title: The role of evidence in the decision-making process of selecting essential medicines in developing countries: the case of Tanzania.
abstract: BACKGROUND
  Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making.
  
  
  METHODS
  This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data.
  
  
  RESULTS
  The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised.
  
  
  CONCLUSIONS
  Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence.
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway ; School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Amani Thomas
authors.initials: AT
authors.lastname: Mori
authors.affiliation: School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
authors.forename: Eliangiringa Amos
authors.initials: EA
authors.lastname: Kaale
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway ; Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
authors.forename: Frida
authors.initials: F
authors.lastname: Ngalesoni
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Ole Frithjof
authors.initials: OF
authors.lastname: Norheim
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Bjarne
authors.initials: B
authors.lastname: Robberstad
mesh_terms: D000329:Advertising; D003362:Cost-Benefit Analysis; D003657:Decision Making; D003906:Developing Countries; D004345:Drug Industry / Q000191:economics; D019317:Evidence-Based Medicine / Q000191:economics / Q000379:methods*; D005104:Expert Testimony; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D038622:Internationality; D017410:Practice Guidelines as Topic; D012449:Safety; D013636:Tanzania