Health in Action Integrating Global and National Knowledge to Select Medicines for Children: The Ghana National Drugs Programme

In 2011, the World Health Organization (WHO) Essential Medicines Programme published a list of ‘‘priority medicines’’ they considered essential for countries to achieve the Millennium Development Goals in child and maternal health [1]. This list was a subset of the model Essential Medicines List (EML), produced every 2 years by the WHO, which selects medicines on the basis of public health relevance, comparative effectiveness, safety, cost, and regulatory status [2]. The WHO model EML is adapted for use in Ghana by the Ghana National Drugs Programme of the Ministry of Health (MOH), and access to essential medicines is now largely financed through the National Health Insurance Scheme (NHIS). This scheme was established by the government of Ghana in 2003, and covers over 60% of the population [3]. Membership of the NHIS is through annual subscription, but free of charge to those under 18, over 70, pregnant, or the very poor, and members may access care through accredited public and private health care providers [4]. Following publication of the 2011 model EML it was noted that five of the priority paediatric medicines were not included in the 2010 Ghana EML: oral zinc sulphate for acute diarrhoea, injectable artesunate for severe malaria, topical chlorhexidine for preventing neonatal cord sepsis, dispersible oral amoxicillin for community acquired pneumonia, and oral and injectable caffeine citrate for neonatal apnoea [5]. Before adopting these medicines, the Ghana National Drugs Programme (GNDP) wanted to review the evidence base and how it applied to Ghana, using a transparent and evidence-informed approach, which further considered the local priorities, feasibility, and resource implications. In this paper we report on how the GNDP did this, and the difficulties experienced when interpreting and applying global recommendations to a national context.