Universal aspirations and contextual decisions: The Essential Medicines List and Health Technology Assessment

Tineke Kleinhout-Vliek and Susi Geiger

Chapter 26 in Handbook of Pharmaceutical Science and Technology Studies, 2026, pp 418-433 from Edward Elgar Publishing

Abstract: International bodies like the World Health Organization (WHO) and the World Bank strongly shape the normative agenda of global health, with access to medicines as a main axis. Outlining a minimum set of medicines that everyone should ideally have access to has historically been achieved through the WHO's Essential Medicines List (EML), of particular relevance in low and middle-income countries. As high-income countries are increasingly impacted by budgetary constraints, priority setting has gained in prominence there too. Instead, however, these countries typically use Health Technology Assessment (HTA) to steer towards value for money, constructing a maximum of provision or coverage. Methods of priority setting have thus varied significantly in scope and application contexts. We juxtapose these methods – the EML and HTA – describing their histories and spread across the globe. Both have universal ambitions but require contextualization, i.e., adaptation to national contexts, which leads to tensions between aspirations of universal coverage and uneven realities on the ground, but also provides opportunities for increasing the contextual appropriateness of decision-making processes and outcomes. As scholars and practitioners seek to open up these processes to as-yet unheard voices and so gain context-derived input, we argue that this is a necessary step but no guarantee for achieving contextually robust outcomes.

Keywords: Priority setting; Access to medicines; Essential Medicines List; Health Technology Assessment; Deliberative decision-making; Contextualization (search for similar items in EconPapers)
Date: 2026
ISBN: 9781035338443
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