Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana.
Ghana National Drugs Programme, Ministry of Health, Accra, Ghana.
Health Policy Plan. 2019 Nov 1;34(Supplement_2):ii104-ii120. doi: 10.1093/heapol/czz107.
Understanding how countries review their national standard treatment guidelines (STGs) and essential medicines list (EML) is important in the light of ever-changing trends in public health and evidence supporting the selection and use of medicines in disease management. This study examines the 2017 STGs and EML review process, the actors involved and how the list of medicines and disease conditions evolved between the last two editions. We examined expert committee reports, stakeholder engagement reports and the last two editions (2010, 2017) STGs and EML. The review process occurred in both bureaucratic and public arenas where various actors with varied power and interest engaged in ways to consolidate their influence with the use of evidence from research and practice. In the bureaucratic arena, a national medicines selection committee inaugurated by the Minister of Health assessed the 2010 edition through technical sessions considering the country's disease burden, hierarchical healthcare structure and evidence on safety and efficacy and expert opinion. To build consensus and ensure credibility service providers, professional bodies and healthcare managers scrutinized the assessed guidelines and medicines list in public arenas. In such public arenas, technical discussions moved towards negotiations with emphasis on practicability of the policies. Updates in the 2017 guidelines involved the addition of 64 new disease conditions in the STG, with the EML including 153 additional medicines and excluding 56 medicines previously found in the 2010 EML. Furthermore, the level of care categorization for Level 'A' [i.e. community-based health planning and services (CHPS)] and Level 'M' (i.e. midwifery and CHPS with a midwife) evolved to reflect the current primary healthcare and community mobilization activities for healthcare delivery in Ghana. Ghana's experience in using evidence from research and practice and engaging wide stakeholders can serve as lessons for other low and middle-income countries.
了解各国如何审查国家标准治疗指南 (STG) 和基本药物清单 (EML)，对于不断变化的公共卫生趋势以及支持疾病管理中药物选择和使用的证据至关重要。本研究考察了 2017 年 STG 和 EML 审查过程、涉及的行为体以及在过去两个版本之间，药物清单和疾病状况的演变情况。我们审查了专家委员会报告、利益相关者参与报告以及过去两个版本 (2010 年、2017 年) 的 STG 和 EML。审查过程发生在官僚主义和公共领域，各种具有不同权力和利益的行为体以各种方式参与其中，利用来自研究和实践的证据来巩固自己的影响力。在官僚主义领域，由卫生部长发起的国家药物选择委员会通过技术会议对 2010 年版进行评估，考虑了该国的疾病负担、分层医疗保健结构以及安全性和疗效证据和专家意见。为了建立共识并确保服务提供者、专业机构和医疗保健管理人员的可信度，他们在公共领域仔细审查了评估后的指南和药物清单。在这样的公共领域，技术讨论转向了谈判，重点是政策的实用性。2017 年指南的更新涉及在 STG 中增加了 64 种新的疾病状况，EML 中增加了 153 种新的药物，同时排除了 2010 年 EML 中之前发现的 56 种药物。此外，A级[即社区卫生规划和服务 (CHPS)]和 M 级 (即助产士和 CHPS 助产士) 的护理分类水平也发生了变化，以反映加纳当前的初级卫生保健和社区动员活动，以提供医疗服务。加纳在利用研究和实践证据以及广泛的利益相关者参与方面的经验可以为其他低收入和中等收入国家提供借鉴。
