The selection of essential medicines in China: progress and the way forward.

Objective: The objective of this paper is to analyze the development of China’s national essential medicines list (NEML) from 1979 to 2010. These findings were then used as a basis to provide suggestions on how to improve essential medicines selection in China. Methods: The literature search was conducted on the issues related to “essential medicines”, “China” and “national essential medicines lists”. The information on essential medicines principles, criteria and procedures was also reviewed. Literature review and key informants interview were also conducted. Key informants were interviewed mainly on how medicines are selected at central and provincial level and how medicine selection could be improved in China. Results: In the past, China’s national essential medicines list has not been successful in promoting access to essential medicines. Reasons for this failure included biased selection and non evidence-based selection. Analysis of China’s essential medicines list and WHO’s generic essential medicines show that two lists varied substantially in disease coverage. The NEML failed to cover some diseases of public health significance in China such as cancers. The way medicines are classified and defined is also different between the two lists, e.g., medicines in the NEML are listed without defining the dose. There are differing levels in transparency, involvement, collaboration and accountability in the way the medicines are selected. Lastly, most of the provinces selected additional medicines to complement NEML. However, in 2009 version of Chinese essential medicines list, some improvements have been noted. Conclusions: There has been significant improvement in China’s NEML. The latest NEML made progress by setting achievable targets, adopting balanced guidelines and updating principles and criteria. However, there is still need to increase evidence-based selection, reassess which diseases are in need to be covered and define medicines with dosage forms and doses. In selecting medicines, efforts should be made towards higher transparency, involvement, collaboration and accountability. Provincial selection should be improved by establishing relevant measures and receiving technical support from the national government.