1. Discrepancies between International and National Lists of Essential Reproductive Health Medicines Jayasekar S, Gray R, Hogerzeil H V, Usher-Patel M Depts. of Essential Drugs and Medicines Policy & Reproductive Health Research WHO, Geneva. ICIUM 2004

3. Background International Conference on Population Development (Cairo,1999) goal: “Achieve universal access to reproductive health by 2015”. Objectives 1. Review of national essential medicines (EMLs) lists for reproductive health (RH). 2. Identification of discrepancies between UN lists for reproductive health medicines. 3. Harmonization of UN lists. 1

4. 1.Review of National EML’s for RH medicines Methodology 112 national EML’s reviewed of a possible 192 (WHO Member States). The interagency* RH list contains 169 medicines. RH medicines were divided into 4 categories, for analysis. –Reproductive health/Maternal health medicines –Family Planning –Sexually transmitted infections/reproductive tract infections (STI/RTI) –HIV/AIDS and opportunistic infections * UN agencies involved: WHO, UNFPA and UNAIDS 2

5. Comparison of National EML’s for RH medicines to the interagency list 3

6. Added to the WHO EML  No. of countries that list magnesium sulphate on their EML Example; magnesium sulphate is listed in only 45 national EMLs ( of 112 reviewed) 4

7. 316 on WHO* EML 169 Interagency* list medicines 75 UNFPA* List medicines 7 UNFPA/WHO medicines not on EML13 nor Interagency list 25 Interagency list medicines not on EML13 5 UNFPA medicines on EML13 but not on Interagency list 2. Discrepancies identified between UN lists for reproductive health medicines * The 13th WHO Model List of Essential Medicines * Draft UNFPA/WHO List of essential drugs and commodities for Reproductive Health Services *Draft interagency UNFPA/UNAIDS/WHO Reproductive Health Medicines List 5

8. 6 Initial comparison between lists: Medicines which seem to have been forgotten on R URE ethanolxx hydrochlorothiazide*x*x norethisterone enantatexx retinolxx *furosemide on R U= UNFPA list; R=Interagency list; E= WHO Model List

9. 7 Initial comparison between lists: Alternative choice of medicine preferred on WHO EML Discrepancy medicines URalternative on E clotrimazolexxmiconazole zalcitabine, delavirdine, amprenavirxsee ARV guide dephenylhydraminexpromethazine itraconazole, ketoconazolexfluconazole labetalolxatenolol magnesium trisilicate, sodium citratexalum.hydroxide tinidazolexmetronidazole ritodrine, terbutalinexsalbutamol methylergometrinexergometrine

10. 8 Initial comparison between lists: (Recently) deleted from the WHO Model List (E) but listed on U & R URE spermicides x contraceptive foams/gelsx pethidinex iron dextranx misoprostol (application recently rejected) x

11. To include or not to include? Suggested for systematic review and submission to WHO Expert Committee URE levonorgestrel-IUDsx norethisterone enantate + valeratex oestradiol cyprionate +med.prog.acetatex indometacin (tocolytic)x cefazolin (geneal surgical prophylaxis)x cefixime (gonorhoea)x prostaglandinsx subdermal contraceptive inplantsx hydralazine*xx * Recently discussed but needs more review 9

12. 3.Harmonization of UN lists Document available RH STG*s for discrepancy medicines. –Recommendations on STGs –Recommendations on medicines Collect additional clinical evidence. Convene an Interagency working group to decide on the discrepancy medicines and STGs. Develop a harmonized list of essential RH medicines for dissemination and feedback. *STG: Standard treatment guideline 10

13. Collaborating partners United Nations Population Fund (UNFPA) United Nations Children’s Fund (UNICEF) Joint United Nations Programme on HIV/AIDS (UNAIDS) World Bank Dept. for International Development, (DfID) Gesellschaft für Technische Zusammenarbeit (GTZ) KFW Development Bank Family Health International (FHI) Program for Appropriate Technology in Health (PATH) John Snow, Inc (JSI) Médecins Sans Frontiéres (MSF) The Supply Initiative The Bill and Melinda Gates Foundation The Mellon Foundation 11