Best practices for implementing the WHO Model List of Essential Cancer Medicines: Chile, Kenya, and Thailand.

BACKGROUND

Cancer is a leading global cause of death, with the burden rising fastest in low- and middle-income countries (LMICs). The WHO Model List of Essential Medicines for Cancer (EML-C) provides an evidence-based benchmark for prioritizing safe and cost-effective therapies for reaching Universal Health Coverage (UHC). However, only 25% of countries have a national cancer EML-C, and fewer than 10% adequately fund it.

OBJECTIVE

This study aims to identify factors determining successful implementation beyond income levels.

METHODS

We used a comparative case-study design of Chile, Kenya, and Thailand. Cases were selected through a two-stage purposive process using five criteria: at least 80% EML-C alignment, early-2010s upward income transition, cross-regional representation, UHC service-coverage improvement (2010-2023), and documentary support. Using the 2023 WHO EML-C (64 medicines), we analyzed national alignment, policy timelines, context, and stakeholder roles. Data came from predefined bilingual searches and were validated by country co-authors.

RESULTS

All three countries showed high alignment with the 2023 WHO EML-C-60/64 medicines in Chile and 58/64 in both Kenya and Thailand-while expanding substantially beyond WHO-listed items (119, 84, and 127 total medicines, respectively). These findings reflect three implementation pathways: Chile's political-fiscal model, anchored in statutory guarantees with ministries of Health-Finance co-decisions; Thailand's technical-negotiation model, using HTA-informed selection and negotiation; and Kenya's protocol-partnership model, driven by specialist consensus and international technical collaboration.

CONCLUSIONS

WHO EML-C adoption is most effective when embedded within broader UHC reforms. Policymakers should leverage "policy windows" to build institutional bridges that connect priority-setting, evidence appraisal, fiscal negotiation, and procurement. By aligning clinical evidence with fiscal authority -whether through inter-ministerial joint-decisions, health technology assessments, or expert consensus- oncology drugs can be successfully embedded into sustainable national benefit packages. High list alignment indicates implementation readiness, but does not by itself guarantee realized patient access or financial protection.