Recommendation Mapping Between WHO Guidelines and the Model List of Essential Medicines: Alignment, Gaps, and Discordances

Abstract

The World Health Organization (WHO) Model List of Essential Medicines (EML) and WHO guidelines represent two key tools for health decision-making globally. The WHO EML includes medicines that are essential for national health policies, while WHO guidelines provide evidence-based recommendations to inform clinical and public health practice. Despite their complementary purposes, the coordination between the two tools has remained underexplored.

In this thesis, we investigate the intersection between WHO guidelines and the WHO EML to evaluate the alignment, gaps, and discrepancies of their coverage and recommendations on medicines. This is accomplished through one manuscript in this sandwich thesis.

We built a relational database to map 811 recommendations from 87 WHO guidelines (2009 – 2024) against 753 medicines listed in the 2023 WHO EML. A modular algorithm enabled mapping at the medicine, indication, and recommendation-direction levels, allowing classification into scenarios of alignment, gaps, or discordance. Our analysis included 294 guideline-recommended medicines, of which 20.7% (61/294) had not yet been evaluated by the EML Expert Committee. Conversely, 68.3% (514/753) of medicines listed in the EML lacked corresponding WHO guideline recommendations. Medicines recommended in both tools (190 in total) demonstrated substantial alignment, though notable discordances in recommendation direction and indication gaps were identified.

The findings highlight the need for stronger coordination between the two tools. The identified gaps and discordance could inform further improvement to enhance the alignment between the two WHO tools.