Facing unprecedented global health challenges and shrinking resources, it's time to rethink how we spend every healthcare dollar. The core issue? Many countries are missing a golden opportunity to save lives and stretch their budgets simply by making smart adjustments to their essential medicines lists. But here's where it gets controversial: are we making the best choices for the medicines we need?
The World Health Organization (WHO) created the Essential Medicines List to ensure everyone can access necessary medications. When done right, these lists help countries prioritize treatments for the most pressing health needs, considering disease prevalence, treatment effectiveness and safety, and value for money. A strong list ensures the right drugs are available, affordable, and accessible – a powerful tool for reducing illness and saving lives.
However, a critical problem is that many health ministries don't regularly update these lists, nor are they transparent about their decision-making processes. Instead of systematic analysis, they often rely on the status quo, lobbying from suppliers, or the preferences of donors who support specific treatments.
This isn't just inefficient; it's unsustainable in today's complex health landscape. The consequences extend far beyond government budgets. When the right medicines aren't available, patients are forced to pay out-of-pocket for drugs that should be free, pushing the dream of universal health coverage further away.
Let's paint a picture: Imagine an elderly diabetic man in rural Uganda who walks for hours to a clinic, only to find his medication is out of stock. He then must pay for it at a private pharmacy, potentially sacrificing meals or school fees. This scenario plays out daily, while the government spends millions on newer, more expensive diabetes drugs that aren't necessarily more effective. It's a failure that costs lives.
Our recent analysis of Uganda's Essential Medicines and Health Supplies List revealed that evidence-backed changes could significantly improve the system. We focused on medications for type 2 diabetes, a rapidly growing health concern in sub-Saharan Africa.
In Uganda, it's estimated that **2.2% of the total population had diabetes in 2024, and nearly half of the patients remain undiagnosed.** We found that some newer diabetes medications added to Uganda's list in 2023 were less accessible and significantly more expensive than older alternatives with similar safety and efficacy. For example, replacing two newer drugs with an older, WHO-recommended drug could save the Ugandan government up to $2.65 million annually. Additional savings, potentially in the hundreds of thousands of dollars, could come from using higher-dose formulations that reduce packaging costs.
These savings represent real money that could be reinvested in screening, diagnostics, or staffing to expand care.
If this approach worked in Uganda, it could work anywhere. We need to make evidence-based reviews a standard practice for countries when choosing their medicines. Our analysis used a structured, WHO-aligned framework, measuring cost, efficacy, cost-effectiveness, availability, and geographic accessibility.
This kind of comprehensive review is rare when countries update their medicine lists, especially in resource-limited settings. Just as health systems measure vaccine coverage or maternal mortality, they should assess the effectiveness of their essential medicine lists. Countries need practical ways to make the WHO's list work for their realities. It's about making smart, local decisions that meet people's needs.
The math is compelling: if small changes to Uganda's diabetes drug selection can save millions annually, imagine the global impact of systematically optimizing essential medicine lists worldwide. Uganda's case demonstrates that we could have a smarter list, stronger outcomes, and more value for every health dollar. As the world strives toward universal health coverage, optimizing essential medicine lists is a small, practical step with an outsized impact.
We urge health ministries, funders, and technical partners to make these smart medicine reviews the norm. It's simple, effective, and overdue. With modest effort, countries can free up millions, improve care, and move closer to universal health coverage.
Dr. Tracy Kuo Lin is an associate professor of health economics at the University of California, San Francisco. Her research focuses on health system financing and resource allocation.
Atousa Bonyani is a PhD student in Global Health Sciences at the University of California, San Francisco, with research interests in essential medicines lists and access to medicines.
What are your thoughts? Do you think your country's essential medicine list is up-to-date and effective? Share your opinions in the comments below!
