Skip to main content
  • Loading metrics

Implementing essential diagnostics-learning from essential medicines: A scoping review

  • Moriasi Nyanchoka ,

    Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Validation, Visualization, Writing – original draft, Writing – review & editing

    Affiliation Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya

  • Mercy Mulaku,

    Roles Conceptualization, Data curation, Investigation, Methodology, Writing – review & editing

    Affiliations Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa, Department of Pharmacology, Clinical Pharmacy, and Pharmacy Practice, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya

  • Bruce Nyagol,

    Roles Investigation, Writing – review & editing

    Affiliation Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya

  • Eddy Johnson Owino,

    Roles Investigation, Writing – review & editing

    Affiliation Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya

  • Simon Kariuki,

    Roles Writing – review & editing

    Affiliation Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya

  • Eleanor Ochodo

    Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

    Affiliations Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa


The World Health Organization (WHO) model list of Essential In vitro Diagnostic (EDL) introduced in 2018 complements the established Essential Medicines List (EML) and improves its impact on advancing universal health coverage and better health outcomes. We conducted a scoping review of the literature on implementing the WHO essential lists in Africa to inform the implementation of the recently introduced EDL. We searched eight electronic databases for studies reporting on implementing the WHO EDL and EML in Africa. Two authors independently conducted study selection and data extraction, with disagreements resolved through discussion. We used the Supporting the Use of Research Evidence (SURE) framework to extract themes and synthesised findings using thematic content analysis. We used the Mixed Method Appraisal Tool (MMAT) version 2018 to assess the quality of included studies. We included 172 studies reporting on EDL and EML after screening 3,813 articles titles and abstracts and 1,545 full-text papers. Most (75%, n = 129) studies were purely quantitative in design, comprising descriptive cross-sectional designs (60%, n = 104), 15% (n = 26) were purely qualitative, and 10% (n = 17) had mixed-methods approaches. There were no qualitative or randomised experimental studies about EDL. The main barrier facing the EML and EDL was poorly equipped health facilities—including unavailability or stock-outs of essential in vitro diagnostics and medicines. Financial and non-financial incentives to health facilities and workers were key enablers in implementing the EML; however, their impact differed from one context to another. Only fifty-six (33%) of the included studies were of high quality. Poorly equipped and stocked health facilities remain an implementation barrier to essential diagnostics and medicines. Health system interventions such as financial and non-financial incentives to improve their availability can be applied in different contexts. More implementation study designs, such as experimental and qualitative studies, are required to evaluate the effectiveness of essential lists.


Access to diagnostic tests is key to achieving Sustainable Development Goals (SDG) 3.8. and Universal Health Coverage (UHC) [1, 2]. Insufficient access to essential in-vitro diagnostics is a major global health challenge, and nearly half (47%) of the global population have little to no access to diagnostics [3]. The scale and scope of this challenge contribute to delays in diagnosis and initiation of appropriate treatment compromising health outcomes, especially in Africa [313].

The World Health Organization (WHO) published the first model list of Essential In Vitro Diagnostics (EDL) in 2018 [14] to guide the selection and prioritisation of essential diagnostics according to national needs. It complements the WHO Essential Medicines List (EML) and links medicines with diagnostic tests to advance the UHC [11, 15]. It paves the way toward improved healthcare delivery and ultimately better patient outcomes by promoting greater equitable access to quality and affordable diagnostics at all levels of the healthcare delivery system [16]. Countries need to adopt and develop national lists that suit their national or regional needs, disease burdens, and health system capacities to ensure their impact on healthcare practice and patient outcomes [2, 5, 17]. To date, the WHO has published three EDL model lists [14, 18, 19]. The first WHO EDL contained 113 tests and was updated by WHO in 2019 to include nine additional tests for non-infectious diseases. The 2020 list had more other tests, including pandemics such as Covid-19.

The WHO published the first EML about 45 years ago, in 1977 This established initiative has been updated biannually since 1977, with the latest 22nd version updated in September 2021 [20]. Though the adaption of WHO EML to National Essential Medicines Lists (NEMLs) has been broad in Africa, numerous challenges continue to blunt its impact, including persistent inadequate and inequitable access to medicines [2124]. Lessons learned in implementing the established WHO EML may shed light on implementation considerations of the WHO EDL and guide the development of practice tools to support the broader adoption of the WHO EDL in Africa.‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬

The objective of this scoping review was to map evidence on the implementation of the WHO’s essential lists in African countries to guide the effective implementation of the new WHO EDL.


A protocol of our review can be found in the Open Science Framework [25] with deviations from the protocol listed in the Appendix (S1 Appendix).

We conducted this review according to the Joanna Briggs Institute guidelines for scoping reviews [26] and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [27] checklist recommended for scoping reviews (S1 Checklist).

Eligibility criteria

Types of studies.

We included EDL studies published in English after the launch of the first EDL in 2018. However, given the vast number of studies for the 40-year EML initiative, we included EML studies published in 2010 and after to get a recent representative sample that would inform the implementation of the EDL. If data saturation were not achieved in this sample, we would look to studies published before 2010. We included primary experimental and observational studies and primary qualitative studies. We excluded study protocols, literature reviews, systematic reviews, scoping reviews, book chapters, personal opinions papers, editorials, and conference abstracts with insufficient information. We, however, excluded all conference abstracts and editorials on EML due to the vast number of full-text studies and the high likelihood of data saturation.

We selected eligible studies guided by the Population-Concept-Context (PCC) framework designed by the Joanna Briggs Institute [28], commonly used to focus research questions for scoping reviews as detailed below:


We included articles reporting on the provision of essential medicines and diagnostic tests (as defined by authors or by the WHO Criteria) [19, 20] to human populations. We did not limit our review to any disease condition.

Concept. We included articles that discussed the implementation of the WHO essential lists, defined in our review as the adoption and adaptation of WHO essential lists by individual WHO member states to address national priority healthcare needs and gaps in the health systems. We also included articles that evaluated interventions used to enhance or enable the implementation or uptake of the essential lists.


We included all studies conducted in all health care settings or levels in Africa. Due to the high likelihood of data saturation, we restricted EML studies to a convenient sample of those conducted in single countries. Such studies were likely to give rich data about implementation considerations in one setting or context.


Our outcomes of interest were:

  • Types of study designs about the implementation of the EDL and EML.
  • Themes about barriers and enablers of EDL and EML.

Information sources and search

A systematic literature search was conducted up to May 2021 without date restrictions. We searched several electronic databases: Ovid MEDLINE, Embase, CINAHL, Web of Science, African Index Medicus, Cochrane Central Register of Controlled Trials, SCOPUS, and Health system evidence for eligible studies. An example of the search strategies MEDLINE can be found in the S2 Appendix. The literature search was complemented by scanning the reference lists of included studies. The references were exported to an EndNote database following the literature search, and the duplicates were removed.

Study selection

We uploaded references compiled using Endnote to Covidence [29], a web-based systematic review software platform. We first screened titles and abstracts for potentially eligible articles and then screened full texts of the articles where available. Independent reviewers (MN, BN, EJO, MM) screened all titles, abstracts, and full-text articles in duplicate for eligibility. We resolved disagreements through consensus in consultation with a senior reviewer (EO). Articles that met the inclusion criteria following a full-text review were selected for data extraction.

Data items and data charting process

We conducted data extraction using the google form platform developed a priori. We piloted it with 10% of the included studies by two reviewers to ensure the accuracy of the form and consistency of the extracted content. After completing the pilot tests, the research team held a meeting for feedback and discussion on discrepancies. Following the consensus, we updated the form before extracting data from the included studies.

We used the Supporting the Use of Research Evidence (SURE) framework suitable for qualitative data extraction (S2 Appendix) [30]. The SURE framework provided a comprehensive list of possible factors (barriers and enablers) that we used to systematically describe the implementation of adopted WHO essential lists. These factors are categorised into five groups: recipients of care, providers of care, other stakeholders, health systems, and social and political constraints (S2 Appendix) [30]. MN, MM, BN, and EJO independently extracted relevant phrases that corresponded to the SURE framework in duplicate. Bibliographic information was also extracted, including first author, year of publication, study title, study type or design, and country of study.

We further analysed the extracted phases, categorised them as barriers and enablers, and coded each phrase with one or more relevant SURE framework codes. The 34 applied codes were grouped into themes and analysed using Microsoft Excel version 16.66. We also explored the frequency of the applied SURE framework codes and used them to calculate the proportion of total themes per code. We resolved disagreements in data extraction through consensus in consultation with a senior reviewer (EO).

Quality assessment

According to the JBI manual for scoping reviews, quality assessment is not mandatory for scoping reviews but can be applied depending on the nature of the review [26]. In our context, knowing the quality of existing study designs was essential to our appraisal of the available evidence about implementing the EDL and EML. We assessed the methodological quality of all included studies using the Mixed Method Appraisal Tool (MMAT 2018) [31]. The tool is grouped into five categories of study designs: qualitative designs, quantitative randomized controlled trials, quantitative non-randomized, quantitative descriptive, and mixed methods. The appraisal led to an overall methodological quality rating varying from unclassified, 0% (no quality), 20% (low quality), 60% (moderate quality), 80 (considerable quality), and 100% (high quality) for each study. Not all eligible studies provided sufficient information to appraise quality using the MMAT. A study was categorised as unclassified if it was a report or study that did not provide adequate information for MMAT appraisal. We incorporated information for quality assessment into the data extraction form and piloted it in 10% of the included studies. Quality ratings were not used to include or exclude studies but to describe the overall quality of the available evidence about the implementation of the essential lists.

Synthesis of results

Results were coded and synthesised using thematic content analysis [32]. One reviewer (MN) performed thematic analysis and was verified by a senior reviewer (EO). We used established themes based on the SURE framework [30] to summarise the results descriptively and graphically.


Search results

Our search yielded 3813 records, nine of which were duplicates Fig 1. Of the remaining 3804 citations screened, 2259 did not meet the inclusion criteria. A further 1373 citations were excluded at full text review, as they did not meet the inclusion criteria for full text review based on year of publication (n = 523), not focussing on implementation of WHO essential lists (n = 324), ineligible article type (n = 265), ineligible context (n = 102), multi-country studies about EML (n = 67), no full text availability (n = 52), duplicates (n = 21), non-English publication language (n = 16), animal studies (n = 3).

Characteristics of included studies

We included 172 studies. Four (2.3%) of the studies were on the implementation of EDL, eleven (6.4%) focused both on EDL and EML, and 157 (91.3%) focused only on the EML. A summary of key findings for all included studies can be found in the appendix (S3 Appendix).

Of the (EDL) studies (n = 15), eight (53.3%) were from Eastern Africa, five (33.3%) from Southern Africa, and two (13.3%) from West Africa. Methodologically, twelve (80%) of EDL studies used quantitative methods (cross-sectional designs), and three (20%) used the mixed methods approach (Table 1).

Table 1. Characteristics of studies about the Essential In Vitro Diagnostics List (EDL).

Of the EML studies (n = 168), eighty-five (51.2%) were from Eastern Africa, forty-five (27.4%) were from Southern Africa, thirty-two (19.0%) were from West Africa, five (3.0%) from Central Africa and one (0.6%) from North Africa (Table 2).

Table 2. Characteristics of studies about the Essential Medicine List (EML).

Study designs of included studies

Overall, most of the studies (n = 129, 75%) in our review used quantitative study designs, followed by qualitative (n = 26, 15%) and mixed methods (n = 17, 10%). Studies with quantitative methods were mainly descriptive cross-sectional designs (n = 104, 60%), followed by experimental or intervention studies (n = 11, 6%) and cohort study designs (n = 5, 3%). A summary of EDL study designs is presented in Table 1, and EML studies in Table 2.

All studies with a sole focus on EDL were cross-sectional study designs. Most studies on EML were quantitative studies (n = 125, 73%) and primarily descriptive cross-sectional studies.

Quality of evidence

One hundred and sixty-seven (97%) articles were appraised for methodological quality. Fifty-six (33%) articles were graded as having high quality, 52 (30%) as considerable quality, fifty-four (31%) as moderate quality, and 5 (3%) as poor quality. Five (3%) articles were not rated since they did not provide sufficient information to permit a complete MMAT appraisal.

Synthesis of results

We present key themes about the barriers and enablers of the EDL and EML stratified in SURE themes. Barriers and enablers facing the EDL and EML were similar and were mostly about health system constraints (Fig 2, Tables 3 and 4). The main reported themes across all the SURE domains about barriers facing the EDL were as follows: the health system domain (Poorly equipped/stocked facilities) and socio-political domain (Insufficient legislation/policy and regulations, i.e., lack of policies to facilitate funding allocation for essential tests). The main reported themes across all the SURE domains for barriers facing the EML were as follows: the health system domain (poorly equipped/stocked facilities); the socio-political domain (insufficient legislation/policy and regulation); the provider of care domain (limited knowledge and skills of health workers); the recipient of care domain (poor acceptability of services); Other stakeholders (limited knowledge).

Table 3. Thematic content analysis of applied SURE codes to barriers to the implementation of EDL.

Table 4. Thematic content analysis of the most applied SURE codes to barriers to the implementation of EML.

Below we present the most common themes about health systems, social and political level, providers of care, recipients of care, and other stakeholders. The themes about enablers for implementing the EML and EDL are opposite to the health system barriers listed above. They are about tackling the listed barriers and have been summarised in Fig 3.

Barriers and enablers for the implementation of the EDL and EML

Health systems-level.

The facility-related constraints were the most reported barriers to implementing WHO essential lists (EDL&EML) (Tables 3 and 4). Unavailability of EDL tests [6, 3339] and reagent stock-outs [6, 37, 40] were the most prominent themes within the facility-related barriers to EDL implementation. Other EDL barriers referenced lack of proper equipment and supplies described as low availability of key consumables for laboratory diagnosis, limited items of the major laboratory equipment [6, 33], and inadequate infrastructure and space [33] to facilitate laboratory and diagnostics services. Similarly, in the EML implementation, the most prominent themes within this barrier were the low availability and unavailability of essential medicines [4155].

The enabler themes for the EDL implementation are opposite to the EDL barriers mentioned above [40, 5658]. The EML enablers are opposite of the EML barriers reported above and mainly include the availability of essential medicines in facilities [47, 5989] and adequate capacity of facilities to provide care [71, 90].

Social and political level.

The most frequently reported barrier at the social and political level was related to legislation or regulations (Tables 3 and 4). Insufficient policy to facilitate access to essential diagnostics was identified as a barrier to the EDL implementation [34]. Barriers unique to the EML included lack of price regulations or pricing policy [45, 47, 9195], incompliance to regulations [49, 50, 9699], lack of structured guidelines for registration and control [59, 67, 100102]. Other barriers included lack of policies [101, 103, 104], inadequate policies that provide control and use of medicines [105107], a long registration process [108110], and restriction on the use of medicines [111, 112]. Lack of political will in implementing policies [113], lack of a regulatory body for certifying and professionalizing medical and logistical companies [113], and inadequate procedures [114] were also cited as barriers to EML.

The EML enablers reported include supportive health financing policy reforms [111, 115] and the presence of a structured registration process [70] that supported the implementation of the EML.

Providers of care.

Barriers related to knowledge and skills were the most prominent theme under the providers of care domain. The main barriers identified included inadequate training on current evidence-based treatment [71, 116119], an insufficient number of skilled healthcare workers [105, 112, 120122], and inadequate providers’ knowledge of disease management [50, 83, 123]. Other barriers included lack of knowledge of inventory management [124, 125], lack of awareness of available guidelines [52], and poor understanding of partner programmes [106, 126].

The knowledge and skills-related enablers for implementing the EML are opposite to the main barriers listed above [85, 88, 127129].

Recipient of care.

Patients’ attitudes regarding acceptability, appropriateness and credibility related to EML implementation were the most prominent theme under the recipient of care. The main barriers reported include a preference to seek care from private pharmacies than primary health care centres due to a lack of essential drugs and beliefs on the quality of medicines [101, 108], social-cultural influences [130, 131], and use of alternative treatments (traditional medicine) [101, 108]. Other barriers reported include perception of the unaffordability of drugs [132], uncertainty on availability of services [133], drug safety concerns [134], and low health-seeking behaviour [132].

Other stakeholders (community health committees, community leaders, programme managers, donors, policymakers, opinion leaders).

The most prominent theme in this domain was the stakeholder’s knowledge and skills to facilitate the implementation of EML. The common barriers reported include inadequate training on rational use of medicines [135, 136], inadequate understanding of health commodities and financial reports amongst health facility and governing committee members [89], unequal access to information on medical products to all stakeholders [98], and variation in the knowledge of child-appropriate dosage formulations among stakeholders [50].

Stakeholders’ knowledge and skills on the quality, safety, and efficacy of medicines and pharmacoeconomic evaluations in selecting medicines for the EML were cited as enablers for implementing the EML [137].


This scoping review was conducted to map evidence on implementing the WHO’s essential lists in Africa to guide the effective implementation of the new WHO EDL. Our comprehensive scoping review identified themes based on the SURE framework into the barriers and enablers for implementing WHO essential lists across 172 articles. In lieu of the novelty of the EDL, there was limited published primary research on the implementation of WHO EDL. We found many studies reporting evidence on the implementation of EML in Africa. The review findings showed that the main barrier facing the more established EML, and newly introduced EDL was poorly equipped health facilities that entailed unavailability of essential in vitro diagnostics and medicines, stock-outs of laboratory reagents, and inadequate infrastructure and space to enable health service delivery. The main reported enabler was facility-related; considerable availability of basic tests and medicines and improved facility capacity to provide essential services.

Most of the studies in our review used quantitative methods, with nearly two-thirds of all studies using cross-sectional study designs. There were few qualitative studies, mixed-methods studies, and randomized trials. Qualitative studies are useful for exploring and understanding barriers and facilitators for the EDL and EML in different contexts [138]. Experimental studies are more useful for evaluating interventions that may improve the effectiveness of the EDL on health outcomes [139].

Similar work to ours, a systematic review by Peacocke et al., [140] explored the process of adapting the WHO EML at the national level. The authors provided key insights on the complexities and interdependencies essential to implementing the EML. Their review focused on key factors influencing the adaptation and implementation process of the EML at the macro level of the health system: country-level institutional structure; legislative and regulatory frameworks; governance, leadership, and coordination for NEMLs. Our review provides further insights and maps evidence on implementing the WHO EDL and EML at national levels, focusing on the African context. In our review, we present barriers and enablers facing the EDL and EML at different levels of implementation; individual, health system, and social and political levels that influence the implementation of the WHO essential lists in-depth.

The essential lists and, more recently, the EDL alone are insufficient to ensure their impact on access and health outcomes. A sound health system is vital to strengthen the existence of the lists. In Africa, health systems face complex challenges such as the continued burden of communicable and non-communicable diseases pandemics amidst limited resources [141143]. Indeed, our review highlighted that health systems constraints remain the main barrier to implementing the EDL and EML. Such barriers included poorly equipped health facilities with limited essential tests and medicines available. Socio-political constraints, such as the inadequacy of existing legislation and regulations to support the implementation of EDL and EML, also impact other domains. They influence the health system’s performance and, subsequently, limit the capacity of providers of care and other stakeholders and acceptability and service availability to care recipients, as highlighted by our findings. Many influencing factors in the health system determine the access, implementation, and effectiveness of diagnostic tests. Dealing with such challenges requires that decisions on health systems are informed by robust evidence that applies to the local context. Policymakers and health decision-makers can look to evidence-informed approaches, especially synthesising health policy and systems evidence and contextualize findings to their settings. Methods for conducting or utilizing health systems synthesis can be found in the WHO methods guide for evidence synthesis for health policy and systems [144].

Evidence-informed approaches are useful in guiding the adapting process and improving the implementation of the lists. WHO has a guidance resource enabling African countries to adopt the WHO EDL to national contexts [145]. To our knowledge, in Africa, Nigeria is the only country that has adopted the WHO EDL list and developed its own national EDL [146]. Many African countries have adopted the WHO EML in national settings. Thirty-nine of the 47 countries in the WHO Africa region have developed NEML linked to STGs [147]. However, stock-outs and limited access to medicines persist, emphasising the importance of enabling health systems to strengthen the implementation of the essential lists and ensure their impact. Evidence about the evidence-informed approaches or processes in adapting the EML has been published by South Africa [137], Ghana [148], and Tanzania [70]. These publications highlighted enablers such as a well-structured and rigorous process [137, 148], utilization of evidence summaries in decision-making [137, 148], and involvement of a diverse committee and stakeholder engagements [137, 148]. Challenges included insufficient and intermittent funding [148], limited use of scientific evidence [70], lack of expertise in evidence synthesis [70, 148] and health economic analyses [70, 137] in the review and development of NEML. Besides providing adaption guides for the essential lists, the implementation handbook guides can be released in conjunction with the versions of the model lists.

The WHO also released a handbook for monitoring the building blocks of health systems. It is structured around the six main building blocks of the WHO health systems framework: service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership and governance [149]. The proposed measures of health systems performance are crucial in health systems strengthening and valuable tools to accurately monitor the health system’s progress across the six building blocks over time. It facilitates the development of a sound Country monitoring strategy providing an enabling environment and sustainable scale-up of governance tools such as the EML and the newly introduced EDL. The EML and EDL play a vital role in realising UHC and access to quality health service delivery [150]. The impact of the essential medicine and diagnostics lists will become truly effective only in well-functioning strengthened health systems. The core indicators to performance measures of key building blocks, including access to essential medicines and technologies, health service delivery, health workforce, health information systems, health financing, and leadership and governance [149], are all critical to the development, review, and implementation of the essential lists. The use of core indicators in the health systems could also assist in addressing EDL and EML implementation barriers timely, efficiently, and effectively to impact populations’ health outcomes.

In this review, there were notable successes of interventions developed to address barriers to the EML implementation that could be considered useful in the EDL implementation. The RDF [61, 89, 151], PBF [119, 152, 153], and P4P [154, 155] interventions addressed several barriers to implementing the EML: accessibility for care-related barriers, facility-related barriers, incentive-related barriers, information system-related barriers, accountability-related barriers, and facility financial resource-related barriers. The revolving fund pharmacy (RFP) [156], accredited drug dispensing outlets (ADDOS) [128], and auditable pharmaceutical services and transaction system (APTS) [157] interventions also addressed the facility-related barriers. They contributed to the improved availability of essential medicines. Procurement and distribution-related barriers were addressed through direct distribution of supplies from partners [73, 125, 158160], PBF [161], RDF programmes [61, 89, 151], and utilization of ICT [108, 162] in stock management. Similar interventions could be used to address the shortfalls of the EML and strengthen the EDL implementation designs. However, considering the country’s context and specificities to be addressed will be crucial when implementing interventions. Some interventions worked in some contexts and did not work in other contexts. For instance, the PBF intervention did not affect the stock-out rate of essential medicines compared to payments not tied to the performance of essential medicines in some contexts [164]. On the other hand, the provision of financial incentives in the P4P intervention addressed some health system barriers; still, it was reported to have no evidence for increasing healthcare workers’ motivation [154]. Though financial and non-financial incentives may motivate implementation, they can unrealistically raise expectations and hinder implementation in the long run due to sustainability issues [163].

We evaluated the existing literature through a systematic and rigorous process that involved reviewing qualitative, quantitative, and mixed methods studies using established guidance for scoping reviews. To inform the implementation of EDL, we also referred to a representative sample of the established EML. We did not include non-English studies; hence, we could have missed studies published by French, Portuguese, or Arabic-speaking African countries. Secondly, due to accessibility limitations, we excluded 52 EML articles and multi-country studies about EML (n = 67) due to the vast number of full-text EML studies and the high likelihood of data saturation given rich, in-depth information from single countries in the multiple numbers of available studies. We also did not explore the process of adapting the WHO essential list to national contexts. Trend analysis from EML inception to the date of implementation aspects of the EML would help identify the successes, pitfalls, and plateaus of EML implementation over four decades. However, this was out of the scope of this work.

There has been limited primary research published on essential in vitro diagnostics in Africa since the introduction of the WHO EDL in 2018. Further studies can be conducted to provide contextual insights on the capacity of health systems to support the successful implementation of national EDLs bearing in mind the need to improve access to essential in vitro diagnostics in Africa. Consideration of dissemination and implementation frameworks such as the CFIR (Consolidated Framework for Implementation Research) [164, 165], RE-AIM (Reach, effectiveness, adoption, implementation, and maintenance) [165, 166], and PRISM (practical, robust implementation sustainability model) [167, 168] frameworks would be crucial when planning the implementation of the essential lists to guide adoption, adaptation, and evaluation of the lists. Qualitative research and process evaluations can be done to evaluate the impact of the essential lists and identify enablers and challenges to their implementation. More implementation trials or experimental studies can be conducted to assess effective interventions in different settings.


The most dominant constraints facing EML implementation, a more established WHO essential list and the new EDL are mainly about the health system. The main theme barrier was poorly equipped health facilities, including limited availability of essential in vitro diagnostics and medicines and stock-outs, which mainly limited the implementation of the EML and EDL. The EDL implementation can learn from interventions to improve the availability and supply of essential medicines. When developing and implementing the National EDLs, consideration of these barriers will strengthen health service delivery, access to essential diagnostics and universal health coverage. Financial and non-financial incentives may be enablers, but their effect varies in different contexts. Most of the EDL and EML studies used cross-sectional designs. While cross-sectional designs are suitable for identifying implementation challenges, exploratory qualitative and interventional designs are more suitable for understanding the challenges and evaluating the impact and effectiveness of the EDL and EML interventions and health outcomes, respectively.

Supporting information

S1 Table. Barriers to the implementation of an essential diagnostic and medicines list.


S2 Table. Enablers for the implementation of an essential diagnostic and medicines list.


S2 Appendix. Search strategy and SURE framework checklist.



We thank Vittoria Lutje, Information Specialist at the Liverpool School of Tropical Medicine, who advised on and developed the search strategy. The authors express their gratitude to the Kenya Medical Research Institute for the support provided for this review.


  1. 1. World Health Organisation (WHO). Universal health coverage (UHC) [Internet]. 2019 [cited 2021 Mar 25]. Available from:
  2. 2. Schroeder LF, Pai M. A List To Cement the Rightful Place of Diagnostics in Health Care. McAdam AJ, editor. J Clin Microbiol [Internet]. 2018 Oct 1;56(10):e01137–18. Available from: pmid:30045867
  3. 3. Fleming KA, Horton S, Wilson ML, Atun R, DeStigter K, Flanigan J, et al. The Lancet Commission on diagnostics: transforming access to diagnostics. Lancet [Internet]. 2021; Available from: pmid:34626542
  4. 4. Wilson ML, Atun R, DeStigter K, Flanigan J, Fleming KA, Horton S, et al. The Lancet Commission on diagnostics: advancing equitable access to diagnostics. Lancet [Internet]. 2019 May 18;393(10185):2018–20. Available from: pmid:31106735
  5. 5. Velazquez Berumen A, Garner S, Hill SR, Swaminathan S. Making diagnostic tests as essential as medicines. BMJ Glob Heal [Internet]. 2018 Aug 1;3(4):e001033. Available from: pmid:30116599
  6. 6. Shumbej T, Menu S, Gebru T, Girum T, Bekele F, Solomon A, et al. Essential in-vitro laboratory diagnostic services provision in accordance with the WHO standards in Guragae zone primary health care unit level, South Ethiopia. Trop Dis Travel Med vaccines [Internet]. 2020 Mar 6;6(4):1–7. Available from: pmid:32161656
  7. 7. Sayed S, Cherniak W, Lawler M, Tan SY, El Sadr W, Wolf N, et al. Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions. Lancet [Internet]. 2018;391(10133):1939–52. Available from: pmid:29550027
  8. 8. Wilson ML, Fleming KA, Kuti MA, Looi LM, Lago N, Ru K. Access to pathology and laboratory medicine services: a crucial gap. Lancet [Internet]. 2018;391(10133):1927–38. Available from: pmid:29550029
  9. 9. Bhatia R. WHO essential diagnostics list (2018): A revolutionary step in strengthening health laboratories at all levels of healthcare. Indian J Med Microbiol [Internet]. 2018;36(2):153–4. Available from: pmid:30084403
  10. 10. Moussy FG, Berumen AV, Pai M. The WHO list of essential in vitro diagnostics: Development and next steps. EBioMedicine [Internet]. 2018/10/30. 2018 Nov;37:1–2. Available from: pmid:30389503
  11. 11. Vijay S, Gangakhedkar RR, Shekhar C, Walia K. Introducing a national essential diagnostics list in India. Bull World Health Organ [Internet]. 2021;99:236–8. Available from: pmid:33716346
  12. 12. African Society for Laboratory Medicine. ASLM2020: Strategies and Vision to Strengthen Public Health Laboratory Medicine in Africa [Internet]. 2020 [cited 2021 Mar 25]. p. 2020. Available from:
  13. 13. Nichols K, Girdwood SJ, Inglis A, Ondoa P, Sy KTL, Benade M, et al. Bringing Data Analytics to the Design of Optimized Diagnostic Networks in Low- and Middle-Income Countries: Process, Terms and Definitions. Diagnostics (Basel, Switzerland) [Internet]. 2020 Dec 24;11(1):22. Available from:
  14. 14. World Health Organization. First WHO model list of essential in vitro diagnostics. [Internet]. 2019. Available from:
  15. 15. Pai M, Walia K, Boehme CC. Essential medicines and essential diagnostics: a package deal. Lancet Public Heal [Internet]. 2019 Oct 1;4(10):e492. Available from: pmid:31451443
  16. 16. Sen P, Kohli M, Pai M. Industry Perspectives on the WHO Essential Diagnostics List. McAdam AJ, editor. J Clin Microbiol [Internet]. 2019 Feb 1;57(2):e01637–18. Available from: pmid:30518544
  17. 17. Pai M, Kohli M. Essential Diagnostics: A Key Element of Universal Health Coverage. Dr Sulaiman Al Habib Med J. 2019;1(00):3–7.
  18. 18. World Health Organisation. Second WHO model of essential in vitro diagnostics [Internet]. Geneva; 2019. Available from:
  19. 19. World Health Organization. The selection and use of essential in vitro diagnostics: report of the third meeting of the WHO Strategic Advisory Group of Experts on In Vitro Diagnostics, 2020 (‎including the third WHO model list of essential in vitro diagnostics)‎. [Internet]. World Health Organization technical report series. Geneva; 2021. Available from:
  20. 20. World Health Organization. World Health Organization Model List of Essential Medicines– 22nd List, 2021. [Internet]. 2021. Available from:
  21. 21. Atif M, Malik I, Dawoud D, Gilani A, Ahmed N, Babar Z-U-D. Essential Medicine List, Policies, and the World Health Organization. In: Babar Z-U-DBT-E of PP and CP, editor. Oxford: Elsevier; 2019. p. 239–49. Available from:
  22. 22. Cameron A, Roubos I, Ewen M, Mantel-Teeuwisse AK, Leufkens HGM, Laing RO. Differences in the availability of medicines for chronic and acute conditions in the public and private sectors of developing countries. Bull World Health Organ [Internet]. 2011/03/14. 2011 Jun 1;89(6):412–21. Available from: pmid:21673857
  23. 23. Wirtz VJ, Hogerzeil H V, Gray AL, Bigdeli M, de Joncheere CP, Ewen MA, et al. Essential medicines for universal health coverage. Lancet (London, England) [Internet]. 2016/11/08. 2017 Jan 28;389(10067):403–76. Available from:
  24. 24. Bigdeli M, Jacobs B, Tomson G, Laing R, Ghaffar A, Dujardin B, et al. Access to medicines from a health system perspective. Health Policy Plan [Internet]. 2013 Oct 1;28(7):692–704. Available from: pmid:23174879
  25. 25. Nyanchoka M, Mulaku M, Kariuki S, Kuile F, Young T, Garner P, et al. Implementation considerations for the WHO Essential Diagnostics List with insights from the Essential Medicines List: A scoping review protocol. OSF Prepr [Internet]. 2021;1–10. Available from:
  26. 26. Peters M, Godfrey C, McInerney P, Soares CB, Khalil H, Parker D. The Joanna Briggs Institute reviewers’ manual 2015: methodology for JBI scoping reviews. In 2015.
  27. 27. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med [Internet]. 2018 Sep 4;169(7):467–73. Available from: pmid:30178033
  28. 28. Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc [Internet]. 2015 Sep;13(3):141–6. Available from: pmid:26134548
  29. 29. Veritas Health Innovation. Covidence systematic review software [Internet]. Melbourne, Australia; Available from:
  30. 30. The SURE Collaboration. SURE Guides for Preparing and Using Evidence-Based Policy Briefs. Version 2.1 [updated November 2011]. [Internet]. 2011. Available from:
  31. 31. Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, et al. The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Educ Inf. 2018;34:285–91.
  32. 32. Hsieh H-F, Shannon SE. Three Approaches to Qualitative Content Analysis. Qual Health Res [Internet]. 2005 Nov 1;15(9):1277–88. Available from: pmid:16204405
  33. 33. Ward CL, Guo MZ, Amukele TK, Abdul-Karim A, Schroeder LF. Availability and Prices of WHO Essential Diagnostics in Laboratories in West Africa: A Landscape Survey of Diagnostic Testing in Northern Ghana. J Appl Lab Med [Internet]. 2021 Jan 12;6(1):51–62. Available from: pmid:33438734
  34. 34. Ndagire E, Kawakatsu Y, Nalubwama H, Atala J, Sarnacki R, Pulle J, et al. Examining the ugandan health system’s readiness to deliver rheumatic heart disease-related services. PLoS Negl Trop Dis [Internet]. 2021;15(2):1–16. Available from: pmid:33591974
  35. 35. Jessen N, Ferrer JM, Mocumbi AO, Boladuadua S, Jones J, Auala T, et al. PO376 Measuring Access to Essential CVD Medicines and Diagnostics in Maputo City, Mozambique. Glob Heart. 2018 Dec;13(4):458.
  36. 36. Horton S, Fleming KA, Kuti M, Looi L-M, Pai SA, Sayed S, et al. The Top 25 Laboratory Tests by Volume and Revenue in Five Different Countries. Am J Clin Pathol [Internet]. 2019 Apr 2;151(5):446–51. Available from: pmid:30535132
  37. 37. Bay N, Juga E, Macuacua C, Joao J, Costa M, Stewart S, et al. Assessment of care provision for hypertension at the emergency Department of an Urban Hospital in Mozambique. BMC Health Serv Res [Internet]. 2019 Dec 18;19(1):975. Available from: pmid:31852481
  38. 38. Wahlfeld CC, Muicha A, Harrison P, Kipp AM, Claquin G, Silva WP, et al. HIV Rapid Diagnostic Test Inventories in Zambézia Province, Mozambique: A Tale of 2 Test Kits. Int J Heal Policy Manag [Internet]. 2019 Feb 26;8(5):292–9. Available from:
  39. 39. Rawlins B, Plotkin M, Rakotovao JP, Getachew A, Vaz M, Ricca J, et al. Screening and management of pre-eclampsia and eclampsia in antenatal and labor and delivery services: findings from cross-sectional observation studies in six sub-Saharan African countries. BMC Pregnancy Childbirth [Internet]. 2018 Dec 23;18(1):346. Available from: pmid:30139342
  40. 40. Tickell KD, Mangale DI, Tornberg-Belanger SN, Bourdon C, Thitiri J, Timbwa M, et al. A mixed method multi-country assessment of barriers to implementing pediatric inpatient care guidelines. Gurgel RQ, editor. PLoS One [Internet]. 2019 Mar 25;14(3):e0212395. Available from: pmid:30908499
  41. 41. Saiyoki LL, Rose O, Aggrey O. Accessibility of essential medicines for non-communicable diseases in a devolved system of government in trans nzoia County, Kenya. Int J Dev Res. 2019;09(11):31586–90.
  42. 42. Martei YM, Chiyapo S, Grover S, Ramogola-Masire D, Dryden-Peterson S, Shulman LN, et al. Availability of WHO Essential Medicines for Cancer Treatment in Botswana. J Glob Oncol [Internet]. 2018 Dec;2018(4):1–8. Available from: pmid:30241225
  43. 43. Lonnée HA, Madzimbamuto F, Erlandsen ORM, Vassenden A, Chikumba E, Dimba R, et al. Anesthesia for Cesarean Delivery. Anesth Analg [Internet]. 2018 Jun;126(6):2056–64. Available from:
  44. 44. Karanja S, Gichuki R, Igunza P, Muhula S, Ofware P, Lesiamon J, et al. Factors influencing deliveries at health facilities in a rural Maasai Community in Magadi sub-County, Kenya. BMC Pregnancy Childbirth [Internet]. 2018 Dec 3;18(1):5. Available from: pmid:29298670
  45. 45. Onyango MA, Vian T, Hirsch I, Salvi DD, Laing R, Rockers PC, et al. Perceptions of Kenyan adults on access to medicines for non-communicable diseases: A qualitative study. Postma M, editor. PLoS One [Internet]. 2018 Aug 24;13(8):e0201917. Available from: pmid:30142218
  46. 46. Loveday M, Scott V, McLoughlin J, Amien F, Zweigenthal V. Assessing care for patients with TB/HIV/STI infections in a rural district in Kwazulu-Natal. South African Med J. 2011;101(12):887–90.
  47. 47. Orubu ESF, Robert FO, Samuel M, Megbule D. Access to essential cardiovascular medicines for children: a pilot study of availability, price and affordability in Nigeria. Health Policy Plan [Internet]. 2019 Dec 1;34(Supplement_3):iii20–6. Available from: pmid:31816074
  48. 48. Demessie MB, Workneh BD, Mohammed SA, Hailu AD. Availability of Tracer Drugs and Implementation of Their Logistic Management Information System in Public Health Facilities of Dessie, North-East Ethiopia. Integr Pharm Res Pract [Internet]. 2020 Aug;Volume 9:83–92. Available from: pmid:32850300
  49. 49. Treleaven E, Liu J, Prach LM, Isiguzo C. Management of paediatric illnesses by patent and proprietary medicine vendors in Nigeria. Malar J [Internet]. 2015;14(232):1–9. Available from: pmid:26041654
  50. 50. Nsabagasani X, Hansen E, Mbonye A, Ssengooba F, Muyinda H, Mugisha J, et al. Explaining the slow transition of child-appropriate dosage formulations from the global to national level in the context of Uganda: A qualitative study. J Pharm Policy Pract [Internet]. 2015;8(19):1–10. Available from: pmid:26203358
  51. 51. Obiechina G, Ekenedo G. Factors affecting utilization of University health services in a tertiary institution in South-West Nigeria. Niger J Clin Pract [Internet]. 2013;16(4):454. Available from: pmid:23974738
  52. 52. Seid SS, Sendo EG. A survey on Integrated Management of Neonatal and Childhood Illness implementation by nurses in four districts of West Arsi zone of Ethiopia. Pediatr Heal Med Ther [Internet]. 2018 Jan;Volume 9:1–7. Available from: pmid:29443325
  53. 53. Perumal-Pillay VA, Suleman F. Parents’ and guardians’ perceptions on availability and pricing of medicines and healthcare for children in eThekwini, South Africa–a qualitative study. BMC Health Serv Res [Internet]. 2017 Dec 19;17(1):417. Available from: pmid:28629443
  54. 54. Daniel G, Tegegnework H, Demissie T, Reithinger R. Pilot assessment of supply chains for pharmaceuticals and medical commodities for malaria, tuberculosis and HIV infection in Ethiopia. Trans R Soc Trop Med Hyg [Internet]. 2012;106(2012):60–2. Available from: pmid:22093812
  55. 55. Kefale AT, Shebo HH. Availability of essential medicines and pharmaceutical inventory management practice at health centers of Adama town, Ethiopia. BMC Health Serv Res [Internet]. 2019 Dec 25;19(1):254. Available from: pmid:31023314
  56. 56. Isadru VR, Nanyonga RC, Alege JB. Health Facilities’ Readiness to Manage Hypertension and Diabetes Cases at Primary Health Facilities in Bidibidi Refugee Settlement, Yumbe District, Uganda. J. Gonzalez J-P, editor. J Trop Med [Internet]. 2021 Jan 22;2021:1–10. Available from:
  57. 57. Elnour FA, Alagib MEA, Bansal D, Farag EABA, Malik EM. Severe malaria management: Current situation, challenges and lessons learned from Gezira State, Sudan. Malar J [Internet]. 2019;18(1):1–8. Available from:
  58. 58. Rogers HE, Akiteng AR, Mutungi G, Ettinger AS, Schwartz JI. Capacity of Ugandan public sector health facilities to prevent and control non-communicable diseases: an assessment based upon WHO-PEN standards. BMC Health Serv Res [Internet]. 2018 Dec 6;18(1):606. Available from: pmid:30081898
  59. 59. Lonnée HA, Taule K, Knoph Sandvand J, Koroma MM, Dumbuya A, Jusu KSK, et al. A survey of anaesthesia practices at all hospitals performing caesarean sections in Sierra Leone. Acta Anaesthesiol Scand [Internet]. 2021 Mar 5;65(3):404–19. Available from: pmid:33169383
  60. 60. Tadesse T, Abuye H, Tilahun G. Availability and affordability of children essential medicines in health facilities of southern nations, nationalities, and people region, Ethiopia: key determinants for access. BMC Public Health [Internet]. 2021 Dec 13;21(1):714. Available from: pmid:33849513
  61. 61. Legesse H, Seyoum H, Abdo A, Ameha A, Abdulber S, Sylla M, et al. Supply chain management for community-based newborn care in rural Ethiopia: Challenges, strategies implemented and recommendations. Ethiop Med J. 2019;57(3):247–53.
  62. 62. Kamuhabwa AAR, Twaha K. Availability and affordability of essential antibiotics for pediatrics in semi-rural areas in Tanzania. Int J Pharm Sci Res [Internet]. 2014;7(2):587–600. Available from:
  63. 63. Aryeetey GC, Nonvignon J, Amissah C, Buckle G, Aikins M. The effect of the National Health Insurance Scheme (NHIS) on health service delivery in mission facilities in Ghana: A retrospective study. Global Health [Internet]. 2016;12(32):1–9. Available from: pmid:27267911
  64. 64. Rutebemberwa E, Buregyeya E, Lal S, Clarke SE, Hansen KS, Magnussen P, et al. Assessing the potential of rural and urban private facilities in implementing child health interventions in Mukono district, central Uganda-a cross sectional study. BMC Health Serv Res [Internet]. 2016;16(268):1–7. Available from: pmid:27421644
  65. 65. Gutema G, Engidawork E. Affordability of commonly prescribed antibiotics in a large tertiary teaching hospital in Ethiopia: A challenge for the national drug policy objective. BMC Res Notes [Internet]. 2018;11(925):1–6. Available from:
  66. 66. Okech UK, Chokwe T, Mung’Ayi V. The operational setup of intensive care units in a low income country in east africa. East Afr Med J. 2015;92(2):72–80.
  67. 67. Auwal F, Dahiru MN, Abdu-Aguye SN. Availability and rationality of fixed dose combinations available in Kaduna, Nigeria. Pharm Pract (Granada) [Internet]. 2019 Jun 30;17(2):1470. Available from: pmid:31275504
  68. 68. Mhlanga BS, Suleman F. Price, availability and affordability of medicines. African J Prim Heal Care Fam Med [Internet]. 2014 Jun 24;6(1):1–6. Available from: pmid:26245401
  69. 69. Mujinja PGM, Mackintosh M, Justin-Temu M, Wuyts M. Local production of pharmaceuticals in Africa and access to essential medicines: ’urban bias’ in access to imported medicines in Tanzania and its policy implications. Global Health [Internet]. 2014 Dec 10;10(1):12. Available from: pmid:24612518
  70. 70. Mori AT, Kaale EA, Ngalesoni F, Norheim OF, Robberstad B. The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania. Tu Y-K, editor. PLoS One [Internet]. 2014 Jan 8;9(1):e84824. Available from: pmid:24416293
  71. 71. Gebremedhin T, Daka DW, Alemayehu YK, Yitbarek K, Debie A. Process evaluation of the community-based newborn care program implementation in Geze Gofa district, south Ethiopia: a case study evaluation design. BMC Pregnancy Childbirth [Internet]. 2019 Dec 11;19(1):492. Available from: pmid:31829193
  72. 72. Mbonyinshuti F, Takarinda KC, Manzi M, Iradukunda PG, Kabatende J, Habiyaremye T, et al. Public Health Action Campaign. Public Heal Action [Internet]. 2021;11(1):5–11. Available from:
  73. 73. Mathewos B, Musema Y, Bekele A, Yeshanew B, Tadele G, Teferi E, et al. Community-based newborn care in Ethiopia: Implementation strength and lessons learned. Ethiop Med J. 2019;57(3):269–79.
  74. 74. Namuyinga RJ, Mwandama D, Moyo D, Gumbo A, Troell P, Kobayashi M, et al. Health worker adherence to malaria treatment guidelines at outpatient health facilities in southern Malawi following implementation of universal access to diagnostic testing. Malar J [Internet]. 2017 Dec 23;16(1):40. Available from: pmid:28114942
  75. 75. Olubumni M O, Maria S M, Jabu M. Nurses’ Perceptions About Stock-outs of Essential Medicines at Primary Health Care Facilities in Vhembe District, South Africa. Open Public Health J [Internet]. 2019 Dec 31;12(1):550–7. Available from:
  76. 76. Khuluza F, Haefele-Abah C. The availability, prices and affordability of essential medicines in Malawi: A cross-sectional study. Thet Wai K, editor. PLoS One [Internet]. 2019 Feb 12;14(2):e0212125. Available from: pmid:30753219
  77. 77. Khuluza F, Heide L. Availability and affordability of antimalarial and antibiotic medicines in Malawi. Postma M, editor. PLoS One [Internet]. 2017 Apr 18;12(4):e0175399. Available from: pmid:28419126
  78. 78. Lyon CB, Merchant AI, Schwalbach T, Pinto EF V., Jeque EC, McQueen KAK. Anesthetic Care in Mozambique. Anesth Analg [Internet]. 2016 May;122(5):1634–9. Available from: pmid:26983052
  79. 79. Crowley T, Stellenberg EL. An evaluation of the adequacy of pharmaceutical services for the provision of antiretroviral treatment in primary health care clinics. Heal SA Gesondheid [Internet]. 2015;20(1):83–90. Available from:
  80. 80. Jingi AM, Noubiap JJN, Ewane Onana A, Nansseu JRN, Wang B, Kingue S, et al. Access to Diagnostic Tests and Essential Medicines for Cardiovascular Diseases and Diabetes Care: Cost, Availability and Affordability in the West Region of Cameroon. Reboldi G, editor. PLoS One [Internet]. 2014 Nov 4;9(11):e111812. Available from: pmid:25369455
  81. 81. Ogunkunle O, Olanrewaju D, Oyinlade O. An evaluation of school health services in Sagamu, Nigeria. Niger J Clin Pract [Internet]. 2014;17(3):336. Available from: pmid:24714013
  82. 82. Wirtz VJ, Turpin K, Laing RO, Mukiira CK, Rockers PC. Access to medicines for asthma, diabetes and hypertension in eight counties of Kenya. Trop Med Int Heal [Internet]. 2018 Aug;23(8):879–85. Available from: pmid:29808960
  83. 83. Ozoh OB, Eze JN, Garba BI, Ojo OO, Okorie E, Yiltok E, et al. Nationwide survey of the availability and affordability of asthma and COPD medicines in Nigeria. Trop Med Int Heal [Internet]. 2021 Jan 14;26(1):54–65. Available from: pmid:32985028
  84. 84. Mutale W, Bosomprah S, Shankalala P, Mweemba O, Chilengi R, Kapambwe S, et al. Assessing capacity and readiness to manage NCDs in primary care setting: Gaps and opportunities based on adapted WHO PEN tool in Zambia. Moise IK, editor. PLoS One [Internet]. 2018 Aug 23;13(8):e0200994. Available from: pmid:30138318
  85. 85. Millogo O, Doamba JEO, Sié A, Utzinger J, Vounatsou P. Constructing a malaria-related health service readiness index and assessing its association with child malaria mortality: an analysis of the Burkina Faso 2014 SARA data. BMC Public Health [Internet]. 2021 Dec 5;21(1):20. Available from: pmid:33402160
  86. 86. Bekele A, Getachew T, Amenu K, Defar A, Teklie H, Gelibo T, et al. Service availability and readiness for diabetes care at health facilities in Ethiopia. Ethiop J Heal Dev. 2017;31(2):110–9.
  87. 87. Kabunga LN, Mujasi P. Does access to credit services influence availability of essential child medicines and licensing status among private medicine retail outlets in Uganda? J Pharm Policy Pract [Internet]. 2017 Dec 21;10(1):30. Available from: pmid:28948025
  88. 88. Mukose AD, Bastiaens H, Buregyeya E, Naigino R, Makumbi F, Musinguzi J, et al. Health Provider Perspectives of Health Facility Preparedness and Organization in Implementation of Option B+ among Pregnant and Lactating Women in Central Uganda: A Qualitative Study. J Int Assoc Provid AIDS Care [Internet]. 2019 Jan 1;18:232595821983393. Available from: pmid:30836827
  89. 89. Kuwawenaruwa A, Tediosi F, Obrist B, Metta E, Chiluda F, Wiedenmayer K, et al. The role of accountability in the performance of Jazia prime vendor system in Tanzania. J Pharm Policy Pract. 2020;13(25):1–13. pmid:32523700
  90. 90. Orji IA, Baldridge AS, Omitiran K, Guo M, Ajisegiri WS, Ojo TM, et al. Capacity and site readiness for hypertension control program implementation in the Federal Capital Territory of Nigeria: a cross-sectional study. BMC Health Serv Res [Internet]. 2021 Dec 9;21(1):322. Available from: pmid:33836719
  91. 91. Dzudie A, Njume E, Abanda M, Aminde L, Hamadou B, Dzekem B, et al. Availability, cost and affordability of essential cardiovascular disease medicines in the south west region of Cameroon: Preliminary findings from the Cameroon science for disease study. PLoS One [Internet]. 2020;15(3):1–12. Available from: pmid:32130252
  92. 92. Kirua RB, Temu MJ, Mori AT. Prices of medicines for the management of pain, diabetes and cardiovascular diseases in private pharmacies and the national health insurance in Tanzania. Int J Equity Health [Internet]. 2020 Dec 10;19(1):203. Available from: pmid:33172498
  93. 93. Kaiser AH, Hehman L, Forsberg BC, Simangolwa WM, Sundewall J. Availability, prices and affordability of essential medicines for treatment of diabetes and hypertension in private pharmacies in Zambia. Thet Wai K, editor. PLoS One [Internet]. 2019 Dec 13;14(12):e0226169. Available from: pmid:31834889
  94. 94. Abiye Z, Tesfaye A, Hawaze S. Barriers to access: Availability and affordability of essential drugs in a retail outlet of a public health center in south western ethiopia. J Appl Pharm Sci. 2013;3(10):101–5.
  95. 95. Bizimana T, Kayumba PC, Heide L. Prices, availability and affordability of medicines in Rwanda. PLoS One [Internet]. 2020;15(8 August):1–14. Available from: pmid:32745100
  96. 96. Orubu ESF, Okwelogu C, Opanuga O, Nunn T, Tuleu C. Access to age-appropriate essential medicines: a retrospective survey of compounding of medicines for children in hospitals in Nigeria and implications for policy development. Health Policy Plan [Internet]. 2016 Sep 1;czw115. Available from:
  97. 97. Ashigbie PG, Rockers PC, Laing RO, Cabral HJ, Onyango MA, Buleti JPL, et al. Availability and prices of medicines for non-communicable diseases at health facilities and retail drug outlets in Kenya: a cross-sectional survey in eight counties. BMJ Open [Internet]. 2020 May 15;10(5):e035132. Available from: pmid:32414824
  98. 98. Mackintosh M, Mujinja PGM. Markets and Policy Challenges in Access to Essential Medicines for Endemic Disease. J Afr Econ [Internet]. 2010 Nov 1;19(Supplement 3):iii166–200. Available from:
  99. 99. Birabwa C, Murison J, Evans V, Obua C, Agaba A, Waako P, et al. The availability of six tracer medicines in private medicine outlets in Uganda. J Pharm Policy Pract [Internet]. 2014 Dec 8;7(1):18. Available from: pmid:25667747
  100. 100. Wagenaar BH, Stergachis A, Rao D, Hoek R, Cumbe V, Napúa M, et al. The availability of essential medicines for mental healthcare in Sofala, Mozambique. Glob Health Action [Internet]. 2015 Dec 15;8(1):27942. Available from: pmid:26081970
  101. 101. Muhammed KA, Umeh KN, Nasir SM, Suleiman IH. Understanding the barriers to the utilization of primary health care in a low-income setting: implications for health policy and planning. J Public Health Africa [Internet]. 2013 Oct 7;4(2):13. Available from:
  102. 102. Patel A, Gauld R, Norris P, Rades T. Quality of generic medicines in South Africa: Perceptions versus Reality–A qualitative study. BMC Health Serv Res [Internet]. 2012 Dec 3;12(1):297. Available from: pmid:22943592
  103. 103. Wood-Thompson DK, Enyuma COA, Laher AE. Procedural sedation and analgesia practices in the emergency centre. African J Emerg Med [Internet]. 2019;9(1):1–6. Available from: pmid:30873345
  104. 104. Nsabagasani X, Ogwal-Okeng J, Hansen EH, Mbonye A, Muyinda H, Ssengooba F. “Better medicines for children” within the Integrated Management of Childhood Illness framework: A qualitative inquiry in Uganda. J Pharm Policy Pract [Internet]. 2016;9(22):1–16. Available from: pmid:27280024
  105. 105. Amadi C, Tsui EK. How the quality of essential medicines is perceived and maintained through the pharmaceutical supply chain: A perspective from stakeholders in Nigeria. Res Soc Adm Pharm [Internet]. 2019;15(11):1344–57. Available from:
  106. 106. Yevutsey SK, Buabeng KO, Aikins M, Anto BP, Biritwum RB, Frimodt-Møller N, et al. Situational analysis of antibiotic use and resistance in Ghana: policy and regulation. BMC Public Health [Internet]. 2017 Dec 23;17(1):896. Available from: pmid:29169340
  107. 107. Feikin DR, Slutsker L, Adazu K, Hamel MJ, Sewe M, Williamson JM, et al. A Reversal in Reductions of Child Mortality in Western Kenya, 2003–2009. Am J Trop Med Hyg [Internet]. 2011 Oct 1;85(4):597–605. Available from: pmid:21976557
  108. 108. Rizk HI, Elkholy MM, Barakat AA, Elsayed RMM, Abd El Fatah SAM. Perspectives of pharmaceutical stakeholders on determinants of medicines accessibility at the primary care level. J Egypt Public Health Assoc [Internet]. 2021 Dec 13;96(1):1. Available from: pmid:33439381
  109. 109. Brhlikova P, Maigetter K, Murison J, Agaba AG, Tusiimire J, Pollock AM. Registration and local production of essential medicines in Uganda. J Pharm Policy Pract [Internet]. 2020 Dec 11;13(1):31. Available from: pmid:32793355
  110. 110. Ooms GI, Klatser P, van den Ham HA, Reed T. Barriers to Accessing Internationally Controlled Essential Medicines in Uganda: A Qualitative Study. J Pain Symptom Manage [Internet]. 2019;58(5):835–43. Available from: pmid:31302261
  111. 111. Perumal-Pillay VA, Suleman F. Understanding the decision making process of selection of medicines in the private sector in South Africa–lessons for low-middle income countries. J Pharm Policy Pract [Internet]. 2020 Dec 21;13(1):17. Available from:
  112. 112. Sumankuuro J, Crockett J, Wang S. Perceived barriers to maternal and newborn health services delivery: a qualitative study of health workers and community members in low and middle-income settings. BMJ Open [Internet]. 2018 Nov 8;8(11):e021223. Available from: pmid:30413495
  113. 113. Chukwu OA, Chukwu U, Lemoha C. Poor performance of medicines logistics and supply chain systems in a developing country context: lessons from Nigeria. J Pharm Heal Serv Res [Internet]. 2018 Dec;9(4):289–91. Available from:
  114. 114. Saouadogo H, Compaore M. Essential medicines access survey in public hospitals of Burkina Faso. African J Pharm Pharmacol. 2010;4(6):373–80.
  115. 115. Maïga D, Williams-Jones B. Assessment of the impact of market regulation in Mali on the price of essential medicines provided through the private sector. Health Policy (New York) [Internet]. 2010 Oct;97(2–3):130–5. Available from:
  116. 116. Ayenew A, Abebe M, Ewnetu M. Essential Newborn Care and Associated Factors Among Obstetrical Care Providers in Awi Zone Health Facilities, Northwest Ethiopia: An Institutional-Based Cross-Sectional Study. Pediatr Heal Med Ther [Internet]. 2020 Nov;Volume 11:449–58. Available from: pmid:33204205
  117. 117. Andriantsimietry S, Rakotomanga R, Rakotovao JP, Ramiandrison E, Razakariasy ME, Favero R, et al. Service Availability and Readiness Assessment of Maternal, Newborn and Child Health Services at Public Health Facilities in Madagascar. Afr J Reprod Health [Internet]. 2016 Sep 29;20(3):149–58. Available from: pmid:29553204
  118. 118. Kakyo TA, Xiao LD. Challenges faced in rural hospitals: the experiences of nurse managers in Uganda. Int Nurs Rev [Internet]. 2019 Mar;66(1):70–7. Available from: pmid:29672843
  119. 119. Hailu AD, Mohammed SA. Availability, price, and affordability of WHO priority maternal and child health medicine in public health facilities of Dessie, north-East Ethiopia. BMC Med Inform Decis Mak [Internet]. 2020 Dec 11;20(1):221. Available from: pmid:32917201
  120. 120. Maswime T, Buchmann E. Inequities in resources and preparedness for surgical complications of caesarean section in southern gauteng hospitals. S Afr J Obstet Gynaecol. 2016;22(1):21–4.
  121. 121. Sambo LG, Kirigia JM, Ki-Zerbo G. Perceptions and viewpoints on proceedings of the Fifteenth Assembly of Heads of State and Government of the African Union Debate on Maternal, Newborn and Child Health and Development, 25–27 July 2010, Kampala, Uganda. BMC Proc [Internet]. 2011 Dec 13;5(S5):S1. Available from: pmid:21810211
  122. 122. Dekker AM, Amon JJ, le Roux KW, Gaunt CB. “What is Killing Me Most”: Chronic Pain and the Need for Palliative Care in the Eastern Cape, South Africa. J Pain Palliat Care Pharmacother [Internet]. 2012 Dec 5;26(4):334–40. Available from: pmid:23216172
  123. 123. Kiplagat A, Musto R, Mwizamholya D, Morona D. Factors influencing the implementation of integrated management of childhood illness (IMCI) by healthcare workers at public health centers & dispensaries in Mwanza, Tanzania. BMC Public Health [Internet]. 2014 Dec 25;14(1):277. Available from:
  124. 124. Chukwu OA, Ezeanochikwa VN, Eya BE. Supply chain management of health commodities for reducing global disease burden. Res Soc Adm Pharm [Internet]. 2016;1–4. Available from: pmid:27720436
  125. 125. Nakyanzi JK, Kitutu FE, Oria H, Kamba PF. Expiry of medicines in supply outlets in Uganda. Bull World Health Organ [Internet]. 2010 Feb 1;88(2):154–8. Available from: pmid:20428373
  126. 126. Rockers PC, Laing RO, Ashigbie PG, Onyango MA, Mukiira CK, Wirtz VJ. Effect of Novartis Access on availability and price of non-communicable disease medicines in Kenya: a cluster-randomised controlled trial. Lancet Glob Heal [Internet]. 2019;7(4):e492–502. Available from:
  127. 127. Richard OT, Maghanga M, Kenneth O. Challenges Facing the Push and Pull Hybrid System in the Supply of Essential Medicines in Gulu, Northern Uganda. Am J Public Heal Res [Internet]. 2015;3(3):106–12. Available from:
  128. 128. Rutta E, Liana J, Embrey M, Johnson K, Kimatta S, Valimba R, et al. Accrediting retail drug shops to strengthen Tanzania’s public health system: An ADDO case study. J Pharm Policy Pract [Internet]. 2015;8(23):1–15. Available from:
  129. 129. Vledder M, Friedman J, Sjöblom M, Brown T, Yadav P. Improving Supply Chain for Essential Drugs in Low-Income Countries: Results from a Large Scale Randomized Experiment in Zambia. Heal Syst Reform [Internet]. 2019;5(2):158–77. Available from: pmid:31194645
  130. 130. Mugo NS, Dibley MJ, Damundu EY, Alam A. “The system here isn’t on patients’ side”- perspectives of women and men on the barriers to accessing and utilizing maternal healthcare services in South Sudan. BMC Health Serv Res [Internet]. 2018 Dec 9;18(1):10. Available from: pmid:29316933
  131. 131. Magadzire BP, Budden A, Ward K, Jeffery R, Sanders D. Frontline health workers as brokers: provider perceptions, experiences and mitigating strategies to improve access to essential medicines in South Africa. BMC Health Serv Res [Internet]. 2014 Dec 5;14(1):520. Available from:
  132. 132. Kuwawenaruwa A, Wyss K, Wiedenmayer K, Metta E, Tediosi F. The effects of medicines availability and stock-outs on household’s utilization of healthcare services in Dodoma region, Tanzania. Health Policy Plan [Internet]. 2020 Apr 1;35(3):323–33. Available from: pmid:31942625
  133. 133. Oduro-Mensah E, Kwamie A, Antwi E, Amissah Bamfo S, Bainson HM, Marfo B, et al. Care Decision Making of Frontline Providers of Maternal and Newborn Health Services in the Greater Accra Region of Ghana. Leone T, editor. PLoS One [Internet]. 2013 Feb 13;8(2):e55610. Available from: pmid:23418446
  134. 134. Mubyazi GM, Magnussen P, Byskov J, Bloch P. Feasibility and coverage of implementing intermittent preventive treatment of malaria in pregnant women contacting private or public clinics in Tanzania: experience-based viewpoints of health managers in Mkuranga and Mufindi districts. BMC Health Serv Res [Internet]. 2013 Dec 1;13(1):372. Available from: pmid:24079911
  135. 135. Sakyi EK, Atinga RA, Adzei FA. Managerial problems of hospitals under Ghana’s National Health Insurance Scheme. Clin Gov An Int J [Internet]. 2012 Jul 27;17(3):178–90. Available from:
  136. 136. Mwathi MW, Ben OO. Availability of essential medicines in public hospitals: A study of selected public hospitals in Nakuru County, Kenya. African J Pharm Pharmacol [Internet]. 2014 May 8;8(17):438–42. Available from:
  137. 137. Perumal-Pillay VA, Suleman F. Selection of essential medicines for South Africa—An analysis of in-depth interviews with national essential medicines list committee members. BMC Health Serv Res [Internet]. 2017;17(17):1–17. Available from:
  138. 138. Busetto L, Wick W, Gumbinger C. How to use and assess qualitative research methods. Neurol Res Pract [Internet]. 2020;2(1):14. Available from: pmid:33324920
  139. 139. Miller CJ, Smith SN, Pugatch M. Experimental and quasi-experimental designs in implementation research. Psychiatry Res [Internet]. 2020;283:112452. Available from: pmid:31255320
  140. 140. Peacocke EF, Myhre SL, Foss HS, Gopinathan U. National adaptation and implementation of WHO Model List of Essential Medicines: A qualitative evidence synthesis. PLOS Med [Internet]. 2022 Mar 11;19(3):e1003944. Available from: pmid:35275938
  141. 141. Kane J, Landes M, Carroll C, Nolen A, Sodhi S. A systematic review of primary care models for non-communicable disease interventions in Sub-Saharan Africa. BMC Fam Pract [Internet]. 2017;18(1):46. Available from: pmid:28330453
  142. 142. Bollyky TJ, Templin T, Cohen M, Dieleman JL. Lower-Income Countries That Face The Most Rapid Shift In Noncommunicable Disease Burden Are Also The Least Prepared. Health Aff [Internet]. 2017 Nov 1;36(11):1866–75. Available from:
  143. 143. Tessema GA, Kinfu Y, Dachew BA, Tesema AG, Assefa Y, Alene KA, et al. The COVID-19 pandemic and healthcare systems in Africa: a scoping review of preparedness, impact and response. BMJ Glob Heal [Internet]. 2021 Dec 1;6(12):e007179. Available from:
  144. 144. World Health Organization. Evidence synthesis for health policy and systems: a methods guide [Internet]. Langlois EV, Daniels K AE, editor. Geneva: World Health Organization; 2018. Available from:
  145. 145. World Health Organisation (WHO). Selection of essential in vitro diagnostics at country level using the WHO Model List of Essential In Vitro Diagnostics to develop and update a national list of essential in vitro diagnostics. [Internet]. Geneva: World Health Organization; 2021. Available from:
  146. 146. World Health Organisation (WHO). WHO publishes new Essential Diagnostics List and urges countries to prioritize investments in testing [Internet]. 2021. Available from:
  147. 147. WHO AFRO. Essential Medicines [Internet]. Available from:
  148. 148. Koduah A, Asare BA, Gavor E, Gyansa-Lutterodt M, Andrews Annan E, Ofei FW. Use of evidence and negotiation in the review of national standard treatment guidelines and essential medicines list: experience from Ghana. Health Policy Plan [Internet]. 2019 Nov 1;34(Supplement_2):ii104–20. Available from: pmid:31723963
  149. 149. World Health Organisation (WHO). Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies [Internet]. Geneva; 2010. Available from:
  150. 150. Horton S, Camacho Rodriguez R, Anderson BO, Aung S, Awuah B, Delgado Pebé L, et al. Health system strengthening: Integration of breast cancer care for improved outcomes. Cancer [Internet]. 2020 May 15;126 Suppl(Suppl 10):2353–64. Available from: pmid:32348567
  151. 151. Agodokpessi G, Aït-Khaled N, Gninafon M, Tawo L, Bekou W, Perrin C, et al. Assessment of a revolving drug fund for essential asthma medicines in Benin. J Pharm Policy Pract [Internet]. 2015 Dec 13;8(1):12. Available from: pmid:25914829
  152. 152. Sieleunou I, De Allegri M, Roland Enok Bonong P, Ouédraogo S, Ridde V. Does performance‐based financing curb stock‐outs of essential medicines? Results from a randomised controlled trial in Cameroon. Trop Med Int Heal [Internet]. 2020 Aug 16;25(8):944–61. Available from: pmid:32446280
  153. 153. Sieleunou I, Turcotte-Tremblay A-M, De Allegri M, Taptué Fotso J-C, Azinyui Yumo H, Magne Tamga D, et al. How does performance-based financing affect the availability of essential medicines in Cameroon? A qualitative study. Health Policy Plan [Internet]. 2019 Dec 1;34(Supplement_3):iii4–19. Available from: pmid:31816071
  154. 154. Anselmi L, Binyaruka P, Borghi J. Understanding causal pathways within health systems policy evaluation through mediation analysis: an application to payment for performance (P4P) in Tanzania. Implement Sci [Internet]. 2017 Dec 2;12(1):10. Available from: pmid:28148305
  155. 155. Binyaruka P, Borghi J. Improving quality of care through payment for performance: examining effects on the availability and stock-out of essential medical commodities in Tanzania. Trop Med Int Heal [Internet]. 2017 Jan;22(1):92–102. Available from: pmid:27928874
  156. 156. Manji I, Manyara SM, Jakait B, Ogallo W, Hagedorn IC, Lukas S, et al. The Revolving Fund Pharmacy Model: backing up the Ministry of Health supply chain in western Kenya. Int J Pharm Pract [Internet]. 2016 Sep 13;24(5):358–66. Available from: pmid:26913925
  157. 157. Beyene D, Abuye H, Tilahun G. Effect of Auditable Pharmaceutical Services and Transaction System on Pharmaceutical Service Outcomes in Public Hospitals of SNNPR, Ethiopia. Integr Pharm Res Pract [Internet]. 2020 Oct;Volume 9:185–94. Available from:—peer-reviewed-article-IPRP pmid:33117665
  158. 158. Bravo MP, Peratikos MB, Muicha AS, Mahagaja E, Alvim MFS, Green AF, et al. Monitoring Pharmacy and Test Kit Stocks in Rural Mozambique: U.S. President’s Emergency Plan for AIDS Relief Surveillance to Help Prevent Ministry of Health Shortages. AIDS Res Hum Retroviruses [Internet]. 2020 May 1;36(5):415–26. Available from: pmid:31914787
  159. 159. Tsofa B, Goodman C, Gilson L, Molyneux S. Devolution and its effects on health workforce and commodities management–early implementation experiences in Kilifi County, Kenya. Int J Equity Health [Internet]. 2017 Dec 15;16(1):169. Available from: pmid:28911328
  160. 160. Coghlan R, Stephens P, Mwale B, Siyanga M. A new approach to gathering pharmaceutical market data to support policy implementation and access to medicines: As demonstrated by malaria medicines in Zambia. Malar J [Internet]. 2018;17(444):1–14. Available from: pmid:30497504
  161. 161. Brenner S, Wilhelm D, Lohmann J, Kambala C, Chinkhumba J, Muula AS, et al. Implementation research to improve quality of maternal and newborn health care, Malawi. Bull World Health Organ [Internet]. 2017 Jul 1;95(7):491–502. Available from: pmid:28670014
  162. 162. Modisakeng C, Matlala M, Godman B, Meyer JC. Medicine shortages and challenges with the procurement process among public sector hospitals in South Africa; findings and implications. BMC Health Serv Res [Internet]. 2020 Dec 19;20(1):234. Available from: pmid:32192481
  163. 163. Biermann O, Atkins S, Lönnroth K, Caws M, Viney K. ‘Power plays plus push’: experts’ insights into the development and implementation of active tuberculosis case-finding policies globally, a qualitative study. BMJ Open [Internet]. 2020 Jun 3;10(6):e036285. Available from: pmid:32499270
  164. 164. Keith RE, Crosson JC, O’Malley AS, Cromp D, Taylor EF. Using the Consolidated Framework for Implementation Research (CFIR) to produce actionable findings: a rapid-cycle evaluation approach to improving implementation. Implement Sci [Internet]. 2017;12(1):15. Available from: pmid:28187747
  165. 165. King DK, Shoup JA, Raebel MA, Anderson CB, Wagner NM, Ritzwoller DP, et al. Planning for Implementation Success Using RE-AIM and CFIR Frameworks: A Qualitative Study. Front Public Heal [Internet]. 2020;8. Available from: pmid:32195217
  166. 166. Shaw RB, Sweet SN, McBride CB, Adair WK, Martin Ginis KA. Operationalizing the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework to evaluate the collective impact of autonomous community programs that promote health and well-being. BMC Public Health [Internet]. 2019;19(1):803. Available from: pmid:31234804
  167. 167. McCreight MS, Rabin BA, Glasgow RE, Ayele RA, Leonard CA, Gilmartin HM, et al. Using the Practical, Robust Implementation and Sustainability Model (PRISM) to qualitatively assess multilevel contextual factors to help plan, implement, evaluate, and disseminate health services programs. Transl Behav Med [Internet]. 2019 Nov 25;9(6):1002–11. Available from: pmid:31170296
  168. 168. Liles EG, Schneider JL, Feldstein AC, Mosen DM, Perrin N, Rosales AG, et al. Implementation challenges and successes of a population-based colorectal cancer screening program: a qualitative study of stakeholder perspectives. Implement Sci [Internet]. 2015;10(1):41. Available from: