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The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania

BACKGROUND: Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims t...

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Autores principales: Mori, Amani Thomas, Kaale, Eliangiringa Amos, Ngalesoni, Frida, Norheim, Ole Frithjof, Robberstad, Bjarne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3885598/
https://www.ncbi.nlm.nih.gov/pubmed/24416293
http://dx.doi.org/10.1371/journal.pone.0084824
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author Mori, Amani Thomas
Kaale, Eliangiringa Amos
Ngalesoni, Frida
Norheim, Ole Frithjof
Robberstad, Bjarne
author_facet Mori, Amani Thomas
Kaale, Eliangiringa Amos
Ngalesoni, Frida
Norheim, Ole Frithjof
Robberstad, Bjarne
author_sort Mori, Amani Thomas
collection PubMed
description BACKGROUND: Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making. METHODS: This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data. FINDINGS: The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised. CONCLUSIONS: Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence.
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spelling pubmed-38855982014-01-10 The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania Mori, Amani Thomas Kaale, Eliangiringa Amos Ngalesoni, Frida Norheim, Ole Frithjof Robberstad, Bjarne PLoS One Research Article BACKGROUND: Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making. METHODS: This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data. FINDINGS: The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised. CONCLUSIONS: Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence. Public Library of Science 2014-01-08 /pmc/articles/PMC3885598/ /pubmed/24416293 http://dx.doi.org/10.1371/journal.pone.0084824 Text en © 2014 Mori et al http://creativecommons.org/licenses/by/4.0/ 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 properly credited.
spellingShingle Research Article
Mori, Amani Thomas
Kaale, Eliangiringa Amos
Ngalesoni, Frida
Norheim, Ole Frithjof
Robberstad, Bjarne
The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania
title The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania
title_full The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania
title_fullStr The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania
title_full_unstemmed The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania
title_short The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania
title_sort role of evidence in the decision-making process of selecting essential medicines in developing countries: the case of tanzania
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3885598/
https://www.ncbi.nlm.nih.gov/pubmed/24416293
http://dx.doi.org/10.1371/journal.pone.0084824
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