Abstract
BackgroundThe World Health Organization Essential Medicines List (WHO-LIST) and national essential medicines lists differ because many countries face significant challenges, such as product availability, cost, product quality and epidemiological disease profiles. In Brazil, governments pay for drugs that are included on the federal, state and municipal government (REMUME) lists. The extent to which municipal lists differ from state and national lists and from the WHO-LIST is unclear. We investigate the use of the WHO-LISTas a tool with which to evaluate the selection process for the essential psychiatric medicines in the public system coverage list of Brazilian communities (cities) and the use of the target drugs.MethodsMunicipal health secretaries were interviewed regarding the selection process for REMUMEs and the antidepressants and benzodiazepines included in REMUMEs and reference lists. We calculated the use of REMUME drugs that appeared or did not appear on reference lists according to the defined daily dose (DDD) per 10,000 inhabitants.ResultsLocal physicians and pharmacists without specific training or explicit criteria developed the REMUMEs. Of the 13 drugs and 24 products (i.e., the different dosages of these 13 drugs) in the REMUMEs, 8 drugs and 10 products were included in at least one reference list and in one municipal list; 4 drugs and 6 products were included in at least one reference list but in none of the municipal lists; and 7 drugs and 8 products were included in at least one municipal list but in none of the reference lists. The antidepressants that appeared in at least one municipal list but in none of the reference lists represented 25.1 % (mean 60.9 DDD/10,000 inhabitants-day) of the usage. The benzodiazepines that appeared in at least one of the municipal lists but in none of the reference lists represented 14.7 % mean 18.5 DDD/10,000 inhabitants-day) of the usage.ConclusionsBrazilian cities have no rigorous processes for selecting the drugs that appear on their lists, and drugs that do not appear on the reference lists represent a significant proportion of antidepressant and benzodiazepine use, resulting in public health and social problems.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2589-1) contains supplementary material, which is available to authorized users.
Highlights
The World Health Organization Essential Medicines List (WHO-LIST) and national essential medicines lists differ because many countries face significant challenges, such as product availability, cost, product quality and epidemiological disease profiles
The WHO-LIST published in 2011 (WHOLIST) serves as a guide for the development of national essential medicines lists, aguide that can be modified according to the national context –for instance, according to the prevalent diseases in a particular country [4]
In 1964 –prior to the first WHO-LIST, which was developed in 1977– Brazil developed its first list of essential medicines (RENAME)
Summary
The World Health Organization Essential Medicines List (WHO-LIST) and national essential medicines lists differ because many countries face significant challenges, such as product availability, cost, product quality and epidemiological disease profiles. In 1964 –prior to the first WHO-LIST, which was developed in 1977– Brazil developed its first list of essential medicines (RENAME) Despite this pioneering initiative, the discontinuity of public policy in subsequent decades and long periods in which the RENAME list was not revised may have delayed consolidation of the concept of essential medicines among managers, health professionals and users [5]. The review of the RENAME list in 2010 addressed a number of medicines that are needed to treat and control diseases that are public health priority in Brazil [6]
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