Abstract:
Understanding how countries review their national standard treatment guidelines (STGs) and
essential medicines list (EML) is important in the light of ever-changing trends in public health and
evidence supporting the selection and use of medicines in disease management. This study examines
the 2017 STGs and EML review process, the actors involved and how the list of medicines and
disease conditions evolved between the last two editions. We examined expert committee reports,
stakeholder engagement reports and the last two editions (2010, 2017) STGs and EML. The review
process occurred in both bureaucratic and public arenas where various actors with varied power and
interest engaged in ways to consolidate their influence with the use of evidence from research and
practice. In the bureaucratic arena, a national medicines selection committee inaugurated by the
Minister of Health assessed the 2010 edition through technical sessions considering the country’s
disease burden, hierarchical healthcare structure and evidence on safety and efficacy and expert
opinion. To build consensus and ensure credibility service providers, professional bodies and healthcare
managers scrutinized the assessed guidelines and medicines list in public arenas. In such public
arenas, technical discussionsmoved towards negotiations with emphasis on practicability of the policies.
Updates in the 2017 guidelines involved the addition of 64 new disease conditions in the STG,
with the EML including 153 additional medicines and excluding 56 medicines previously found in the
2010 EML. Furthermore, the level of care categorization for Level ‘A’ [i.e. community-based health
planning and services (CHPS)] and Level ‘M’ (i.e. midwifery and CHPS with a midwife) evolved to reflect
the current primary healthcare and community mobilization activities for healthcare delivery in
Ghana. Ghana’s experience in using evidence from research and practice and engaging wide stakeholders
can serve as lessons for other low and middle-income countries.
