WHO technical consultation: Nutrition-related products and the World Health Organization Model List of Essential Medicines – practical considerations and feasibility, Geneva, Switzerland, 20–21 September 2018. Meeting report. (WHO/NMH/NHD/19.1). Geneva: World Health Organization; 2019
(2019; 139 pages)

Abstract

Access to essential medicines is a core element of universal health coverage and therefore a priority for the World Health Organization (WHO). Nutrition-related health products are commonly used in public health and clinical settings to address any form of malnutrition, and particularly to prevent and treat undernutrition or micronutrient deficiencies. These include formulations such as ready-to-use therapeutic foods (RUTFs), therapeutic milks (F-75, F-100), iron-containing multiple-micronutrient powders, and vitamin and mineral supplements. Other medicines or health products used in disease prevention, treatment and management and rehabilitation and palliative care services, may have relevance for nutrition-related conditions and throughout the life-course. Access to and availability of these nutrition-related health products is of high priority, owing to the unabating trends in undernutrition in some parts of the world.

The prioritization of, subsequent access to, and availability of, medicines at the country level is often guided by the WHO Model List of Essential Medicines (EML). Including nutrition-related health products in the EML can support the development, review and updating of national lists of essential medical products. The WHO Department of Nutrition for Health and Development, in collaboration with the Department of Essential Medicines and Health Products, convened a technical consultation in Geneva, Switzerland on 20–21 September 2018, to gather stakeholders’ views on considerations related to, and the feasibility of, including nutrition-related health products in the EML. Stakeholders at the consultation included representatives from governmental agencies, intergovernmental agencies, non-state actors in official relations with WHO, and the private sector.

The objectives of this consultation were to (i) identify common criteria that characterize a nutrition-related health product for potential listing in the EML; (ii) evaluate advantages and disadvantages of listing RUTFs and other nutrition-related health products in the EML, in particular considering manufacturing standards for foods and pharmaceuticals; (iii) identify which dimensions and elements (e.g. availability, access, cost, alternative formulations, quality, country preferences) and trade-offs are considered by stakeholders when assessing RUTFs and other nutrition-related health products for improved access in public health; and (iv) discuss country experiences in the regulatory processes that could help to improve access to nutrition-related health products.

This report summarizes the presentations, some country perspectives and discussions that occurred during the technical consultation and does not contain any official WHO recommendations. Before the meeting, WHO launched a call for authors covering the proposed objectives. Six papers were selected and presented at the meeting, which also included presentations on other topics of interest and several discussion sessions. Five of the six commissioned papers are published as part of this report.

The topics covered included the EML and the criteria for selection of medicines included in it; data on the efficacy, safety, feasibility and availability of products; and a mapping of the nutrition-related health products in the 2017 EML and the WHO Model List of Essential Medicines for Children (EMLc), showing efficacy data on vitamins and minerals used in the management of anaemia or as coadjuvants in the treatment of diarrhoea, and as dietary supplements.

Some of the current WHO recommendations that involve nutrition-related health products were discussed. It was made clear that, although the WHO guidelines and other official documents make recommendations for nutrition interventions that include nutrition-related health products, not all recommended nutrition-related health products are currently included in the EML.

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