Nyanchoka Moriasi, Mulaku Mercy, Nyagol Bruce, Owino Eddy Johnson, Kariuki Simon, Ochodo Eleanor
Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya.
Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
PLOS Glob Public Health. 2022 Dec 19;2(12):e0000827. doi: 10.1371/journal.pgph.0000827. eCollection 2022.
The World Health Organization (WHO) model list of Essential In vitro Diagnostic (EDL) introduced in 2018 complements the established Essential Medicines List (EML) and improves its impact on advancing universal health coverage and better health outcomes. We conducted a scoping review of the literature on implementing the WHO essential lists in Africa to inform the implementation of the recently introduced EDL. We searched eight electronic databases for studies reporting on implementing the WHO EDL and EML in Africa. Two authors independently conducted study selection and data extraction, with disagreements resolved through discussion. We used the Supporting the Use of Research Evidence (SURE) framework to extract themes and synthesised findings using thematic content analysis. We used the Mixed Method Appraisal Tool (MMAT) version 2018 to assess the quality of included studies. We included 172 studies reporting on EDL and EML after screening 3,813 articles titles and abstracts and 1,545 full-text papers. Most (75%, n = 129) studies were purely quantitative in design, comprising descriptive cross-sectional designs (60%, n = 104), 15% (n = 26) were purely qualitative, and 10% (n = 17) had mixed-methods approaches. There were no qualitative or randomised experimental studies about EDL. The main barrier facing the EML and EDL was poorly equipped health facilities-including unavailability or stock-outs of essential in vitro diagnostics and medicines. Financial and non-financial incentives to health facilities and workers were key enablers in implementing the EML; however, their impact differed from one context to another. Only fifty-six (33%) of the included studies were of high quality. Poorly equipped and stocked health facilities remain an implementation barrier to essential diagnostics and medicines. Health system interventions such as financial and non-financial incentives to improve their availability can be applied in different contexts. More implementation study designs, such as experimental and qualitative studies, are required to evaluate the effectiveness of essential lists.
世界卫生组织（WHO）2018年推出的基本体外诊断方法（EDL）模型清单对现有的基本药物清单（EML）进行了补充，提升了其在推进全民健康覆盖和改善健康成果方面的影响力。我们对非洲实施WHO基本清单的相关文献进行了范围界定审查，以为最近推出的EDL的实施提供参考。我们在八个电子数据库中搜索了关于在非洲实施WHO EDL和EML的研究报告。两位作者独立进行研究筛选和数据提取，如有分歧则通过讨论解决。我们使用“支持研究证据的使用”（SURE）框架提取主题，并采用主题内容分析法综合研究结果。我们使用2018版混合方法评估工具（MMAT）评估纳入研究的质量。在筛选了3813篇文章标题和摘要以及1545篇全文论文后，我们纳入了172项关于EDL和EML的研究报告。大多数（75%，n = 129）研究在设计上纯粹是定量的，包括描述性横断面设计（60%，n = 104），15%（n = 26）是纯粹定性的，10%（n = 17）采用了混合方法。没有关于EDL的定性或随机实验研究。EML和EDL面临的主要障碍是卫生设施配备不足，包括基本体外诊断方法和药品不可用或缺货。对卫生设施和工作人员的财政和非财政激励措施是实施EML的关键推动因素；然而，其影响因不同情况而异。纳入的研究中只有五十六项（33%）质量较高。卫生设施配备不足和库存短缺仍然是基本诊断方法和药品实施的障碍。可以在不同情况下应用诸如财政和非财政激励措施等卫生系统干预措施来提高其可及性。需要更多的实施研究设计，如实验性和定性研究，来评估基本清单的有效性。
