Background
“those that satisfy the priority health care needs of the population. These are selected with regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness; and should be available and affordable at all times within functioning health systems. Countries then determine which medicines are considered essential” [4].
Methods
Results
Quantitative changes in the SA STG/EMLs over time
Level of SA STG/EML | Year of SA STG/EML | Total molecules (excluding duplicates) | Total Molecules (including duplicates) | Total dosage forms (including duplicates) | Ratio dosage forms per molecule (including duplicates) | Total number of therapeutic classes present |
---|---|---|---|---|---|---|
Primary Health Care | 1996 | 134 | 180 | 201 | 1.12 | 0 |
1998 | 125 | 177 | 198 | 1.12 | 0 | |
2003 | 140 | 202 | 219 | 1.08 | 6 | |
2008 | 161 | 231 | 243 | 1.05 | 12 | |
Adult Hospital | 1998 | 364 | 397 | 447 | 1.13 | 0 |
2006 | 390 | 428 | 432 | 1.01 | 32 | |
2012 | 357 | 395 | 407 | 1.03 | 31 | |
Paediatric Hospital | 1998 | 231 | 316 | 368 | 1.16 | 1 |
2006 | 240 | 348 | 384 | 1.10 | 12 | |
2013 | 228 | 342 | 372 | 1.09 | 22 |
Section of SA STG/EML | Primary Health Care | Adult Hospital | Paediatric Hospital | ||||||
---|---|---|---|---|---|---|---|---|---|
1996 | 2008 | Ratio | 1998 | 2012 | Ratio | 1998 | 2013 | Ratio | |
Alimentary Tract and Metabolism | 25 | 37 | 1.5 | 52 | 49 | 0.9 | 50 | 44 | 0.9 |
Blood and Blood-forming Products | 4 | 11 | 2.8 | 18 | 23 | 1.3 | 26 | 33 | 1.3 |
Cardiovascular System | 12 | 22 | 1.8 | 34 | 41 | 1.2 | 33 | 26 | 0.8 |
Dermatologicals | 21 | 17 | 0.8 | 21 | 17 | 0.8 | 7 | 23 | 3.3 |
Genitourinary System and Sex Hormones | 18 | 17 | 0.9 | 30 | 28 | 0.9 | 5 | 8 | 1.6 |
Systemic Hormonal Preparations, excluding Sex Hormones | 2 | 2 | 1.0 | 15 | 17 | 1.1 | 9 | 12 | 1.3 |
General Anti-infectives for Systemic Use | 39 | 55 | 1.4 | 73 | 83 | 1.1 | 62 | 98 | 1.6 |
Antineoplastic and Immunomodulating Agents | 0 | 0 | 0.0 | 29 | 8 | 0.3 | 30 | 5 | 0.2 |
Musculoskeletal System | 4 | 4 | 1.0 | 11 | 12 | 1.1 | 8 | 3 | 0.4 |
Central Nervous System | 21 | 30 | 1.4 | 58 | 53 | 0.9 | 41 | 41 | 1.0 |
Antiparasitic Products | 10 | 10 | 1.0 | 9 | 7 | 0.8 | 10 | 9 | 0.9 |
Respiratory System | 10 | 15 | 1.5 | 11 | 14 | 1.3 | 11 | 18 | 1.6 |
Sensory Organs | 8 | 9 | 1.1 | 14 | 28 | 2.0 | 10 | 12 | 1.2 |
Various | 6 | 2 | 0.3 | 22 | 15 | 0.7 | 14 | 10 | 0.7 |
Level of SA STG/EML | Year of SA STG/EML | Number of additions* | Number of deletions* | Net change |
---|---|---|---|---|
Primary Health Care | 1998 | 46 | 47 | −1 |
2003 | 37 | 26 | 11 | |
2008 | 60 | 34 | 26 | |
Adult Hospital | 2006 | 150 | 123 | 27 |
2012 | 47 | 91 | 44 | |
Paediatric Hospital | 2006 | 127 | 104 | 23 |
2013 | 93 | 96 | −3 |
Comparative analysis of SA STG/EMLs with WHO model lists
Section | Name of medicine (core list) | Name of medicine (complementary list) |
---|---|---|
2. Medicine for pain and palliative care | Docusate sodium | |
4. Antidotes and other substances used in poisoning | Potassium ferric hexacyano-ferrate(II)-2H2O Sodium nitrite Sodium thiosulfate | Fomepizole Sodium calcium edetate Succimer, |
5. Anticonvulsants/antiepileptics | Ethosuximide | |
6. Anti-infective medicines | Levamisole (not registered in SA), Niclosamide, Pyrantel, Diethylcarbamazine (not readily available in SA, can be obtained from pharma company), Ivermectin (not registered in SA, can be obtained after MCC approval) Triclabendazole (not available for human use in SA) Azithromycin, Trimethoprim (available in combination with Sulfamethoxazole), Spectinomycin (not available in SA), Clofazimine (available on named patient basis) Ethambutol + Isoniazid Ethambutol + Isoniazid + Rifampicin Rifabutin Flucytosine (available on named patient basis after MCC approval) Griseofulvin Potassium iodide Atazanavir Saquinavir Indinavir Lamivudine + nevirapine + stavudine (FDC) Lamivudine + nevirapine + zidovudine (FDC) Lamivudine + zidovudine (FDC) Emtricitabine + Tenofovir (FDC) Efavirenz + Emtricitabine + Tenofovir (FDC) Oseltamivir Ribavirin, Diloxinide (not available in SA) Miltefosine, Paromomycin (not available in SA) Sodium stibogluconate, Amodiaquine (not available in SA) Artemether (available in combination with lumefantrine) Artesunate (not registered in SA, can be obtained through the IV artesunate access programme on a named patient basis after MCC approval) Artesunate + amodiaquine (not available in SA) Artesunate + mefloquine (not available in SA), Mefloquine (not registered for treatment in SA) Proguanil (not registered for treatment only prophylaxis and in combination with Atovaquone) Sulfadoxine + Pyrimethamine (no longer recommended due to increased resistance) Pyrimethamine Sulfadiazine (available as silver sulfadiazine) Pentamidine (not available in SA, available on named patient basis) Suramin sodium (not readily available in SA, can be obtained on named patient basis) Eflornithine (not readily available in SA, can be obtained on named patient basis) Melarsoprol (not readily available in SA, can be obtained on named patient basis) Nifurtimox (not available in SA) | Capreomycin, Oxaminiquine (not available in SA) Cycloserine (alternative terizidone is listed) p-aminosalicylic acid (PAS), potassium iodide Pegylated interferon alpha (2a or 2b) |
8. Antineoplastic and immunosuppresives | Cytotoxics: Ciclosporin, asparaginase, calcium folinate, carboplatin, chlorambucil, mercaptopurine, cytarabine, dactinomycin, daunorubicin, dacarbazine, doxorubicin, docetaxel, mercaptopurine, mesna, thioguanine, etoposide, fluorouracil, ifosfamide, paclitaxel, procarbazine, vinblastine, | |
10. Medicines affecting the blood | protamine sulfate | |
12. Cardiovascular medicines | Sodium nitroprusside | |
13. Dermatological medicines (topical) | Sodium thiosulfate Terbinafine Mupirocin Potassium permanganate Urea Fluorouracil | |
14. Diagnostic agents | Amidotrizoate | Meglumine iotroxate |
15. Disinfectants and antiseptics | Glutaral | |
16. Diuretics | Amiloride | |
18. Hormones, other endocrine medicines and contraceptives | Estradiol cypionate + medroxyprogesterone acetate Diaphragms Levonorgestrel releasing implant Potassium iodide, Propylthiouracil (not available in SA) | |
19. Immunologicals | Tuberculin (PPD) Diphtheria antitoxin Cholera vaccine Hepatitis A vaccine Japanese encephalitis vaccine Meningococcal meningitis vaccine Mumps vaccine Rotavirus vaccine Rubella vaccine Typhoid vaccine Yellow fever vaccine | |
21. Ophthalmological preparations | Azithromycin Latanoprost | Bevacizumab |
23. Peritoneal dialysis solution | Intraperitoneal dialysis solution | |
24. Medicines for mental and behavioural disorders | Clomipramine Nicotine replacement therapy | |
27. Vitamins and minerals | Ascorbic acid (only available in a multivitamin preparation) Riboflavin (only available in a multivitamin preparation) Sodium fluoride |
Priority life‐saving medicines for children under five years of age for major causes of mortality and morbidity, palliative care and child survival | ||||||||
---|---|---|---|---|---|---|---|---|
Condition | Drug | Formulation and Strength | PHC 2008 | ADULT 2012 | PAED 2013 | |||
Mol | DF | Mol | DF | Mol | DF | |||
Pneumonia | Amoxicillin | dispersible, scored tablets 250 mg and 500 mg or equivalent flexible oral solid dosage form | √ | X | √ | X | ||
Pneumonia | Ampicillin | powder for injection 500 mg and 1 g | X | √ | IV | |||
Pneumonia | Ceftriaxone | powder for injection 250 mg and 1 g | √ | IV | √ | IV | ||
Pneumonia | Gentamicin | injection 40 mg/ml; 20 mg/ml | X | √ | IV | |||
Pneumonia | Oxygen | medicinal gas | √ | √ | ||||
Diarrhoea | Oral rehydration salts (ORS): | sachets of 200 ml; 500 ml and 1 l, appropriate flavour | √ | sachets | √ | sachets | ||
Diarrhoea | Zinc | 20 mg scored dispersible tablet or equivalent flexible oral solid dosage form | X | X | ||||
Malaria | Artemesinin combination therapy (ACT) | dispersible tablet or flexible oral solid dosage form and dose optimized | X | X | ||||
Malaria | Artesunate | rectal and injection dosage forms 50–200 mg | X | X | ||||
Neonatal sepsis | Ampicillin | powder fir injection 250 mg and 500 mg | X | √ | IV | |||
Neonatal sepsis | Ceftriaxone | powder for injection 250 mg and 500 mg | √ | IV | √ | IV | ||
Neonatal sepsis | Gentamicin | injection 40 mg/ml; 20 mg/ml | X | √ | IV | |||
Neonatal sepsis | Procaine benzylpenicillin | powder for injection 1 g | X | √ | IM | |||
HIV | Standard regimen for first-line antiretroviral treatment | 1 NNRTI + 2 NRTIs e.g. lamivudine + nevirapine + zidovudine - tablet 30 mg + 50 mg + 60 mg; 150 mg + 200 mg + 300 mg | √ | oral | √ | oral | ||
Vitamin A deficiency | Vitamin A | capsule 100 000 IU strength; 200 000 IU strength | √ | capsule | √ | capsule | ||
Palliative care/Pain | Morphine | granules 20 mg, 30 mg, 60 mg, 100 mg, 200 mg; injection 10 mg/ml, oral liquid 10 mg/5 ml, | √ | IV | √ | Oral liquid | ||
Palliative care/Pain | Paracetamol | variable flexible oral solid dosage forms | √ | x | √ | x | ||
Vaccines | BCG | √ | √ | |||||
Vaccines | Hepatitis B | √ | √ | |||||
Vaccines | Polio | √ | √ | |||||
Vaccines | DTP | √ | X | |||||
Vaccines | Haemophilus influenze Type b | √ | X | |||||
Vaccines | Pneumococcal (conjugate) | X | √ | |||||
Vaccines | Rotavirus | X | X | |||||
Vaccines | Measles | √ | √ | |||||
Vaccines | Rubella | X | X | |||||
Vaccines | HPV | X | X | |||||
Vaccines | Japanese Encephalitis | X | X | |||||
Vaccines | Yellow fever | X | X | |||||
Vaccines | Tick Borne encephalitis | X | X | |||||
Vaccines | Typhoid | X | X | |||||
Vaccines | Cholera | X | X | |||||
Vaccines | Meningococcal | X | X | |||||
Vaccines | Hepatitis A | X | X | |||||
Vaccines | Rabies | √ | √ | |||||
Vaccines | Mumps | X | X | |||||
Vaccines | Influenze (Inactivated) | √ | √ | |||||
Priority life‐saving medicines for women for major causes of sexual and reproductive health related mortality and morbidity | ||||||||
Post-partum haemorrhage | Oxytocin | injection 10 IU in 1‐ml ampoule | √ | √ | ||||
Post-partum haemorrhage | Misoprostol | tablet 200 micrograms (when oxytocin is not available or cannot safely be used) | √ | √ | ||||
Post-partum haemorrhage | Sodium chloride | injectable solution 0.9% isotonic or | √ | √ | ||||
Post-partum haemorrhage | Sodium lactate compound | injectable solution (Ringer’s lactate) for infusion | √ | X | ||||
Severe pre‐eclampsia/eclampsia | Magnesium sulfate | injection 500 mg/ml in 10‐ml ampoule | √ | √ | ||||
Severe pre‐eclampsia/eclampsia | Calcium gluconate injection (for treatment of magnesium toxicity) | 100 mg/ml in 10‐ml ampoule | √ | √ | ||||
Severe pre‐eclampsia/eclampsia | Hydralazine | powder for injection 20 mg (hydrochloride) in ampoule or tablet 25 mg; 50 mg (hydrochloride) | X | √ | ||||
Severe pre‐eclampsia/eclampsia | Methyldopa | tablet 250 mg | √ | √ | ||||
Maternal sepsis | Ampicillin | powder for injection 500 mg; 1 g | X | √ | ||||
Maternal sepsis | Gentamicin | injection 40 mg/ml in 2‐ml vial | X | √ | ||||
Maternal sepsis | Metronidazole | injection 500 mg in 100‐ml vial | X | √ | ||||
Abortion/miscarriage | Misoprostol | tablet 200 micrograms | √ | √ | ||||
Abortion/miscarriage | Mifepristone + misoprostol | tablet 200 mg + tablet 200 micrograms (where permitted under national law) | X | √ | ||||
STIs | Azithromycin | capsule 250 mg; 500 mg or oral liquid 200 mg/5 ml | X | X | ||||
STIs | Cefixime | capsule 400 mg | √ | √ | ||||
STIs | Benzathine Benzylpenicillin | powder for injection 900 mg benzylpenicillin in 5 ml vial; 1,44 g benzylpenicillin in 5 ml vial | √ | √ | ||||
Preterm labour | Nifedipine | immediate release capsule 10 mg | √ | √ | ||||
preterm labour (foetal lung maturity) | Dexamethasone | injection 4 mg dexamethasone phosphate (as disodium salt) in 1‐ml ampoule or | X | √ | ||||
preterm labour (foetal lung maturity) | Betamethasone | injection 6 mg/ml (3 mg/ml betamethasone sodium phosphate + 3 mg/ml betamethasone acetate) in an aqueous vehicle | √ | √ | ||||
Maternal Malaria | Artesunate | parenteral | X | X | ||||
Maternal Malaria | Artemether | parenteral | X | X | ||||
Maternal Malaria | Quinine | parenteral | √ | √ | ||||
Maternal HIV/AIDS | AZT; 3TC; EFV; NVP; EFV; TDF; FTC; ABC; LPV | Doses not stipulated | √ | √ | ||||
Prevention of tetanus from MTC | Tetanus vaccine | √ | √ | |||||
Contraception | Oral contraceptives such as ethinylestradiol + levonorgestrel | tablet 30 micrograms + 150 micrograms; | √ | √ | ||||
Contraception | levonorgestrel | 750 micrograms (pack of 2); | √ | X | ||||
Contraception | Injectable: estradiol cypionate + medroxyprogesterone acetate | injection 5 mg + 25 mg or | X | X | ||||
Contraception | medroxyprogesterone acetate | depot injection 150 mg/ml in 1‐ml vial or | √ | X | ||||
Contraception | norethisterone enantate | 200 mg/ml in 1‐ml ampoule | √ | X | ||||
Contraception | implantable: levonorgestrel-releasing implant | 150 mg total | X | X | ||||
Contraception | intrauterine devices and barrier methods of contraception | copper-containing devices; condoms; diaphragms | √ | X |