Evaluating the implementation of the standard treatment guidelines (STGs) and essential medicines list (EML) at a public South African tertiary institution and its associated primary health care (PHC) facilities

Background The standard treatment guidelines (STGs) and essential medicines list (EML) were a policy option recommended in the National Drug Policy for South Africa in 1996 to address the irrational and bloated medicines procurement list. STGs/EML serve as a tool to promote cost-effective use of medicines; rational prescribing; and improve accessibility to medicines for all citizens. The purpose of this study was to evaluate the use and implementation of the STGs/EML by prescribers at a public tertiary institution and its associated Primary Health Care (PHC) facilities in the uMhlathuze subdistrict of KwaZulu Natal. The study aimed to provide feedback and to make recommendations to policy makers to improve the use and implementation of the STGs/EML and to inform National Health Insurance (NHI) policy development. Method An observational quantitative descriptive research design was used. A retrospective audit of prescriptions was conducted, and questionnaires were utilized to collect data from prescribers and the facilities to evaluate the utilization of the STGs/EML and the rational use of medicines. All descriptive analyses were presented as counts with percentages, and Fisher’s exact test was used to compare results. The data was summarized, reduced, and analysed using SAS statistics software. Results 107 medical doctors (97%) responded to the questionnaire at hospital level and 98 nurses (98%) responded to the questionnaire at the PHC level. Results revealed that the majority of doctors, 94.4%, had access to the latest STGs/EML compared with only 41.8% of nurses. 70.3% and 78.3% of doctor’s and nurse’s prescriptions, respectively, adhered to the guidelines. 94.9% of nurses requested training on the use of STGs/EML as most of them had not received formal training on its use. Conclusion This study showed suboptimal adherence to STGs/EML by all prescribers, in contrast to previous research amongst nurses when hardcopies were available. Training on the use of the STGs/EML is needed at PHC level and improved monitoring of STGs/EML compliance is necessary. This study may be replicated for a wider population to paint a national picture and to periodically assess the extent of the implementation of the STGs/EML.

Natural products as drugs source in the Ecuador´s essential medicines list

This paper presents the analysis of the origin of 391 active ingredients (AIs) of the 9th list of essential medicines in Ecuador, using the system proposed by Newman and Cragg with certain modifications. The AIs of natural origin represent 54.2% of the list and have greater importance in the categories H, R and B of the Anatomical, Therapeutic and Chemical classification system for pharmacological substances and medicines. In addition, the influence of natural products was analyzed in the categories with the highest amount of IAs J, L and N, as well as in category C, which is associated with the main cause of death in Ecuador.

Perceptions from pharmaceutical stakeholders on how the pharmaceutical budget is allocated in South Africa

Background South Africa faces a heavy burden of disease, which impacts resource allocation. The needs of South Africa require efficient translation into pharmaceutical expenditure for medicine provision, to ensure availability of medicines. Given that South Africa faces various challenges with medicine provision accompanied by rising pharmaceutical expenditure, this study aimed to report on the considerations and methods used to determine the healthcare budget for South Africa, and how it is translated into pharmaceutical expenditure for medicines provision on the Standard Treatment Guidelines and Essential Medicines List and non-essential medicines in the public sector. Method Qualitative, semi-structured interviews guided by a discussion guide were conducted with seven pharmaceutical officials involved in the budget and resource allocation process, between October 2019 and March 2020. Interviews were recorded and transcribed verbatim. Once the interviews were coded by the first author they were verified by the other authors. Data were thematically analysed. Results This study depicted the knowledge and participation of pharmaceutical services in the budget process. The National and Provincial Department of Health have improved pharmaceutical budgeting by making strides towards a collaborative, informed, and more evidence-based approach. Pharmaceutical services have roles in advising on requirements; commenting where necessary, constantly monitor and taking accountability for their budget. The main considerations that determined the budget included population size and growth, historical expenditure, the extra heavy burden of disease and incidence rate, demand data and forecasting. The local and provincial pharmacy and therapeutics committee play a vital role in monitoring the budget and expenditure; ensuring adherence to guidelines; controlling the extent to which non-Essential Medicine List items are used and advising accordingly. Conclusion This was the first study to report on the decision and thought processes of the healthcare budget and its translation into pharmaceutical expenditure for medicine provision in South Africa. Many factors were considered to inform the budget, with the Standard Treatment Guideline and Essential Medicines List being the principal guide for medicine provision. This process was well-controlled and monitored by the pharmaceutical therapeutics committee. Documenting the South African experience can assist other countries in their budget decisions for medicines.

Implementation considerations for the WHO Essential Diagnostics List with insights from the Essential Medicines List: A scoping review protocol

Background: Access to medicines and technologies is a key building block of the WHO health systems framework. In 2018, the World Health Organization (WHO) published the first Essential Diagnostics List (EDL) to address the need for countries to make essential diagnostics more accessible and affordable to patients in low-and-middle-income countries and to complement the more established Essential Medicines List (EML). The effective implementation of the WHO EDL is vital to ensure its impact on improving health outcomes. This scoping review aims to map literature on the implementation, uptake and evaluation of the WHO essential lists in African nations in order to guide the effective implementation and evaluation of the WHO EDL. Methods: This review will map literature on the implementation and evaluation of the WHO’s essential diagnostic list (EDL) and essential medical list (EML), using the Joanna Briggs Institute guidelines for scoping review. The implementation considerations we will review include, study designs used in the evaluation of the WHO essential lists, and the outcome measures, findings, gaps and limitations highlighted in the included articles. We will review both primary and secondary quantitative and qualitative literature evaluating the WHO essential lists. A comprehensive search strategy, developed with an information scientist, will be used to identify relevant sources. The database to be searched include: MEDLINE (Pubmed), CINAHL, the Cochrane Library, the Health Technology Assessment database, EMBASE, Health systems evidence, African Index Medicus, Web of Science, Science Direct, Scopus and WHO library databases. Grey Literature will be accessed by searching for policy documents, diagnostic guidelines, and reports of ministry of health, health agencies through their websites and links published in the last three years from selected African countries. Searches, study selection and data extraction will be conducted using the covidence platform by two independent reviewers. The Mixed Method Appraisal Tool (MMAT) version 2018 will be used to assess the quality of included studies. The findings will be analysed using the thematic content analysis approach and the results presented narratively and graphically.Discussion: We anticipate finding relevant literature on the implementation considerations for WHO’s essential diagnostic and medicines list in Africa. This review is likely to reveal implementation considerations, challenges, gaps, which could guide future evaluation, implementation, policy development, and development of practice tools to support the wider adoption of the WHO essential diagnostic list in Africa. Dissemination: We plan to publish our findings in a peer-reviewed journal and develop useful and accessible summary of the results.

Pharmaceutical procurement among public sector procurers in CARICOM

Objective. To examine multiple aspects of the medicines in CARICOM procurement markets, including manufacturer headquarters location, regulatory history, and type (innovator versus generic); the proportion of World Health Organization (WHO) essential medicines; and the most expensive medicines procured. Method. An analysis of procurement information from selected CARICOM procurers. Four public sector procurement lists were obtained based on public availability or sharing of data from public sector procurers. Analyses were based on parameters available or deduced from these data. Results. The majority of products come from manufacturers headquartered in North America and Europe (63%–67%). The percentage of medicines procured from generic companies is 60%–87%; and 25%–50% of medicines procured are on the WHO Essential Medicines List. Wide price variations exist in the most expensive medicines purchased. Conclusions. The analysis identifies vulnerabilities and opportunities in the procurement situation of CARICOM states, particularly related to quality and rational use of medicines. This analysis represents a baseline that governments and other stakeholders can use in the future.