the priority of health care needs and selected with due regards to public health relevance. 4 These are intended to be available within the context of functioning health care systems at all times in adequate amount in appropriate dosage form with assured quality and adequate information. 5 Accessibility to essential medicines is influenced by many factors.…”

“…[2][3][4][5][6] Price is one of the remarkable determinants of cost and purchasing power of medicines and also important in developing a medicine pricing policy. 7 WHO estimates that in low-income areas, 90% of citizens pay for their needed medicines out of pocket because of insufficient medical and health services in public sector furthermore most of the population does not have social insurance. 2 Availability is another important issue for health facilities all over the world.…”