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. 2014 Jan 8;9(1):e84824.
doi: 10.1371/journal.pone.0084824. eCollection 2014.

The role of evidence in the decision-making process of selecting essential medicines in developing countries: the case of Tanzania

Amani Thomas Mori  1 , Eliangiringa Amos Kaale  2 , Frida Ngalesoni  3 , Ole Frithjof Norheim  4 , Bjarne Robberstad  4
Affiliations

The role of evidence in the decision-making process of selecting essential medicines in developing countries: the case of Tanzania

Amani Thomas Mori et al. PLoS One. .

Abstract

Background: Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making.

Methods: This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data.

Findings: The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised.

Conclusions: Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Summary of the key milestones during the revision process.
Figure 2
Figure 2. Composition and institutional representation of the guideline review Secretariat.
Figure 3
Figure 3. Composition of the National Medicines and Therapeutic Committee.
*Three representatives.
See this image and copyright information in PMC

References

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