By Dr Ruth Lancaster — Essential Drugs Programme, National Department of Health
Finding and Using Health Information: A Healthcare Worker’s Map
For a clinician managing a patient, questions about a medicine may appear straightforward: Can I prescribe it? Is it available? Why has the recommendation changed? Why is this essential medicine not available? In the South African public health sector, these questions are answered by different information sources, available through the National Department of Health (NDoH).
Knowing where to find the information is only the first step. Understanding what each source tells you, and what it does not tell you, is equally important.
The Standard Treatment Guidelines (STGs) and Essential Medicines List (EML): Clinical Guidance
The STGs/EML are the starting point for questions about the clinical use of medicines. They provide recommendations for managing conditions at different levels of care, including recommended medicines, prescribing requirements and referral criteria.
The Essential Drugs Programme (EDP) website provides the STGs/EML as complete PDFs and as individual chapters with corresponding reviews, costing and reports. These are the current published versions, and may contain chapters from different review cycles, as not every chapter is reviewed during every cycle. A chapter from a previous cycle may therefore remain current until superseded.
For those wanting to understand what has changed, individual updated chapters are accompanied by National Essential Medicines List Committee (NEMLC) reports, which summarise the changes considered and the rationale for the resulting recommendations. Errata are produced as needed to provide corrections to published STGs/EML. In addition, a NEMLC bulletin is issued after each NEMLC meeting and provides a useful way to keep up to date with recent decisions and other EDP information.
A searchable Excel list of medicines by indication and level of care, extracted from the STGs/EML, is also available. This is a useful search tool but does not replace the published STGs/EML. In case of discrepancy, the published guideline takes precedence.
The Master Health Product List (MHPL): Understanding Procurement
The MHPL answers a different question: What products can the public sector procure, and under what procurement arrangements?
The MHPL is an Excel workbook containing information such as the contract under which a product is supplied, contract dates, National Stock Number (NSN), pack size, cost and other product characteristics, and is updated monthly. website.
A product being on contract means that the Department has established an agreement to procure it nationally, at a substantially reduced costs by leveraging economies of scale for greater purchasing power.
This does not determine where and how the medicine may be used. The MHPL describes procurement mechanisms, while the STGs/EML determines clinical use. The two processes are distinct, although efforts are made to improve their alignment.
The MHPL also shows the non-awards and medicines procured through alternative mechanisms. A non-award does not necessarily mean that a product will never be available; depending on the circumstances, alternatives may include a PPQ, supplementary tender or investigation of a therapeutic alternative.
The NSN identifies the medicine specification, including name, strength, formulation and pack size, and allows the product to be ordered and followed through the supply chain. It does not distinguish between manufacturers supplying the same specification. For example, tenofovir/lamivudine/dolutegravir 300/300/50 mg, 28 tablets may have multiple suppliers but one NSN.
EDP Communications: Additional Information Source
The EDP Communication part of the EDP webpage provides important updates that healthcare professionals need to know regarding medicine access, supply and use.
- Circulars may communicate national supply problems, medicine shortages or alternative treatment arrangements.
- NEMLC Bulletins summarise recent NEMLC decisions and other relevant information.
- Requests for Comment provide an opportunity to contribute to the evidence-based review of STG/EML chapters.
- Presentations, webinars and campaigns provide educational and implementation resources.
Healthcare professionals can also subscribe to the EDP mailing list or WhatsApp group to communications directly. Further information is available from SAEDP@health.gov.za.
The Healthcare Worker’s Map
The most useful way to navigate these resources is to start with the question:
- What should I use? → STGs/EML
- What can the public sector procure? → MHPL
- Why did the recommendation change? → NEMLC report
- What are the latest issues affecting current access or supply? → EDP Communications
The value of these resources lies not only in the information they contain, but in understanding how the pieces fit together. Using the appropriate source for the right question allows clinicians to make better-informed decisions about medicine selection, prescribing and access.