WHO Bulletin: Comparison of essential medicines lists in 137 countries (6) The need for an open-access world formulary using BNF principles (5)

25 June, 2019

I agree with Neil's submission on what I call generic nature of BNF in that it contains medicines beyond essential lists and therefore serves as a reference tool for prescribers, users, policy makers and guideline builders. It also serves researchers and authors in health care. We found it most useful along with MIMS Africa when in 2004 we designed and published the Cross River State Ministry of Health Drug Formulary. We had just established the State Drug Revolving Fund with seed money to kick start the initiative and needed to provide a compact list of drugs from which prescribers could quickly access and use in a busy clinic consultation or other clinical intervention. The other sins of the initiative was to abolish 1) out of stock syndrome that meant that patients on receiving a prescription had to go out to town to buy the drugs at usually more costly prices, whereas we could not know how the drug was stored or whether it was genuine; 2) ensure all drugs in the system are NAFDAC approved and licensed; 3) that all drugs procured had long shelf lives and would not expire soon after purchase. It was very successful and by pleasant surprise was very efficient too, doubling the seed investment within three years while achieving all the three main aims.

Both BNF and the so-called Essential Medicines Lists (EML) have their place and benefits. The EMLs tend to be more context-specific to deal with conditions that are more locally prevalent and as such easier to use in that locality. What is important is to ensure that best practice methodology is adopted when preparing a local Formulary or EML: inclusive membership of the committee, evidence based yardstick for choosing content, transparency and value-adding to the system, regular update and revision of content, and monitoring and evaluation.

Joseph Ana

HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: www.hriwestafrica.com Joseph is a member of the HIFA Steering Group and the HIFGA working group on Community Health Workers: http://www.hifa.org/people/steering-group jneana AT yahoo.co.uk