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.
