National Essential Medicine Lists (NEMLIT)

Prescribing and stocking rules

purpose

Medicine use is governed by:

• Facility level (determines which medicines may be stocked).

• Professional cadre (determines which medicines may prescribe medicines).

A medicine can only be prescribed if both the facility level and the prescriber's authority allow it.

Medicine categories

• A = Primary/basic medicines

• B = Intermediate medicines

• C = District hospital level medicines

• D = Regional referral level medicines

• S = Specialized/tertiary medicines

Facility stocking levels

Dispensary

May stock:

• A

Health centre

May stock:

• A, B

District hospital

May stock:

• A, B, C

Regional referral hospital (RRH)

May stock:

• A, B, C, D

Tertiary hospital

(National, Zonal Referral, Specialized Hospitals)

May stock:

• A, B, C, D, S

Prescribing authority by cadre

Assistant clinical Officer (ACO)

May prescribe:

• A

Clinical Officer (CO)

May prescribe:

• A, B

Assistant Medical Officer (AMO)

May prescribe:

• A, B, C

Medical Officer (MO)

May prescribe:

• A, B, C, D

Specialist

May prescribe:

• A, B, C, D, S

Specialists should prescribe within their area of specialization.

Prescribing decision rule

A medicine is permitted only when:

1. The prescriber is authorized for that medicine category.

2. The facility is authorized to stock that medicine category.

If either condition is not met, the medicine should not be prescribed.

Important specialist rule

Specialists may prescribe category S medicines and all lower categories (A, B, C, D).

Examples:

• Cardiologist → cardiovascular medicines.

• Neurologist → neurological medicines.

• Oncologist → oncology medicines.

Prescribing should remain within the specialist's area of expertise.

Examples

Example 1

Medicine Category: C

Facility: District Hospital

Prescriber: AMO

Decision: Permitted

Reason: District Hospital stocks category C medicines and AMO may prescribe category C medicines.

Example 2

Medicine Category: D

Facility: District Hospital

Prescriber: Medical Officer

Decision: Not permitted

Reason: District Hospitals stock only A, B, and C medicines.

Example 3

Medicine Category: D

Facility: Regional Referral Hospital

Prescriber: Clinical Officer

Decision: Not permitted

Reason: Clinical Officers may prescribe only categories A and B.

Example 4

Medicine Category: S

Facility: Tertiary Hospital

Prescriber: Medical Officer

Decision: Not permitted

Reason: Category S medicines require Specialist authority.

Example 5

Medicine Category: S

Facility: Tertiary Hospital

Prescriber: Specialist

Decision: Permitted

Reason: Specialists may prescribe category S medicines.

Quick Reference

Facility Levels

• Dispensary → A

• Health Centre → A, B

• District Hospital → A, B, C

• Regional Referral Hospital → A, B, C, D

• Tertiary Hospital → A, B, C, D, S

Prescriber levels

• ACO → A

• CO → A, B

• AMO → A, B, C

• MO → A, B, C, D

• Specialist → A, B, C, D, S

Bot logic

When answering medicine questions:

1. Identify medicine category (A, B, C, D, or S).

2. Identify facility level.

3. Identify clinician cadre.

4. Check facility authorization.

5. Check prescriber authorization.

6. Return:

   • Permitted

   • Not permitted due to facility level

   • Not permitted due to prescriber level

   • Requires specialist authorization