Supplementary Material for: Insights from the WHO and National Lists of Essential Medicines: Focus on Pediatric Diabetes Care in Africa

<b><i>Background:</i></b> Access to essential medicines in pediatric endocrinology and diabetes is limited in resource-limited countries. The World Health Organization (WHO) maintains two non-binding lists of essential medicines (EMLs) which are often used as a template for developing national EMLs. <b><i>Methods:</i></b> We compared a previously published master list of medicines for pediatric endocrinology and diabetes with the WHO EMLs and national EMLs for countries within the WHO African region. To better understand actual access to medicines by patients, we focused on diabetes and surveyed pediatric endocrinologists from 5 countries and assessed availability and true cost for insulin and glucagon. <b><i>Results:</i></b> Most medicines that are essential in pediatric endocrinology and diabetes were included in the national EMLs. However, essential medicines, such as fludrocortisone, were present in less than 30% of the national EMLs despite being recommended by the WHO. Pediatric endocrinologists from the 5 focus countries reported significant variation in terms of availability and public access to insulin, as well as differences between urban and rural areas. Except for Botswana, glucagon was rarely available. There was no significant relationship between Gross National Income and the number of medicines included in the national EMLs. <b><i>Conclusions:</i></b> Governments in resource-limited countries could take further steps to improve EMLs and access to medicines such as improved collaboration between health authorities, the pharmaceutical industry, patient groups, health professionals, and capacity-building programs such as Paediatric Endocrinology Training Centres for Africa.

<b><i>背景：</i></b> 资源匮乏国家在儿童内分泌与糖尿病领域的必需药品可及性普遍不足。世界卫生组织（World Health Organization, WHO）编制了两份非约束性基本药物清单（Essential Medicines Lists, EMLs），该清单常被用作各国制定本国基本药物清单的模板。
<b><i>方法：</i></b> 本研究将此前发表的儿童内分泌与糖尿病专用药品总清单，与世界卫生组织基本药物清单以及世界卫生组织非洲区域内各国的本国基本药物清单进行了对比。为更全面了解患者实际可及的药品情况，本研究以糖尿病为重点研究对象，调研了5个国家的儿童内分泌科医师，并评估了胰岛素与胰高血糖素的可获得性及实际成本。
<b><i>结果：</i></b> 多数儿童内分泌与糖尿病领域的必需药品均被纳入本国基本药物清单。然而，尽管世界卫生组织推荐了氟氢可的松等必需药品，但仅有不足30%的本国基本药物清单纳入了此类药品。参与调研的5个重点国家的儿童内分泌科医师反馈，胰岛素的可获得性与公众可及性存在显著差异，且城乡之间也存在明显区别。除博茨瓦纳外，胰高血糖素几乎难以获得。国民总收入与本国基本药物清单收录的药品数量之间未存在显著关联。
<b><i>结论：</i></b> 资源匮乏国家的政府可采取进一步措施完善本国基本药物清单并提升药品可及性，例如加强卫生主管部门、制药企业、患者团体、医疗专业人员之间的协作，以及开展非洲儿童内分泌培训中心等能力建设项目。