National adaptation and implementation of WHO Model List of Essential Medicines: A qualitative evidence synthesis

Abstract

Background The World Health Organization Model List of Essential Medicines (WHO EML) has played a critical role in guiding the country-level selection and financing of medicines for more than 4 decades. It continues to be a relevant evidence-based policy that can support universal health coverage (UHC) and access to essential medicines. The objective of this review was to identify factors affecting adaptation and implementation of WHO EML at the national level. Methods and findings We conducted a qualitative evidence synthesis by searching 10 databases (including CINAHL, Embase, Ovid MEDLINE, Scopus, and Web of Science) through October 2021. Primary qualitative studies focused on country-level implementation of WHO EML were included. The qualitative findings were populated in the Specialist Unit for Review Evidence (SURE) checklist, and key themes were identified through an iterative process. We appraised the papers using the Critical Appraisal Skills Programme (CASP) tool and assessed our confidence in the findings using the Grading of Recommendations Assessment, Development and Evaluation working group-Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual). We screened 1,567 unique citations, reviewed 183 full texts, and included 23 studies, from 30 settings. Non-English studies and experiences and perceptions of stakeholders published in gray literature were not collected. Our findings centered around 3 main ideas pertaining to national adaptation and implementation of WHO EML: (1) the importance of designing institutions, governance, and leadership for national medicines lists (NMLs), particularly the consideration of transparency, coordination capacity, legislative mechanisms, managing regional differences, and clinical guidance; (2) the capacity to manage evidence to inform NML updates, including processes for contextualizing global evidence, utilizing local data and expert knowledge, and assessing budget impact, to which locally relevant cost-effectiveness information plays an important role; and (3) the influence of NML on purchasing and prescribing by altering provider incentives, through linkages to systems for financing and procurement and donor influence. Conclusions This qualitative evidence synthesis underscores the complexity and interdependencies inherent to implementation of WHO EML. To maximize the value of NMLs, greater investments should be made in processes and institutions that are needed to support various stages of the implementation pathway from global norms to adjusting prescribed behavior. Moreover, further research on linkages between NMLs, procurement, and the availability of medicines will provide additional insight into optimal NML implementation. Protocol registry PROSPERO CRD42018104112

Availability and stock-out duration of essential medicines in Shegaw Motta general hospital and Motta Health Centre, North West Ethiopia

“…Preparing a comprehensive national essential medicines list is recommended by WHO for all countries to improve access to safe, effective, and high-quality medicines [2]. National essential medicine lists are government approved lists of medicines, often adapted and implemented as local medicine formularies [3]. Based on WHO directions, Ethiopia developed its own national essential medicine list for use in healthcare financing and medicines supply budgeting; procurement, and encouraging the appropriate use of medicines [4].…”

Implementing essential diagnostics-learning from essential medicines: A scoping review

“…Similar work to ours, a systematic review by Peacocke et al, 191 explored the process of adapting the WHO EML at the national level. The authors provided key insights on the complexities and interdependencies essential to the implementation of the EML.…”

“…Such barriers included poorly equipped health facilities which entailed limited availability of essential tests and medicines, limited access to care facilities by patients due to financial and geographical constraints, availability of essential medicines and diagnostics at referral hospitals but not primary health care facilities, limited staff training, inefficient information systems, and inefficient procurement processes leading to regular stock-outs. In Africa, health systems face complex challenges such as the continued burden of communicable and non-communicable diseases pandemics amidst limited resources 192–194 . In addition, many influencing factors in the health system determine the access, implementation, and effectiveness of diagnostic tests.…”

Challenges in updating national guidelines and essential medicines lists in Sub‐Saharan African countries to include WHO‐recommended postpartum hemorrhage medicines

“…Lack of substantive policy and programs (including training) to support the implementation of the guidelines. Some countries faced issues in reflecting new and current evidence because their national guidelines are not regularly updated. The COVID‐19 pandemic made it difficult to keep PPH a key priority with government bodies. Local evidence of HSC use, availability, and pricing became a concern for many countries since the policy updates preceded the regulatory approval of HSC in the countries. This is in alignment with country‐level considerations influencing the process of adapting global guidance which cannot occur in isolation from the broader pharmaceutical system 6 …”