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Essential medicines for emergency care in Africa
  1. Morgan C Broccoli1,
  2. Jennifer L Pigoga2,
  3. Mulinda Nyirenda3,
  4. Lee Wallis4,
  5. Emilie J Calvello Hynes5
  1. 1Boston Medical Center, Department of Emergency Medicine, Boston, Massachusetts, USA
  2. 2Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  3. 3Queen Elizabeth Central Hospital, Ministry of Health and University of Malawi College of Medicine, Blantyre, Malawi
  4. 4Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
  5. 5Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
  1. Correspondence to Dr Emilie J Calvello Hynes, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA; emilie.calvellohynes{at}ucdenver.edu

Abstract

Objectives Essential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications. The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury.

Methods We undertook a multistep consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final inperson consensus process.

Results The final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML, but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (eg, district hospitals) and an additional 78 for advanced facilities (eg, tertiary centres).

Conclusion The 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation and will be a useful tool for practical expansion of emergency care delivery in Africa.

  • acute care
  • emergency care systems
  • emergency department
  • equipment evaluation
  • global health

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Footnotes

  • Contributors MCB, LW and EJCH conceived and designed the study. All authors contributed substantially to the EML refinement process. MCB, JLP, LW and EJCH drafted the manuscript. All the authors contributed to the manuscript’s revision.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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