With the guidance of the Health Financing and Governance Project (HFG), the government of the Dominican Republic released the seventh version of the Basic Framework of Essential Medicines in June 2018. The Basic Framework of Essential Medicines defines the medicines and commodities that must be in stock and accessible to all Dominicans through the public health system. Inclusion on the list is based on criteria such as the country’s current disease and demographic profiles, environmental factors, and drug costs. By law, the Ministry of Public Health (MSP) must revise the framework every two years to ensure that the list contains the most appropriate and cost-effective products. The 2018 list, containing 797 medications, was disseminated at a June 19 event in Santo Domingo attended by the Minister of Health, the Executive Director of the National Health Service (SNS), the Director of the Program of Essential Medicines (PROMESE/CAL), the Superintendent of Health and Labor Risks (SISALRIL), and the representative for the United States Agency for International Development (USAID). The event further drew over 400 stakeholders representing the above agencies as well as the pharmaceutical, health insurance, academic, and NGO sectors. HFG supported the revision of the list with data-driven expertise and facilitated the collection of updated evidence.
HFG began the revision process by training technicians from the Directorate-General of Food, Medicines, and Sanitary Products (DIGEMAPS) on the methodology for revising the Basic Framework of Essential Medicines, and supporting the technicians to gather suggestions from representatives of HIV and other special health programs, regional health services (SRSs), and health centers on which medicines to add or remove from the framework. HFG and DIGEMAPS then aggregated these suggestions into a best practices guide and, after reviewing international standards and drug efficacy evidence, proposed a draft list in April.
Later that month, HFG facilitated a second workshop consisting of representatives of MSP and the National Commission of Basic Framework of Essential Medicines, an intersectorial body of pharmaceutical, academic, and NGO voices, to determine the final framework. Over three days, experts and policymakers gathered to review the suggestion guide and revise the working list. The resulting list was compiled into the final Framework by HFG and approved by the Minister of Health on May 28. The 2018 Framework covers thirty therapeutic areas and includes 35 new medications, which address national priorities such as HIV, tuberculosis, and family planning with innovative therapies. It further introduces new cardiovascular drugs, psychopharmaecuticals, and treatment for hepatitis B and C, among other conditions.
The updated Framework increases access to healthcare for all Dominicans by ensuring that the most effective and cost-efficient medicines are available through the public sector. One group that directly benefitted from the updated list is people living with HIV: the 2018 list added two one-a-day HIV treatment medications, which may improve adherence to treatment regimens. Following the dissemination of the framework, HFG will continue its work to strengthen the access to cost-effective medications in the Dominican Republic by performing cost analyses for medicine procurement.