Table 3 Participants’ views on how the NEMLC and its processes have changed over time

Time period for revision of EMLs

“So standard treatment guidelines, the last one was published in 2006, for paediatrics for instance, and it’s just been reviewed. And there’s a recognition that this time period was too long and that it should be shorter and so we hope to be able to review it in a much shorter time frame in the future. So I think the plan, we’ve already started to, just after the publication of this one; we started the review of the next one. So the idea is almost yearly or two-yearly and especially once we move on to an electronic database that the standard treatment guidelines can be updated almost continuously as things change, evolve”. (2013)

“I would say at this point yearly probably now. With every review of the STG we do it yearly. Prior to this it was happening every few years you know since 2006. That was more like eight years, but the idea is to increase the turnaround at the time” (2013)

Changes in selection criteria

“Prior to, I’d say 2005, we looked predominantly at acquisition price but since 2005 there has been a systematic inclusion of pharma-economic principles. And currently no medicine is added without at least a consideration of the pharma-economic”. (1996–2012)

“I seem to recall at that time even though we were more interested in efficacy regardless of the cost therefore we rarely looking at cost effectiveness analysis. There was a pressure also to consider the cost of a drug, because we wanted to lend selection to procurement. Although for a long time that hasn’t happened. So we didn’t really do cost minimization for the time, any kind of consideration at the time, I think things improved over time, for the first few years, I wouldn’t say we were that strong in our evaluation of the cost effectiveness of medicines”. (1996)

Committee policies and processes

“Potential conflict of interest in the membership of this committee, we probably didn’t have much in place at the beginning, but with time I think with experience we realised that something needed to be developed that would be signed by members, something that can ensure that at the beginning of the year they would declare anything that would bring them into conflict, but I cannot vouch that we did it from the second year, it might have been years before that actually happened”. (1996)

“Are other committees consulted? Yes, of late now with the advent of pharmacists that are PTC committees. I think that is happening”. (PTC, 2003)

I don’t know if it’s called a policy but they do have a SOP in place now to address medicine product shortages. They have a formulary against which you check to see if the product is on tender etc. but the whole process is unclear”. (PTC, 2003)

How often are committee policies reviewed? “I don’t recall that we had that mechanism in place at the beginning; it might have been developed later”. (1996)

General comments

“The only comment is that this has been an evolving process, we’ve learnt through our own educational process, trial, error and trying to explore. And that process has been evolving and continues to evolve. But in effect I think it’s been highly successful and certainly from where we started off with nothing, I think we were able to produce something that was exceedingly successful and we very grateful that we were able to do that work”. (2003–2012)

“The South African one was developed from nowhere and actually has come quite a long way but I think it is time for it to be revisited and there are attempts to look at where we are going in the future and perhaps to re-evaluate what we are doing and why we are doing it, clearly a blessing to a guideline committee and more into a strict formulary thing which would be easier to measure”. (2003–2012)

“Well for us, I mean, although we had information from others who had experience in their own right, and there have been attempts previously, by previous health departments to have some kind of formularies or lists, this was really a new experience and I think it took time before we managed to establish ourselves as department of health and EDL committees that were sort of well-established and was able to follow international best practices. I think it took some time before we could get to that, you know, we started by crawling, gradually over time I think things would have become much better. I recall that we also used to comment at the WHO, we would advise on one or the other mechanism of doing reviews. It was really quite an experience, new experience for us”. (1996)

“It is a very thorough process, people that are not on NEMLC would think who are these people sitting and making decisions but it’s a very thorough process and it’s a very transparent process”. (2013)