Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands; Health Action International, Amsterdam, the Netherlands.
Health Action International, Amsterdam, the Netherlands.
Int J Drug Policy. 2023 Aug;118:104078. doi: 10.1016/j.drugpo.2023.104078. Epub 2023 Jun 3.
Access to internationally controlled essential medicines (ICEMs), medicines that are listed on both the World Health Organization's Essential Medicines List and one of three international drug control conventions, remains problematic in Sub-Saharan Africa (SSA). Previous reviews have focused only on specific ICEMs or ICEM-related healthcare fields, but none have focused on all ICEMs as a distinct class. This scoping review therefore aims to identify the barriers to accessing ICEMs across all relevant healthcare fields in SSA.
A scoping review was conducted across indexing platforms Embase, PubMed, Scopus and Web of Science of studies published between January 1 2012 and February 1 2022. Articles were eligible if they mentioned barriers to accessing ICEMs and/or ICEM-related healthcare fields, if studies were conducted in SSA, or included data on an SSA country within a multi-country study. The review was guided by the Access to Medicines from a Health System Perspective framework.
The search identified 5519 articles, of which 97 met the inclusion criteria. Many barriers to access were reported and were common across the ICEMs drug class. Main barriers were: at the individual level, the lack of knowledge about ICEMs; at the health service delivery level, low availability, stockouts, affordability, long distances to health facilities, insufficient infrastructure to store and distribute ICEMs, and lack of ICEM knowledge and training among healthcare workers; at the health sector level, lack of prioritisation of ICEM-related healthcare fields by governments and subsequent insufficient budget allocation. Cross-cutting, governance-related barriers pertained to lack of proper quantification systems, cumbersome procurement processes, and strict national laws controlling ICEMs, leading to overly restrictive prescription practices.
This review showed that there are a multitude of barriers to accessing ICEMs in SSA across all health system levels. Many of the barriers identified are applicable to all ICEMs, highlighting the importance of tackling barriers for this entire class of drugs together.
在撒哈拉以南非洲（SSA），获得国际管制基本药物（ICEMs），即世界卫生组织基本药物清单和三项国际药物管制公约之一中列出的药物，仍然存在问题。以前的综述仅关注特定的 ICEM 或与 ICEM 相关的医疗保健领域，但没有一项综述关注所有 ICEM 作为一个独特的类别。因此，本次范围界定综述旨在确定在 SSA 所有相关医疗保健领域获得 ICEM 的障碍。
对 Embase、PubMed、Scopus 和 Web of Science 等索引平台进行了范围界定综述，检索了 2012 年 1 月 1 日至 2022 年 2 月 1 日期间发表的研究。如果文章提到了获得 ICEM 和/或与 ICEM 相关的医疗保健领域的障碍，或者研究在 SSA 进行，或者在多国研究中包含了 SSA 国家的数据，则符合纳入标准。综述的指导框架是从卫生系统角度获取药物的框架。
搜索共确定了 5519 篇文章，其中 97 篇符合纳入标准。报告了许多获得 ICEM 的障碍，并且在整个 ICEM 药物类别中都很常见。主要障碍包括：在个人层面上，缺乏对 ICEM 的了解；在卫生服务提供层面上，药品供应不足、库存短缺、药品可负担性、到卫生机构的距离较远、储存和分发 ICEM 的基础设施不足、卫生工作者缺乏 ICEM 知识和培训；在卫生部门层面上，政府对与 ICEM 相关的医疗保健领域没有给予优先重视，随后导致预算分配不足。贯穿始终的与治理相关的障碍涉及缺乏适当的量化系统、繁琐的采购程序以及严格控制 ICEM 的国家法律，导致处方过于严格。
本综述表明，在 SSA 所有卫生系统层面上，获得 ICEM 存在多种障碍。确定的许多障碍适用于所有 ICEM，突出了共同解决整个药物类别的障碍的重要性。
