SELECTION

2 TREATMENT GUIDELINES AND FORMULARY MANUALS

 THE ESSENTIAL MEDICINE LIST
CONTEXT
 An essential medicine list names the medicines considered optimal
treatment of choice to satisfy the health needs of a given population.
 Used for a particular health facility
 Can also be for a group of facilities with similar conditions
 Considered as the supply list for a facility
 Indicate the dosage form/park size/ other specifications
LIST OF REGISTERED MEDICINES
This include the medicines that have been registered for use in the
country.
In Malawi include those that are registered by the Malawi Pharmacy
and Medicines Board.
The number of registered products may be many times greater than the
number of products on the essential medicine list.
The two reasons for having more registered medicines include:
• Equivalent product being manufactured by other manufacturers.
• Other registered medicines may not be considered essential in the
public sector
 FORMULARY MANUAL
The term formulary can be confusing
It is helpful to distinguish formulary list as a selecting tool, the
formulary manual as source of medicine information, and the
formulary system as a pharmaceutical management process
FORMULARY LIST
• A list of pharmaceutical products approved for use in a specific health
care setting.
• It may be:
National
Provincial
Hospital
List of health product reimbursed by health insurance
FORMULARY MANUAL
• Contains a summary of drug information
• Not a full text book
• Handy reference
• Contain selected information that is relevant to the prescriber,
dispenser, nurse and other health workers
• Medicines are in generic forms
• Indicates medicine, indication, dosage frequency, side effects and
important info that should be given to the patient
• It is medicine centred
NATIONAL FORMULARY MANUAL
• This is based on the national essential medicine list
• BNF include medicine that are commonly used in the UK
FORMULARY SYSTEM
• Encompasses all the whole system for developing, updating, and
promoting formulary system usually includes formulary list in
additional to formulary manual
TREATMENT GUIDELINES
• STG, Treatment protocols, clinical guidelines are systematically
developed statements that assist prescribers in deciding on
appropriate treatment for specific clinical problems.
• Reflects a consensus on the options within a health facility or health
system.
• It is disease centered
• Information on medicines is limited to strength, dosage, and duration
• Most guidelines indicate the treatment of first choice
The key difference between
formulary manual and treatment
guidelines
• Formulary manual; drug centered
• STG ; disease centered
APPROACHED TO DEVELOPING ESSENTIAL MEDICINE
LIST, FORMULARIES AND TREATMENT GUIDELINES

• These materials are related and are supposed to be developed in a

systematic manner.
• Logical approach is based on the needs of patients and on the job
description of the job discretion of the health workers.
Approach: 1
Develop a list of common health problems.
The first-choice treatment for each health problem on the list may be
limited to one or more medicines.

This choice of treatments can be basis:

List of essential medicines for a specific level of care
Treatment guidelines for that level of care
The approach works better for primary health care because at hospital
level the number of disease conditions may be too complex
• In practice however some sort of medicine list is already available in
most setting and can serve as the starting point.
• This list has to be reviewed by a therapeutic group and the first choice
medicines and alternatives may be indicated

The list of essential medicines for each level of care should be

combined into one national essential list of medicines.
This list is the basis for the development of national formulary.
Approach 2:
• A list of registered medicines can be critically reviewed for the
selection of a much shorter national list of essential medicines.
• Using the shorter list medicine and therapeutic committees in
individual facilities can choose a treatment of choice for that facility
or district.
• Medicine selection at the facility is especially much valuable when the
national list of essential medicine is extensive to be applicable for
individual facilities.
• This also helps adherence, acceptance and compliance of the
prescriber because of their involvement.
• Medicine selection by committee is the most preferred approach
because it minimizes the opportunity for private interest.
• Helps in transparency and accountability
How to achieve the greatest
efficiency
The following representatives can be included to ensure that a good
coordination is achieved
• Ministry of health
• Purchasing department
• Technical experts:
 Pharmacologist
 Infectious disease specialist
 Pediatrician
 Surgeon
 etc
Implementing and updating
essential medicine lists
• The use of list of essential medicines have some implications for
pharmaceutical procurement, local production, supply, training,
prescribing, and supervision.
• The challenge is you can have essential medicine lists, treatment
guidelines, and formulary manuals developed, printed and forgotten
and fail to be used
Reasons for failure
• Lack of involvement of the policy makers
• List and guidelines developed by department operating in isolation.
• Lack of openness and transparency
• Unrealistic selection e.g. sophisticated medicines for lower health
facilities
Gaining acceptance:
• Obtain support from the professional organizations
• Consultations and involving relevant stakeholders
• At national level after developing, it is important to give it national
prominence and credibility through a launching campaign.
• The steps should involve high level government officials
Authority of essential medicines lists
• Specify the purpose of the list at an early stage is critical
• Will the procurement and distribution of medicines in the public be
limited to the list?
• Will exceptions to the list be allowed?
• Open and transparent system of regular updates crucial in
maintaining authority and acceptance of an essential medicines list.
Reference
• Managing Access to Medicines and Health Technologies, MSH
The end

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