Essential medicines in Central America: Analysis of national lists, macroeconomic factors, and alignment with health priorities

Introduction: The World Health Organization (WHO) Model List of Essential Medicines guides countries in selecting priority drugs to ensure equitable access to effective treatments. In regions such as Central America, with similar health and socioeconomic contexts, comparing national lists reveals patterns and opportunities for regional harmonization. Methodology: A cross-sectional comparative observational study was conducted using public secondary data from the official essential medicines lists of seven Central American countries: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama. These lists were compared against the 2017 WHO Model List. Therapeutic classification was based on the Anatomical, Therapeutic, and Chemical Classification (ATC) system (level 2). Macroeconomic variables, including health expenditure per capita and gross domestic product (GDP) per capita, were analyzed for their relationship with list composition. Results: Panama had the most extensive NEML (570 drugs) and Nicaragua the shortest (271 drugs). Nicaragua showed the highest alignment with the WHO list, while Panama had the most exclusive drugs. A significant positive correlation was found between health expenditure per capita and NEML size ( r = 0.77; p = 0.042), but not with alignment to the WHO list. The most represented therapeutic groups were antibacterials (31.2%) and antineoplastics (24.4%). Conclusion: Although Central American countries share regional similarities, their selection of essential medicines varies considerably. These differences reflect diverse public health priorities, institutional capacities, and economic conditions. The findings support the need for evidence-based, context-sensitive approaches and underscore the potential for regional cooperation in essential medicines policy.