The Selection Process of the Mexican National Essential Medicines List (NEML): A Grounded Theory Approach

One of the biggest challenges that low- and middle-income governments like Mexico have in ensuring equitable access to medicines is to maximize the quantity of drugs they are able to procure with their limited resources. This maximization can be achieved by purchasing, at the lowest possible prices, those drugs that are essential for treating the most prevalent diseases in their population. The first step in addressing this challenge is to have a National Essential Medicines List (NEML) that allows for a rational selection of Essential Medicines (EM). However, considering that the 70% of pharmaceuticals on the world market are duplicative or non-essential, equitable access to EM will also depend on the knowledge and technical capability that governments have to select drugs that meet the safety, efficacy, cost, and quality standards that satisfy the priority health needs of their population. Even though Mexico has a NEML, up until now, there have not been studies that describe how the government selects this list. All that is known is described in the regulation that standardizes the selection process of this list. My grounded theory study allowed me to interview 12 out of the 31 government officials who participate in the selection of the NEML, and also of a group of 5 people familiar with the process to better understand how the NEML is selected. Through these interviews, I learned about unknown aspects of the process that helped me to formulate a theory about how the process functions in reality. This theory suggests that the government selects its NEML in a very political environment, surrounded by many contradictions that cannot be easily uncovered because power controls, via domination, the discursive consciousness of the government officials who select the list and the Mexican population. Discursive consciousness involves the knowledge which actors are able to express on the level of discourse. Even though it is expected that the Mexican government bases the selection of its NEML on rational decisions, my study concludes that the foundation upon which the selection of this list is being made is not rationality, but rather the reflection of many political and economic interests.