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Nav Persaud - One of the best experts on this subject based on the ideXlab platform.
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Withdrawn Medicines included in the Essential Medicines lists of 136 countries.
PloS one, 2019Co-Authors: Onella Charles, Anjli Bali, Hannah Woods, Igho Onakpoya, Simran Benipal, Jeffrey K. Aronson, Carl Heneghan, Nav PersaudAbstract:Essential Medicines lists and related policies are intended to meet the priority health needs of populations and their implementation is associated with more appropriate use of Medicines. The World Health Organization (WHO) recommends that countries carefully select the Medicines to be included in their national Essential Medicines lists. Lists that are used to prioritize access to important treatments should not include Medicines that have been withdrawn elsewhere because of an unfavourable benefit-to-harm balance; however, countries still list and use Medicines that have been withdrawn worldwide. The objective of this study was to determine whether the national Essential Medicines lists of 137 countries include Medicines that have been withdrawn in other countries. We performed an audit of national Essential Medicines lists for Medicines that had been withdrawn. Medicines withdrawn from worldwide markets between 1953 and 2014 were identified using a systematic review of published literature and regulatory documents. The reviewers used sources including the WHO's database of drugs, PubMed, and the websites of regulatory agencies to obtain information regarding adverse effects associated with the Medicines, the year of first withdrawal, markets of withdrawal, and the level of evidence supporting each withdrawal. We recorded the number of countries with a withdrawn medicine included in their national Medicines list, the number of withdrawn Medicines included in each nation's list, and the number of national Essential Medicines including each withdrawn medicine. 97 Medicines were withdrawn in at least one country but still included in one more national Essential Medicines list. Of 137 countries with a national Essential Medicines list, 136 lists included at least one withdrawn medicine, with 54% of the lists containing 5 or fewer withdrawn Medicines, and 27% including 10 or more withdrawn Medicines. 11 Medicines were withdrawn worldwide but still included on at least one national Essential Medicines list. Countries with longer Essential Medicines lists had more withdrawn Medicines included in their lists. This study found that withdrawn Medicines are included in all but one national Essential Medicines list, representing a need for more stringent processes for selecting and removing Medicines on these lists. Countries may wish to apply special scrutiny to Medicines withdrawn in other nations when selecting Medicines to include on their lists.
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withdrawn Medicines included in the Essential Medicines lists of 136 countries
PLOS ONE, 2019Co-Authors: Onella Charles, Anjli Bali, Hannah Woods, Igho Onakpoya, Simran Benipal, Jeffrey K. Aronson, Carl Heneghan, Nav PersaudAbstract:© 2019 Charles et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Essential Medicines lists and related policies are intended to meet the priority health needs of populations and their implementation is associated with more appropriate use of Medicines. The World Health Organization (WHO) recommends that countries carefully select the Medicines to be included in their national Essential Medicines lists. Lists that are used to prioritize access to important treatments should not include Medicines that have been withdrawn elsewhere because of an unfavourable benefit-to-harm balance; however, countries still list and use Medicines that have been withdrawn worldwide. The objective of this study was to determine whether the national Essential Medicines lists of 137 countries include Medicines that have been withdrawn in other countries. Methods and findings We performed an audit of national Essential Medicines lists for Medicines that had been withdrawn. Medicines withdrawn from worldwide markets between 1953 and 2014 were identified using a systematic review of published literature and regulatory documents. The reviewers used sources including the WHO's database of drugs, PubMed, and the websites of regulatory agencies to obtain information regarding adverse effects associated with the Medicines, the year of first withdrawal, markets of withdrawal, and the level of evidence supporting each withdrawal. We recorded the number of countries with a withdrawn medicine included in their national Medicines list, the number of withdrawn Medicines included in each nation's list, and the number of national Essential Medicines including each withdrawn medicine. 97 Medicines were withdrawn in at least one country but still included in one more national Essential Medicines list. Of 137 countries with a national Essential Medicines list, 136 lists included at least one withdrawn medicine, with 54% of the lists containing 5 or fewer withdrawn Medicines, and 27% including 10 or more withdrawn Medicines. 11 Medicines were withdrawn worldwide but still included on at least one national Essential Medicines list. Countries with longer Essential Medicines lists had more withdrawn Medicines included in their lists. Conclusions This study found that withdrawn Medicines are included in all but one national Essential Medicines list, representing a need for more stringent processes for selecting and removing Medicines on these lists. Countries may wish to apply special scrutiny to Medicines withdrawn in other nations when selecting Medicines to include on their lists.
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selection of who recommended Essential Medicines for non communicable diseases on national Essential Medicines lists
PLOS ONE, 2019Co-Authors: Efosa Oronsaye, Anjli Bali, Hannah Woods, Jordan D Jarvis, Nav PersaudAbstract:Background Non-communicable diseases (NCDs) are the leading cause of death worldwide. Inadequate and inequitable access to Essential NCD Medicines is a major concern, particularly in low- and middle-income countries. National Essential Medicines Lists (EMLs) are important policy tools that indicate which Medicines are prioritized as Essential within a country’s health system. This study sought to analyze a wide range of national Essential Medicines lists (EMLs) for their inclusion of priority non communicable disease (NCD) interventions recommended by the World Health Organization (WHO). Methods Three lists of WHO endorsed priority NCD interventions were included. A database with 137 national EMLs and the WHO EML was created from the WHO Repository and these EMLs were compared for listing of priority NCD interventions. Results Across 137 countries with national EMLs, the median percentage of 20 Best Buys interventions listed was 90% (IQR 80–95) and 31 Package of Essential noncommunicable disease interventions (PEN) interventions listed was 94% (IQR 90–97), of 9 HEARTS interventions was 100% (IQR 89–100), and of the 43 unique interventions across the three priority lists was 88% (IQR 84–93). Less than 80% of the 43 interventions were listed by 22 (16%) countries and less than half of the interventions were listed by 2 countries: Angola (35%) and Cambodia (23%). Interventions listed on the fewest number of national EMLs were: influenza vaccine, HPV vaccine, hepatitis B vaccine, cervical cancer chemotherapy, codeine, promethazine, senna, and oxygen. Conclusion Most NCD interventions have been prioritized in national policy in most cases. The majority of priority Medicines for NCDs described within key WHO NCD technical packages are listed on nearly all national EMLs across 137 countries of all income levels. Most NCD interventions have been prioritized in national policy in most cases, but in some countries and for select interventions such as the HPV vaccine, prioritization may be reviewed.
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Comparison of Essential Medicines lists in 137 countries
Bulletin of the World Health Organization, 2019Co-Authors: Nav Persaud, Maggie Jiang, Roha Shaikh, Anjli Bali, Efosa Oronsaye, Hannah Woods, Gregory Drozdzal, Yathavan Rajakulasingam, Darshanand Maraj, Sapna WadhawanAbstract:© 2019, World Health Organization. All rights reserved. Objective To compare the Medicines included in national Essential Medicines lists with the World Health Organization’s (WHO’s) Model list of Essential Medicines, and assess the extent to which countries’ characteristics, such as WHO region, size and health care expenditure, account for the differences. Methods We searched the WHO’s Essential Medicines and Health Products Information Portal for national Essential Medicines lists. We compared each national list of Essential Medicines with both the 2017 WHO model list and other national lists. We used linear regression to determine whether differences were dependent on WHO Region, population size, life expectancy, infant mortality, gross domestic product and health-care expenditure. Findings We identified 137 national lists of Essential Medicines that collectively included 2068 unique Medicines. Each national list contained between 44 and 983 Medicines (median 310: interquartile range, IQR: 269 to 422). The number of differences between each country’s Essential Medicines list and WHO’s model list ranged from 93 to 815 (median: 296; IQR: 265 to 381). Linear regression showed that only WHO region and health-care expenditure were significantly associated with the number of differences (adjusted R2: 0.33; P < 0.05). Most Medicines (1248; 60%) were listed by no more than 10% (14) of countries. Conclusion The substantial differences between national lists of Essential Medicines are only partly explained by differences in country characteristics and thus may not be related to different priority needs. This information helps to identify opportunities to improve Essential Medicines lists.
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Development of a provisional Essential Medicines list for children in Canada: consensus process.
CMAJ open, 2018Co-Authors: Hannah Woods, Anjli Bali, Efosa Oronsaye, Yathavan Rajakulasingam, Taehoon Lee, Norman Umali, Eyal Cohen, Yaron Finkelstein, Martin Offringa, Nav PersaudAbstract:Background Worldwide, many countries have developed a list of Essential Medicines for children to improve prescribing. We aimed to create an Essential Medicines list for children in Canada. Methods We adapted the previously created preliminary list of Essential Medicines for adults in Canada and the WHO Model List of Essential Medicines for Children to create a provisional list of Essential Medicines for children in Canada. Canadian clinicians made suggestions for changes. Literature relevant to each suggestion was presented to clinician-scientists, who used a modified nominal group technique to make recommendations on the suggestions. Ontario Public Drug Programs prescription data were reviewed to identify commonly prescribed medications missing from the list. Literature relevant to these medications was shared with a clinician-scientist review panel to determine which should be added, and a revised list was developed. Results A total of 76 items were removed from the list of Essential Medicines for adults in Canada because they were not indicated for use in children or were not relevant in the Canadian health care context; 7 medications were added to the child list based on Ontario Public Drugs Programs prescribing data and clinician-scientist review. Suggestions to add, remove or substitute medications were made by peer-reviewers and resulted in removal of 1 medication and replacement of 1 medication. The process produced a provisional list of 67 Essential medications for children. Interpretation A provisional list of 67 Essential Medicines for children was created through a peer-reviewed, multistep process based on current clinical evidence, Canadian clinical practice guidelines and historical prescribing data. It is publicly posted at http://cleanmeds.ca/. The list should be further developed based on wider input and should be continuously revised based on emerging evidence of the safety and effectiveness of these Medicines in all pediatric age groups.
Anjli Bali - One of the best experts on this subject based on the ideXlab platform.
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withdrawn Medicines included in the Essential Medicines lists of 136 countries
PLOS ONE, 2019Co-Authors: Onella Charles, Anjli Bali, Hannah Woods, Igho Onakpoya, Simran Benipal, Jeffrey K. Aronson, Carl Heneghan, Nav PersaudAbstract:© 2019 Charles et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Essential Medicines lists and related policies are intended to meet the priority health needs of populations and their implementation is associated with more appropriate use of Medicines. The World Health Organization (WHO) recommends that countries carefully select the Medicines to be included in their national Essential Medicines lists. Lists that are used to prioritize access to important treatments should not include Medicines that have been withdrawn elsewhere because of an unfavourable benefit-to-harm balance; however, countries still list and use Medicines that have been withdrawn worldwide. The objective of this study was to determine whether the national Essential Medicines lists of 137 countries include Medicines that have been withdrawn in other countries. Methods and findings We performed an audit of national Essential Medicines lists for Medicines that had been withdrawn. Medicines withdrawn from worldwide markets between 1953 and 2014 were identified using a systematic review of published literature and regulatory documents. The reviewers used sources including the WHO's database of drugs, PubMed, and the websites of regulatory agencies to obtain information regarding adverse effects associated with the Medicines, the year of first withdrawal, markets of withdrawal, and the level of evidence supporting each withdrawal. We recorded the number of countries with a withdrawn medicine included in their national Medicines list, the number of withdrawn Medicines included in each nation's list, and the number of national Essential Medicines including each withdrawn medicine. 97 Medicines were withdrawn in at least one country but still included in one more national Essential Medicines list. Of 137 countries with a national Essential Medicines list, 136 lists included at least one withdrawn medicine, with 54% of the lists containing 5 or fewer withdrawn Medicines, and 27% including 10 or more withdrawn Medicines. 11 Medicines were withdrawn worldwide but still included on at least one national Essential Medicines list. Countries with longer Essential Medicines lists had more withdrawn Medicines included in their lists. Conclusions This study found that withdrawn Medicines are included in all but one national Essential Medicines list, representing a need for more stringent processes for selecting and removing Medicines on these lists. Countries may wish to apply special scrutiny to Medicines withdrawn in other nations when selecting Medicines to include on their lists.
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Withdrawn Medicines included in the Essential Medicines lists of 136 countries.
PloS one, 2019Co-Authors: Onella Charles, Anjli Bali, Hannah Woods, Igho Onakpoya, Simran Benipal, Jeffrey K. Aronson, Carl Heneghan, Nav PersaudAbstract:Essential Medicines lists and related policies are intended to meet the priority health needs of populations and their implementation is associated with more appropriate use of Medicines. The World Health Organization (WHO) recommends that countries carefully select the Medicines to be included in their national Essential Medicines lists. Lists that are used to prioritize access to important treatments should not include Medicines that have been withdrawn elsewhere because of an unfavourable benefit-to-harm balance; however, countries still list and use Medicines that have been withdrawn worldwide. The objective of this study was to determine whether the national Essential Medicines lists of 137 countries include Medicines that have been withdrawn in other countries. We performed an audit of national Essential Medicines lists for Medicines that had been withdrawn. Medicines withdrawn from worldwide markets between 1953 and 2014 were identified using a systematic review of published literature and regulatory documents. The reviewers used sources including the WHO's database of drugs, PubMed, and the websites of regulatory agencies to obtain information regarding adverse effects associated with the Medicines, the year of first withdrawal, markets of withdrawal, and the level of evidence supporting each withdrawal. We recorded the number of countries with a withdrawn medicine included in their national Medicines list, the number of withdrawn Medicines included in each nation's list, and the number of national Essential Medicines including each withdrawn medicine. 97 Medicines were withdrawn in at least one country but still included in one more national Essential Medicines list. Of 137 countries with a national Essential Medicines list, 136 lists included at least one withdrawn medicine, with 54% of the lists containing 5 or fewer withdrawn Medicines, and 27% including 10 or more withdrawn Medicines. 11 Medicines were withdrawn worldwide but still included on at least one national Essential Medicines list. Countries with longer Essential Medicines lists had more withdrawn Medicines included in their lists. This study found that withdrawn Medicines are included in all but one national Essential Medicines list, representing a need for more stringent processes for selecting and removing Medicines on these lists. Countries may wish to apply special scrutiny to Medicines withdrawn in other nations when selecting Medicines to include on their lists.
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selection of who recommended Essential Medicines for non communicable diseases on national Essential Medicines lists
PLOS ONE, 2019Co-Authors: Efosa Oronsaye, Anjli Bali, Hannah Woods, Jordan D Jarvis, Nav PersaudAbstract:Background Non-communicable diseases (NCDs) are the leading cause of death worldwide. Inadequate and inequitable access to Essential NCD Medicines is a major concern, particularly in low- and middle-income countries. National Essential Medicines Lists (EMLs) are important policy tools that indicate which Medicines are prioritized as Essential within a country’s health system. This study sought to analyze a wide range of national Essential Medicines lists (EMLs) for their inclusion of priority non communicable disease (NCD) interventions recommended by the World Health Organization (WHO). Methods Three lists of WHO endorsed priority NCD interventions were included. A database with 137 national EMLs and the WHO EML was created from the WHO Repository and these EMLs were compared for listing of priority NCD interventions. Results Across 137 countries with national EMLs, the median percentage of 20 Best Buys interventions listed was 90% (IQR 80–95) and 31 Package of Essential noncommunicable disease interventions (PEN) interventions listed was 94% (IQR 90–97), of 9 HEARTS interventions was 100% (IQR 89–100), and of the 43 unique interventions across the three priority lists was 88% (IQR 84–93). Less than 80% of the 43 interventions were listed by 22 (16%) countries and less than half of the interventions were listed by 2 countries: Angola (35%) and Cambodia (23%). Interventions listed on the fewest number of national EMLs were: influenza vaccine, HPV vaccine, hepatitis B vaccine, cervical cancer chemotherapy, codeine, promethazine, senna, and oxygen. Conclusion Most NCD interventions have been prioritized in national policy in most cases. The majority of priority Medicines for NCDs described within key WHO NCD technical packages are listed on nearly all national EMLs across 137 countries of all income levels. Most NCD interventions have been prioritized in national policy in most cases, but in some countries and for select interventions such as the HPV vaccine, prioritization may be reviewed.
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Comparison of Essential Medicines lists in 137 countries
Bulletin of the World Health Organization, 2019Co-Authors: Nav Persaud, Maggie Jiang, Roha Shaikh, Anjli Bali, Efosa Oronsaye, Hannah Woods, Gregory Drozdzal, Yathavan Rajakulasingam, Darshanand Maraj, Sapna WadhawanAbstract:© 2019, World Health Organization. All rights reserved. Objective To compare the Medicines included in national Essential Medicines lists with the World Health Organization’s (WHO’s) Model list of Essential Medicines, and assess the extent to which countries’ characteristics, such as WHO region, size and health care expenditure, account for the differences. Methods We searched the WHO’s Essential Medicines and Health Products Information Portal for national Essential Medicines lists. We compared each national list of Essential Medicines with both the 2017 WHO model list and other national lists. We used linear regression to determine whether differences were dependent on WHO Region, population size, life expectancy, infant mortality, gross domestic product and health-care expenditure. Findings We identified 137 national lists of Essential Medicines that collectively included 2068 unique Medicines. Each national list contained between 44 and 983 Medicines (median 310: interquartile range, IQR: 269 to 422). The number of differences between each country’s Essential Medicines list and WHO’s model list ranged from 93 to 815 (median: 296; IQR: 265 to 381). Linear regression showed that only WHO region and health-care expenditure were significantly associated with the number of differences (adjusted R2: 0.33; P < 0.05). Most Medicines (1248; 60%) were listed by no more than 10% (14) of countries. Conclusion The substantial differences between national lists of Essential Medicines are only partly explained by differences in country characteristics and thus may not be related to different priority needs. This information helps to identify opportunities to improve Essential Medicines lists.
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Development of a provisional Essential Medicines list for children in Canada: consensus process.
CMAJ open, 2018Co-Authors: Hannah Woods, Anjli Bali, Efosa Oronsaye, Yathavan Rajakulasingam, Taehoon Lee, Norman Umali, Eyal Cohen, Yaron Finkelstein, Martin Offringa, Nav PersaudAbstract:Background Worldwide, many countries have developed a list of Essential Medicines for children to improve prescribing. We aimed to create an Essential Medicines list for children in Canada. Methods We adapted the previously created preliminary list of Essential Medicines for adults in Canada and the WHO Model List of Essential Medicines for Children to create a provisional list of Essential Medicines for children in Canada. Canadian clinicians made suggestions for changes. Literature relevant to each suggestion was presented to clinician-scientists, who used a modified nominal group technique to make recommendations on the suggestions. Ontario Public Drug Programs prescription data were reviewed to identify commonly prescribed medications missing from the list. Literature relevant to these medications was shared with a clinician-scientist review panel to determine which should be added, and a revised list was developed. Results A total of 76 items were removed from the list of Essential Medicines for adults in Canada because they were not indicated for use in children or were not relevant in the Canadian health care context; 7 medications were added to the child list based on Ontario Public Drugs Programs prescribing data and clinician-scientist review. Suggestions to add, remove or substitute medications were made by peer-reviewers and resulted in removal of 1 medication and replacement of 1 medication. The process produced a provisional list of 67 Essential medications for children. Interpretation A provisional list of 67 Essential Medicines for children was created through a peer-reviewed, multistep process based on current clinical evidence, Canadian clinical practice guidelines and historical prescribing data. It is publicly posted at http://cleanmeds.ca/. The list should be further developed based on wider input and should be continuously revised based on emerging evidence of the safety and effectiveness of these Medicines in all pediatric age groups.
Hannah Woods - One of the best experts on this subject based on the ideXlab platform.
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withdrawn Medicines included in the Essential Medicines lists of 136 countries
PLOS ONE, 2019Co-Authors: Onella Charles, Anjli Bali, Hannah Woods, Igho Onakpoya, Simran Benipal, Jeffrey K. Aronson, Carl Heneghan, Nav PersaudAbstract:© 2019 Charles et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Essential Medicines lists and related policies are intended to meet the priority health needs of populations and their implementation is associated with more appropriate use of Medicines. The World Health Organization (WHO) recommends that countries carefully select the Medicines to be included in their national Essential Medicines lists. Lists that are used to prioritize access to important treatments should not include Medicines that have been withdrawn elsewhere because of an unfavourable benefit-to-harm balance; however, countries still list and use Medicines that have been withdrawn worldwide. The objective of this study was to determine whether the national Essential Medicines lists of 137 countries include Medicines that have been withdrawn in other countries. Methods and findings We performed an audit of national Essential Medicines lists for Medicines that had been withdrawn. Medicines withdrawn from worldwide markets between 1953 and 2014 were identified using a systematic review of published literature and regulatory documents. The reviewers used sources including the WHO's database of drugs, PubMed, and the websites of regulatory agencies to obtain information regarding adverse effects associated with the Medicines, the year of first withdrawal, markets of withdrawal, and the level of evidence supporting each withdrawal. We recorded the number of countries with a withdrawn medicine included in their national Medicines list, the number of withdrawn Medicines included in each nation's list, and the number of national Essential Medicines including each withdrawn medicine. 97 Medicines were withdrawn in at least one country but still included in one more national Essential Medicines list. Of 137 countries with a national Essential Medicines list, 136 lists included at least one withdrawn medicine, with 54% of the lists containing 5 or fewer withdrawn Medicines, and 27% including 10 or more withdrawn Medicines. 11 Medicines were withdrawn worldwide but still included on at least one national Essential Medicines list. Countries with longer Essential Medicines lists had more withdrawn Medicines included in their lists. Conclusions This study found that withdrawn Medicines are included in all but one national Essential Medicines list, representing a need for more stringent processes for selecting and removing Medicines on these lists. Countries may wish to apply special scrutiny to Medicines withdrawn in other nations when selecting Medicines to include on their lists.
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Withdrawn Medicines included in the Essential Medicines lists of 136 countries.
PloS one, 2019Co-Authors: Onella Charles, Anjli Bali, Hannah Woods, Igho Onakpoya, Simran Benipal, Jeffrey K. Aronson, Carl Heneghan, Nav PersaudAbstract:Essential Medicines lists and related policies are intended to meet the priority health needs of populations and their implementation is associated with more appropriate use of Medicines. The World Health Organization (WHO) recommends that countries carefully select the Medicines to be included in their national Essential Medicines lists. Lists that are used to prioritize access to important treatments should not include Medicines that have been withdrawn elsewhere because of an unfavourable benefit-to-harm balance; however, countries still list and use Medicines that have been withdrawn worldwide. The objective of this study was to determine whether the national Essential Medicines lists of 137 countries include Medicines that have been withdrawn in other countries. We performed an audit of national Essential Medicines lists for Medicines that had been withdrawn. Medicines withdrawn from worldwide markets between 1953 and 2014 were identified using a systematic review of published literature and regulatory documents. The reviewers used sources including the WHO's database of drugs, PubMed, and the websites of regulatory agencies to obtain information regarding adverse effects associated with the Medicines, the year of first withdrawal, markets of withdrawal, and the level of evidence supporting each withdrawal. We recorded the number of countries with a withdrawn medicine included in their national Medicines list, the number of withdrawn Medicines included in each nation's list, and the number of national Essential Medicines including each withdrawn medicine. 97 Medicines were withdrawn in at least one country but still included in one more national Essential Medicines list. Of 137 countries with a national Essential Medicines list, 136 lists included at least one withdrawn medicine, with 54% of the lists containing 5 or fewer withdrawn Medicines, and 27% including 10 or more withdrawn Medicines. 11 Medicines were withdrawn worldwide but still included on at least one national Essential Medicines list. Countries with longer Essential Medicines lists had more withdrawn Medicines included in their lists. This study found that withdrawn Medicines are included in all but one national Essential Medicines list, representing a need for more stringent processes for selecting and removing Medicines on these lists. Countries may wish to apply special scrutiny to Medicines withdrawn in other nations when selecting Medicines to include on their lists.
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selection of who recommended Essential Medicines for non communicable diseases on national Essential Medicines lists
PLOS ONE, 2019Co-Authors: Efosa Oronsaye, Anjli Bali, Hannah Woods, Jordan D Jarvis, Nav PersaudAbstract:Background Non-communicable diseases (NCDs) are the leading cause of death worldwide. Inadequate and inequitable access to Essential NCD Medicines is a major concern, particularly in low- and middle-income countries. National Essential Medicines Lists (EMLs) are important policy tools that indicate which Medicines are prioritized as Essential within a country’s health system. This study sought to analyze a wide range of national Essential Medicines lists (EMLs) for their inclusion of priority non communicable disease (NCD) interventions recommended by the World Health Organization (WHO). Methods Three lists of WHO endorsed priority NCD interventions were included. A database with 137 national EMLs and the WHO EML was created from the WHO Repository and these EMLs were compared for listing of priority NCD interventions. Results Across 137 countries with national EMLs, the median percentage of 20 Best Buys interventions listed was 90% (IQR 80–95) and 31 Package of Essential noncommunicable disease interventions (PEN) interventions listed was 94% (IQR 90–97), of 9 HEARTS interventions was 100% (IQR 89–100), and of the 43 unique interventions across the three priority lists was 88% (IQR 84–93). Less than 80% of the 43 interventions were listed by 22 (16%) countries and less than half of the interventions were listed by 2 countries: Angola (35%) and Cambodia (23%). Interventions listed on the fewest number of national EMLs were: influenza vaccine, HPV vaccine, hepatitis B vaccine, cervical cancer chemotherapy, codeine, promethazine, senna, and oxygen. Conclusion Most NCD interventions have been prioritized in national policy in most cases. The majority of priority Medicines for NCDs described within key WHO NCD technical packages are listed on nearly all national EMLs across 137 countries of all income levels. Most NCD interventions have been prioritized in national policy in most cases, but in some countries and for select interventions such as the HPV vaccine, prioritization may be reviewed.
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Comparison of Essential Medicines lists in 137 countries
Bulletin of the World Health Organization, 2019Co-Authors: Nav Persaud, Maggie Jiang, Roha Shaikh, Anjli Bali, Efosa Oronsaye, Hannah Woods, Gregory Drozdzal, Yathavan Rajakulasingam, Darshanand Maraj, Sapna WadhawanAbstract:© 2019, World Health Organization. All rights reserved. Objective To compare the Medicines included in national Essential Medicines lists with the World Health Organization’s (WHO’s) Model list of Essential Medicines, and assess the extent to which countries’ characteristics, such as WHO region, size and health care expenditure, account for the differences. Methods We searched the WHO’s Essential Medicines and Health Products Information Portal for national Essential Medicines lists. We compared each national list of Essential Medicines with both the 2017 WHO model list and other national lists. We used linear regression to determine whether differences were dependent on WHO Region, population size, life expectancy, infant mortality, gross domestic product and health-care expenditure. Findings We identified 137 national lists of Essential Medicines that collectively included 2068 unique Medicines. Each national list contained between 44 and 983 Medicines (median 310: interquartile range, IQR: 269 to 422). The number of differences between each country’s Essential Medicines list and WHO’s model list ranged from 93 to 815 (median: 296; IQR: 265 to 381). Linear regression showed that only WHO region and health-care expenditure were significantly associated with the number of differences (adjusted R2: 0.33; P < 0.05). Most Medicines (1248; 60%) were listed by no more than 10% (14) of countries. Conclusion The substantial differences between national lists of Essential Medicines are only partly explained by differences in country characteristics and thus may not be related to different priority needs. This information helps to identify opportunities to improve Essential Medicines lists.
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Development of a provisional Essential Medicines list for children in Canada: consensus process.
CMAJ open, 2018Co-Authors: Hannah Woods, Anjli Bali, Efosa Oronsaye, Yathavan Rajakulasingam, Taehoon Lee, Norman Umali, Eyal Cohen, Yaron Finkelstein, Martin Offringa, Nav PersaudAbstract:Background Worldwide, many countries have developed a list of Essential Medicines for children to improve prescribing. We aimed to create an Essential Medicines list for children in Canada. Methods We adapted the previously created preliminary list of Essential Medicines for adults in Canada and the WHO Model List of Essential Medicines for Children to create a provisional list of Essential Medicines for children in Canada. Canadian clinicians made suggestions for changes. Literature relevant to each suggestion was presented to clinician-scientists, who used a modified nominal group technique to make recommendations on the suggestions. Ontario Public Drug Programs prescription data were reviewed to identify commonly prescribed medications missing from the list. Literature relevant to these medications was shared with a clinician-scientist review panel to determine which should be added, and a revised list was developed. Results A total of 76 items were removed from the list of Essential Medicines for adults in Canada because they were not indicated for use in children or were not relevant in the Canadian health care context; 7 medications were added to the child list based on Ontario Public Drugs Programs prescribing data and clinician-scientist review. Suggestions to add, remove or substitute medications were made by peer-reviewers and resulted in removal of 1 medication and replacement of 1 medication. The process produced a provisional list of 67 Essential medications for children. Interpretation A provisional list of 67 Essential Medicines for children was created through a peer-reviewed, multistep process based on current clinical evidence, Canadian clinical practice guidelines and historical prescribing data. It is publicly posted at http://cleanmeds.ca/. The list should be further developed based on wider input and should be continuously revised based on emerging evidence of the safety and effectiveness of these Medicines in all pediatric age groups.
Hans V Hogerzeil - One of the best experts on this subject based on the ideXlab platform.
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Essential Medicines in National Constitutions: Progress since 2008
Health and human rights, 2016Co-Authors: S. Katrina Perehudoff, Brigit Toebes, Hans V HogerzeilAbstract:A constitutional guarantee of access to Essential Medicines has been identified as an important indicator of government commitment to the progressive realization of the right to the highest attainable standard of health. The objective of this study was to evaluate provisions on access to Essential Medicines in national constitutions, to identify comprehensive examples of constitutional text on Medicines that can be used as a model for other countries, and to evaluate the evolution of constitutional Medicines-related rights since 2008. Relevant articles were selected from an inventory of constitutional texts from WHO member states. References to states’ legal obligations under international human rights law were evaluated. Twenty-two constitutions worldwide now oblige governments to protect and/or to fulfill accessibility of, availability of, and/or quality of Medicines. Since 2008, state responsibilities to fulfill access to Essential Medicines have expanded in five constitutions, been maintained in four constitutions, and have regressed in one constitution. Government commitments to Essential Medicines are an important foundation of health system equity and are included increasingly in state constitutions.
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Essential Medicines and human rights what can they learn from each other
Bulletin of The World Health Organization, 2006Co-Authors: Hans V HogerzeilAbstract:Most countries have acceded to at least one global or regional covenant or treaty confirming the right to health. After years of international discussions on human rights, many governments are now moving towards practical implementation of their commitments. A practical example may be of help to those governments who aim to translate their international treaty obligations into practice. WHO's Essential Medicines Programme is an example of how this transition from legal principles to practical implementation may be achieved. This programme has been consistent with human rights principles since its inception in the early 1980s, through its focus on equitable access to Essential Medicines. This paper provides a brief overview of what the international human rights instruments mention about access to Essential Medicines, and proposes five assessment questions and practical recommendations for governments. These recommendations cover the selection of Essential Medicines, participation in programme development, mechanisms for transparency and accountability, equitable access by vulnerable groups, and redress mechanisms. Bulletin of the World Health Organization 2006;84:371-375.
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Human Rights: A Potentially Powerful Force for Essential Medicines
Bulletin of The World Health Organization, 2006Co-Authors: Helena Nygren-krug, Hans V HogerzeilAbstract:Health policy-makers need ways to increase access peoples' access to Essential Medicines. The human rights framework provides new tools for analysis, action, accountability, alignment of policies, and advocacy. To support the analysis of how well access to Essential Medicines is being realized in countries, the UN human rights treaty bodies work with WHO to identify appropriate indicators for the right to the enjoyment of the highest attainable standard of health (the right to health). These indicators will incorporate measures to increase access to Essential Medicines and form an integral component of the regular State Party reports. National benchmarks will be set against these indicators in order to monitor progress. One article in this issue of the Bulletin argues for benchmarks to monitor implementation of various World Health Assembly resolutions on access to Medicines and amendments to the Agreement on the Trade-Related Aspects of Intellectual Property Rights (TRIPS). (1) The UN Special Rapporteur on the Right to Health, Paul Hunt, also works with WHO to set appropriate actions and indicators on Essential Medicines before the UN Human Rights Council. Human rights notes and principles offer a useful framework for action at the national level by providing guidance both on the content of the health programmes and on the process by which programmes are developed. Guiding human rights principles include freedom from discrimination, attention to vulnerable populations (including their right to participate at "all stages of the programming cycle), and the rights to information and to education. The human rights-based approach also includes capacity-building to enable duty bearers to meet their human rights obligations and to enable rights-holders to enjoy and claim their rights. (2) Systems of accountability, are also part of a human rights-based approach. International accountability comes through country reports by the UN treaty bodies; international scrutiny of Failure to meet human rights obligations can spur governments to make corrections. National accountability and redress can be provided through the courts. Judicial decisions in several low- and middle-income countries have already been rendered in support of access to Essential Medicines. National and international accountability requirements can therefore help the Ministry of Health to put access to Medicines higher on the national political agenda, as part of the government's overall human rights performance. Recognizing that access to Essential Medicines is part of government-wide human rights obligations also encourages alignment of policies with the obligation to move towards the highest attainable standard of health. Ministries of finance, trade and planning are equally responsible for safeguarding the right to health; they need to work with the ministry of health to ensure intersectoral cooperation and policy coherence. Intersectoral efforts to make best use of TRIPS' flexibilities are a good example of such cooperation. Finally, the debates about how different intellectual property regimes could stimulate innovation and also increase access to Essential Medicines highlight the powerful advocacy role that human rights can play in achieving health objectives. One of the articles in this issue describes Medicines as knowledge goods and the author argues that we should separate incentives to innovate, from market forces to sell. (3) Everyone has the right to enjoy the benefits of scientific progress and its applications. (4) This right could be used to more effect in ensuring equitable access to such benefits. …
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twenty five years of Essential Medicines
Bulletin of The World Health Organization, 2002Co-Authors: Jonathan D Quick, Hans V Hogerzeil, German Velasquez, Lembit RagoAbstract:The twentieth century opened with only one widely available modern medicine: acetylsalicylic acid (aspirin). In the 1940s the first antibiotic, the first mass produced antimalarial, and the first antitubercular were introduced. The 1950s and 1960s saw the rapid introduction of oral contraceptives, Medicines for diabetes, and then Medicines for mental illness, many infectious diseases, cardiovascular diseases, and cancer. By the 1970s effective Medicines--though not always ideal--existed for nearly every major illness. Yet for half the world's population, it was as if they were still living in the nineteenth century. For them, modern Medicines were unavailable, unaffordable, of poor quality, or ineffective because not properly used. In 1975 the World Health Assembly introduced the concepts of "Essential drugs" and "national drug policy", and they quickly became part of the global public health vocabulary. The Health Assembly was building on precedents set in Scandinavia, North America and some pioneering developing countries, such as Papua New Guinea, Peru, Sri Lanka, and the United Republic of Tanzania, in the hope that they would provide a way to begin closing the huge gap between those who were benefiing from the pharmaceutical harvest of the mid-1900s and those who were not. In October 1977, WHO produced the first Model List of Essential Drugs and in 1978 the Declaration of Alma-Ata identified "provision of Essential drugs" as one of the eight elements of primary health care. According to the current WHO Expert Committee on the Selection and Use of Essential Medicines, "Essential Medicines are those that satisfy the priority health needs of the population. They are selected with due regard to disease prevalence, evidence of efficacy and safety, and comparative cost-effectiveness. Essential Medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms with assured quality, and at a price the individual and the community can afford. The implementation of the concept of Essential Medicines is intended to be flexible and adaptable to many different situations; exactly which Medicines are regarded as Essential remains a national responsibility." Thanks partly to the recognition and application of these principles, the situation has changed enormously since 1977. The following examples give some idea of the contrast. In 1977, perhaps a dozen countries had what would now be considered an Essential Medicines list or an Essential drugs programme. Today, four out of five countries--at least 156 countries in total--have adopted national Essential Medicines lists. National lists are widely used for public procurement systems, reimbursement schemes, training, public education, and other national health activities. Most countries have recently updated their lists, and WHO has updated its own model list of Essential Medicines on average every two years for the 25 years. In 1977, the concept of a national drug policy was unknown to almost everyone. Today, over 100 countries have national drug policies in place or under development. These policies are being introduced at increasing speed in every region. More importantly, a growing number of countries are moving directly from policy to action. The national drug policy is increasingly serving as a framework within which interested parties can work for pharmaceutical sector reform within countries. In 1977, objective information on rational use of drugs was extremely limited, especially in developing countries. Today, at least 135 countries have their own therapeutic manuals and formularies, which provide health professionals with current, accurate and unbiased advice on the rational use of drugs. In addition, this year the WHO Model Formulary was launched. In 1977, medical training was often based on brand names, and little attention was given to systematic teaching about rational drug use. …
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Withdrawn Medicines included in the Essential Medicines lists of 136 countries.
PloS one, 2019Co-Authors: Onella Charles, Anjli Bali, Hannah Woods, Igho Onakpoya, Simran Benipal, Jeffrey K. Aronson, Carl Heneghan, Nav PersaudAbstract:Essential Medicines lists and related policies are intended to meet the priority health needs of populations and their implementation is associated with more appropriate use of Medicines. The World Health Organization (WHO) recommends that countries carefully select the Medicines to be included in their national Essential Medicines lists. Lists that are used to prioritize access to important treatments should not include Medicines that have been withdrawn elsewhere because of an unfavourable benefit-to-harm balance; however, countries still list and use Medicines that have been withdrawn worldwide. The objective of this study was to determine whether the national Essential Medicines lists of 137 countries include Medicines that have been withdrawn in other countries. We performed an audit of national Essential Medicines lists for Medicines that had been withdrawn. Medicines withdrawn from worldwide markets between 1953 and 2014 were identified using a systematic review of published literature and regulatory documents. The reviewers used sources including the WHO's database of drugs, PubMed, and the websites of regulatory agencies to obtain information regarding adverse effects associated with the Medicines, the year of first withdrawal, markets of withdrawal, and the level of evidence supporting each withdrawal. We recorded the number of countries with a withdrawn medicine included in their national Medicines list, the number of withdrawn Medicines included in each nation's list, and the number of national Essential Medicines including each withdrawn medicine. 97 Medicines were withdrawn in at least one country but still included in one more national Essential Medicines list. Of 137 countries with a national Essential Medicines list, 136 lists included at least one withdrawn medicine, with 54% of the lists containing 5 or fewer withdrawn Medicines, and 27% including 10 or more withdrawn Medicines. 11 Medicines were withdrawn worldwide but still included on at least one national Essential Medicines list. Countries with longer Essential Medicines lists had more withdrawn Medicines included in their lists. This study found that withdrawn Medicines are included in all but one national Essential Medicines list, representing a need for more stringent processes for selecting and removing Medicines on these lists. Countries may wish to apply special scrutiny to Medicines withdrawn in other nations when selecting Medicines to include on their lists.
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withdrawn Medicines included in the Essential Medicines lists of 136 countries
PLOS ONE, 2019Co-Authors: Onella Charles, Anjli Bali, Hannah Woods, Igho Onakpoya, Simran Benipal, Jeffrey K. Aronson, Carl Heneghan, Nav PersaudAbstract:© 2019 Charles et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Essential Medicines lists and related policies are intended to meet the priority health needs of populations and their implementation is associated with more appropriate use of Medicines. The World Health Organization (WHO) recommends that countries carefully select the Medicines to be included in their national Essential Medicines lists. Lists that are used to prioritize access to important treatments should not include Medicines that have been withdrawn elsewhere because of an unfavourable benefit-to-harm balance; however, countries still list and use Medicines that have been withdrawn worldwide. The objective of this study was to determine whether the national Essential Medicines lists of 137 countries include Medicines that have been withdrawn in other countries. Methods and findings We performed an audit of national Essential Medicines lists for Medicines that had been withdrawn. Medicines withdrawn from worldwide markets between 1953 and 2014 were identified using a systematic review of published literature and regulatory documents. The reviewers used sources including the WHO's database of drugs, PubMed, and the websites of regulatory agencies to obtain information regarding adverse effects associated with the Medicines, the year of first withdrawal, markets of withdrawal, and the level of evidence supporting each withdrawal. We recorded the number of countries with a withdrawn medicine included in their national Medicines list, the number of withdrawn Medicines included in each nation's list, and the number of national Essential Medicines including each withdrawn medicine. 97 Medicines were withdrawn in at least one country but still included in one more national Essential Medicines list. Of 137 countries with a national Essential Medicines list, 136 lists included at least one withdrawn medicine, with 54% of the lists containing 5 or fewer withdrawn Medicines, and 27% including 10 or more withdrawn Medicines. 11 Medicines were withdrawn worldwide but still included on at least one national Essential Medicines list. Countries with longer Essential Medicines lists had more withdrawn Medicines included in their lists. Conclusions This study found that withdrawn Medicines are included in all but one national Essential Medicines list, representing a need for more stringent processes for selecting and removing Medicines on these lists. Countries may wish to apply special scrutiny to Medicines withdrawn in other nations when selecting Medicines to include on their lists.