Global status of essential medicine selection: a systematic comparison of national essential medicine lists with recommendations by WHO

Abstract

ObjectivesExamining the availability of essential medicines is a necessary step to monitor country-level progress towards universal health coverage. We compared the 2017 essential medicine lists (EML) of 137 countries to the WHO Model List to assess differences by drug class and country setting.MethodsWe extracted all medicines prioritised at country level from most recently available national EMLs and compared each national EML with the 2017 WHO Model List of Essential Medicines (MLEM) as the reference standard. We assess EMLs by WHO region and for different types of medicine subgroups (eg, cancer, anti-infectives, cardiac, psychiatric and anaesthesia medicines) using within second-level anatomical therapeutic class (ATC) drug classes of the ATC Index.ResultsWe included 406 medicines from WHO’s 2017 MLEM to compare to 137 concurrent national EMLs. We found a median of 315 (range from 44 to 983) medicines listed on national EMLs. The global median F1 score was 0.59 (IQR 0.47–0.70, maximum possible score indicating alignment with MLEM is 1). The F1 score was the highest (ie, most similar to MLEM) in the South-East Asia region and the lowest in the European region (ie, most dissimilar to MLEM). The F1 score was highest for stomatological preparations (median: 1.00), gynaecological—anti-infectives and antiseptics (median: 1.00), and medicated dressings (median: 1.00), and lowest for 9 anatomical or pharmacological groups (median: 0.00, eg, treatments for bone diseases, digestive enzymes).ConclusionsMost countries are expected to improve their national health coverage by 2030 offering access to essential medicines, but our results revealed substantial gaps in selection of medicines at the national level compared with those recommended by WHO. It is crucial that governments consider investing in those effective medicines that are now neglected and continue monitoring progress towards essential medicine access as part of universal health coverage.

The Global Status of Universal Health Coverage and Oncology Care

“…This makes the holistic approach to treatment impossible globally and increases avoidable mortality and morbidity from (15). Even some drugs with proven effects in the treatment of certain cancers are not included in the essential drug list of some countries, while others have included medicines without proven effects (16,17).…”

Essential drug list for cardiovascular diseases in a tertiary health care centre

“…7 In most low-income countries, pharmaceuticals are the largest public expenditure on health after personnel costs and the largest household health expenditure. 8 Despite this substantial spending on drugs, lack of access to essential drugs, irrational use of drugs, and poor drug quality remain serious global public health problems. 8 Selection of a limited number of essential medicines as essential, taking into consideration national disease burden and clinical need, can lead to improved access through streamlined procurement and distribution of quality-assured medicines, support more rational or appropriate prescribing and use and lower costs for both health care systems and for patients.…”

“…8 Despite this substantial spending on drugs, lack of access to essential drugs, irrational use of drugs, and poor drug quality remain serious global public health problems. 8 Selection of a limited number of essential medicines as essential, taking into consideration national disease burden and clinical need, can lead to improved access through streamlined procurement and distribution of quality-assured medicines, support more rational or appropriate prescribing and use and lower costs for both health care systems and for patients. 4 The adoption of these priority tools into public policy could generate important savings by concentrating competition on a smaller number of medicines and better negotiating medication prices.…”

Disease-modifying therapies enter the World Health Organization Essential Medicines List: A victory now requiring a roadmap of implementation

“…However, despite countries endorsing the concept of the EML over the years, implementing the list into local practice is variable and fraught with challenges especially in LLMICs. 8,9 Taking epilepsy as an illustrative example: the Intersectoral Global Action Plan (IGAP) report from 2022 describes how the epilepsy treatment gap had not narrowed significantly in the preceding decade despite concerted efforts by members states, the WHO secretariat, international and national organisations. 9,10 Anti-epileptic drug (AED) availability continues to be challenging particularly in developing countries, which have the highest burden of epilepsy, even in the face of simplified formularies, standardised treatment guidelines and mechanisms to reduce cost.…”

“…However, despite countries endorsing the concept of the EML over the years, implementing the list into local practice is variable and fraught with challenges especially in LLMICs. 8,9 Taking epilepsy as an illustrative example: the Intersectoral Global Action Plan (IGAP) report from 2022 describes how the epilepsy treatment gap had not narrowed significantly in the preceding decade despite concerted efforts by members states, the WHO secretariat, international and national organisations. 9,10…”