Parkinson disease treatments on national essential medicines lists, African Region

The prevalence of Parkinson disease is increasing globally. Despite the existence of effective and affordable medicines for Parkinson disease, access to these medicines is limited in the World Health Organization (WHO) African Region. Several factors influence accessibility, including lack of prioritization of Parkinson disease, shortage of a trained health workforce, barriers to health financing and lack of inclusion of medicines in national essential medicines lists. We determined alignment of the most recent national essential medicines lists of 47 countries in the WHO African Region with the 23rd edition of the WHO Model list of essential medicines for Parkinson disease medicines. Overall, of any formulation or strength, 81% (38/47) of countries included levodopa + carbidopa or levodopa + benserazide as a therapeutic alternative on their national lists; and 79% (37/47) included biperiden or trihexyphenidyl as a therapeutic alternative. Inclusion of specific formulations for medicines was lower; for example, 45% (21/47) of countries included levodopa + carbidopa or levodopa + benserazide in a 4:1 ratio. Furthermore, 11% (5/47) of national essential medicines lists included none of the four medicines. While inclusion of medicines for Parkinson disease in national essential medicines lists provides no guarantee of immediate access, it can encourage procurement, prescribing and use, and can help lower costs, raise awareness of and create political will for Parkinson disease treatment. This analysis provides further evidence of the need for action to improve the accessibility of medicines for Parkinson disease in the WHO African Region.