The emergence of endocrine disease has created significant challenges for healthcare Policy-makers and payers across the world. Policy-makers have to ensure availability of drugs used for various endocrinopathies. One way in which this is facilitated is through the World Health Organization (WHO) List of Essential Medicines (LEM). The LEM aims to cover the basic pharmaceutical needs of the majority of people seeking healthcare.

Background: Essential medicine Policy is a successful global health Policy to promote rational drug use. The aim of this study was to evaluate the impact of the National Essential Medicines Policy (NEMP) on the rational drug use in primary care institutions in Jiangsu Province of China. Methods: In this exploratory study, a multistage, stratified, random sampling was used to select 3400 prescrip-tions from 17 primary care institutions who implemented the NEMP before (Jan 2010) and after the implemen-tation of the NEMP (Jan 2014). The analyses were performed in SPSS 18. 0 and SPSS Clementine client. Results: After the implementation of the NEMP, the percentage of prescribed EML (Essential Medicines List) drugs rose significantly, the average number of drugs per prescription and average cost per prescription were declined significantly, while the differences of the prescription proportion of antibiotics and injection were not statistically significant. BP (Back Propagation) neural network analysis showed that the average number of drugs per prescription, the number of using antibiotics and hormone, regional differences, size of institutions, sponsorship, financial income of institutions, doctor degree, outpatient and emergency visits person times were important factors affecting the prescription costs, among these the average number of drugs per prescription has the greatest effect. Conclusion: The NEMP can promote the rational use of drugs in some degree, but its role is limited. We should not focus only on the EML but also make comprehensive NEMP.

Injection is one of the most common medical procedures in the health sector. Annually up to 16 billion injections are prescribed in low- and middle-income countries (LMICs), many of them are not necessary for the patients, increase the healthcare costs and may result in side effects. Currently over 40% of outpatient prescriptions in Iran contain at least one injectable medicine. To address the issue, a working group was established (August 2014 to April 2015) to provide a comprehensive Policy brief to be used by national decision-makers. This report is the extract of methods that were followed and the main Policy options for improving injectable Medicines prescribing in outpatient services. Thirty-three potential Policy options were developed focusing on different stakeholders. The panel reached consensus on seven Policy options, noting effectiveness, cost, durability, and feasibility of each Policy. The recommended Policy options are targeted at patients and public (2 policies), insurers (2), physicians (1), pharmacies (1), and the Ministry of Health and Medical Education (MoHME) (1).

Background: China rolled out the national Essential Medicines Policy (NEMP) in primary care in 2009 and led to some unintended consequences including unavailability of Essential Medicines. This study examined patients’ coping behaviors to these unintended consequences of NEMP as well as the potential impact on primary care system development in Hangzhou, a developed city of China. Methods: We conducted qualitative interviews and surveys with service users, primary care physicians (PCPs), and specialists in tertiary hospitals. Qualitative findings informed the design of the survey questionnaires. Main outcomes included patients’ coping behaviors after the NEMP implementation, as well as providers’ perceptions of NEMP’ s impact on primary care development. Thematic analysis of the qualitative data and descriptive analysis of the survey data were conducted. Results: Unintended effects of NEMP included frequent unavailability of certain Essential drugs, leading to patient flow from primary care to hospital outpatient clinics for drug refills, difficulties in the provision of continuing care in primary care, as well as compromised patient trust in PCPs. In total, 1248 service users completed the questionnaires. A total of 132 (10. 6%) were aged 60 years or above. Among 153 (57. 7%) of the 265 who had some chronic condition(s) and needed long-term medication treatment, 60. 1% went to hospitals for refills. Four-hundred sixty PCPs and 651 specialists were recruited. Among 404 PCPs who were aware of the NEMP Policy implementation in their facility, 169 (41. 8%) reported that there was often a shortage of drugs at their facilities and 44 (10. 9%) reported always. Moreover, 68. 6% of these PCPs thought that the NEMP could not meet their patients’ needs. Further, 44. 2% (220/498) of specialists who were aware of the NEMP Policy in primary care reported that they often heard patients complaining about the Policy. In total, 53. 1% of PCPs and 42. 4% of specialists disagreed that NEMP helped direct patient flow to community-based care. Conclusion: NEMP’ s unintended effects undermined patients’ utilization of primary care in a developed city in China and led to unnecessary hospital visits. Countermeasures are needed to mitigate the negative impacts of NEMP on the primary care system.

Background  Implementing Medicines pricing Policy effectively is important for ensuring equitable access to Essential Medicines and ultimately achieving universal health coverage. However, published analyses of Policy implementations are scarce from low- and middle-income countries (LMICs). This paper contributes to bridging this knowledge gap by reporting analysis of implementation of two Medicines pricing policies in Ghana: value-added tax (VAT) exemptions and framework contracting (FC) for selected Medicines. We analysed implications of actor involvements, contexts, and contents on the implementation of these policies, and the interplay between these. This paper should be of interest, and relevance, to Policy designers, implementers, the private sector and Policy analysts.Methods  Data were collected through document reviews (n = 18), in-depth interviews (IDIs) (n = 30), focus group discussions (FGDs) (n = 2) and consultative meetings (n = 6) with purposefully identified Policy actors. Data were analysed thematically, guided by the four components of the health Policy triangle framework.Results  The nature and complexity of Policy contents determined duration and degree of formality of implementation processes. For instance, in the FC Policy, negotiating Medicines prices and standardizing the tendering processes lengthened implementation. Highly varied stakeholder participation created avenues for decision-making and promoted inclusiveness, but also raised the need to manage different agendas and interests. Key contextual enablers and constraints to implementation included high political support and currency depreciation, respectively. The interrelatedness of Policy content, actors, and context influenced the timeliness of Policy implementations and achievement of intended outcomes, and suggest five attributes of effective Policy implementation: (1) Policy nature and complexity, (2) inclusiveness, (3) organizational feasibility, (4) economic feasibility, and (5) political will and leadership.Conclusion Varied contextual factors, active participation of stakeholders, nature, and complexity of Policy content, and structures have all influenced the implementation of Medicines pricing policies in Ghana.