Ministries of health, funders, and technical partners need to make regular smart reviews of Essential Medicines Lists the norm

As global health faces unprecedented challenges – from pandemic recovery to a changing political landscape –  resources are disappearing on a massive scale, and every healthcare dollar must work harder than ever before. 

Many countries are missing a huge opportunity: with just a few evidence-backed changes to their medicine lists, they could save lives and stretch limited health budgets much further.  

The World Health Organization (WHO) created the Essential Medicines List to help make sure people everywhere can get the medicines they need. When they work the way they’re intended, these lists help countries focus on the medicines that address the most urgent health needs – taking into account how common a disease is, how effective and safe a treatment is, and whether it offers good value. 

A strong essential medicines list makes sure the right drugs are available, in the right places, at prices people can afford. It’s one of the most powerful tools we have to reduce illness and save lives. But in many countries, the ministries of health don’t revise the list often, and aren’t transparent about their decision-making.

Systematic analysis

Rather than using a systematic analysis to make the lists as evidence-based and effective as possible, ministries of health often lean toward continuing what’s been done in the past, supplier lobbying, or the preferences of donors who support specific treatments or supply particular drugs.

That’s not just inefficient. It’s unsustainable in a world facing compounding health threats and fiscal constraints. The consequences extend beyond government budgets. 

When the right medicines aren’t on the list or aren’t stocked where they’re needed, patients are forced to pay out of pocket at private pharmacies for drugs that should be free. 

It’s unfair, it’s avoidable, and it pushes the dream of universal health coverage even further out of reach. Countries should build medicine lists that truly reflect what people need so that care becomes more accessible, more affordable, and more equitable. That’s how we turn universal health coverage from a distant goal into something real.

Tweaking Essential Drug Lists

Picture this: an old man with diabetes walks for hours to reach a public rural clinic in Uganda—only to be told the medicine he needs is out of stock.

So, he turns around and heads to a private pharmacy, where he’ll have to pay out of pocket for medicine that should have been free at the public clinic. The cost might mean skipping meals that week or delaying school fees for a grandchild. 

For many families, it’s a choice between medicine and everything else. This scene plays out every day across Uganda. At the same time, the government spends millions on newer diabetes drugs that are more expensive but no more effective than the other medicines. It’s not just bad policy. It’s a failure that costs lives. 

Our recent analysis of Uganda’s Essential Medicines and Health Supplies List showed that with just a few smart, evidence-backed changes, the system can work better: cheaper drugs, wider access, and real results for real people. 

We focused on medications for type 2 diabetes, a rapidly growing health burden across sub-Saharan Africa. 

The African region has the highest percentage of individuals with undiagnosed diabetes in the world. In Uganda, it is estimated that 2,2% of the total population had diabetes in 2024, and nearly half of patients are undiagnosed. 

We found that several newer diabetes medications added to Uganda’s list in 2023 were less available, less accessible, and substantially more expensive than older alternatives that had similar safety and efficacy profiles. 

For instance, replacing two newer drugs with an older, WHO-recommended drug could save Uganda’s 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 are not just theoretical calculations: they represent real money that could be reinvested in screening, diagnostics, or staffing to expand care.

Evidence-based reviews

If this approach worked in Uganda, it could work anywhere. We need to make this kind of evidence-based review a normal part of how countries choose their medicines. What set our analysis apart was the use of a structured, WHO-aligned framework, measuring not only cost and efficacy, but also cost-effectiveness, availability, and geographic accessibility. 

This kind of big-picture review almost never happens when countries update their medicine lists, especially in places with limited resources. Just as health systems measure vaccine coverage or maternal mortality, they should assess how well their essential medicine lists serve their populations. 

Countries need practical ways to make the WHO’s medicine list work for their own realities. It’s not about following guidance blindly – it’s about making smart, local decisions that truly 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 shows that we could have a smarter list, stronger outcomes, and more value for every health dollar. This is not just good economics—it’s good medicine. As the world strives toward universal health coverage, optimizing essential medicine lists is a small, practical step with an outsized impact.

We’re calling on ministries of health, funders, and technical partners to make this kind of smart medicine review the norm, not the exception. It’s simple, effective, and overdue. With modest effort, countries can free up millions, improve care, and move meaningfully 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.

Image Credits: Laurynas Me/ Unsplash.