'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... This qualitative evidence synthesis underscores the complexity and interdependencies inherent to implementation of WHO EML.'
Citation, author summary and a comment from me below.
CITATION: Citation: Peacocke EF, Myhre SL, Foss HS, Gopinathan U (2022) National adaptation and implementation of WHO Model List of Essential Medicines: A qualitative evidence synthesis. PLoS Med 19(3): e1003944. https://doi.org/10.1371/journal.pmed.1003944
AUTHOR SUMMARY
Why was this study done
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.
National medicine lists (NMLs) are perceived to be an important part of a country’s medicines policy; however, few efforts have been made to systematically integrate insights of WHO EML implementation from the empirical literature.
The objective of this study was to identify the factors that influence implementation of global normative guidance on essential medicines and provide insight on areas where additional support may facilitate country-level implementation.
What did the researchers do and find
A qualitative evidence synthesis was undertaken, using the GRADE-Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach to assess how much confidence to place in the findings. A systematic search of 10 databases identified 23 articles for inclusion after assessing 1,567 unique citations and reviewing 183 full texts.
We found that implementation can be facilitated by national medicine selection committees that operate with consultative mandates, clear leadership and oversight, and monitoring and evaluation.
Implementation of NMLs also requires harmonization with reimbursement processes and recommended clinical practice. National standard treatment guidelines (STGs) therefore play a crucial role in translating intentions of NML to clinical practice, while legislation, oversight, and monitoring are additional tools for ensuring compliance.
The types of information used in adaptations are extremely important. Crucial to country relevant updates of NMLs is the balancing of global evidence, expert knowledge, and local data, and there is an opportunity for further use of health economic methods to inform decision-making on essential medicines.
What do these findings mean
Updating NMLs following biannual global revisions of WHO EML requires significant financial and human resource investment by countries. The number of actors and processes underscore the complexity and interdependencies inherent to implementation of the EML.
These findings suggest that to maximize the value of NMLs, greater investments should be made in different types of institutions that are needed to support various stages along the implementation pathway from global norms to adjusting prescriber behavior.
COMMENT (NPW): I have not had time to review this paper in depth, but the study appears to focus more on adaptation than implementation. A fundamental question is "What information do prescribers (and users) of medicines need, and in what format?, in order to use medicines effectively and without overprescription?" A national EML is just part of the solution. Its value depends not only on whether it its inherent quality and relevance to the country, but also on how it is used to support practical information for prescribers. Some countries, for example, have formularies that are based on national EMLs. As the paper notess, the reality of medicines availability and use is not binary; many medicines are available and used in any given country that are not on the national EML, whereas some medicines on the national EML may not be available in many/most facilities. A perspective that starts with the question "What information do prescribers and users need?" is required to complement the above study and better understand how to improve the use of medicines.
Best wishes, Neil
Joint Coordinator HIFA Project on Information for Prescribers and Users of Medicines http://www.hifa.org/projects/prescribers-and-users-medicines
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HIFA profile: Neil Pakenham-Walsh is global coordinator of the HIFA global health movement (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. HIFA brings stakeholders together to accelerate progress towards universal access to reliable healthcare information.
Twitter: @hifa_org neil@hifa.org
