E-DRUG: WHO Essential Medicines concept and procedures
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The following text with concepts and procedures of WHO's Essential Medicines
system is found at:
http://www.who.int/medicines/services/essmedicines_def/en/index.html
Definition
Essential medicines are those that satisfy the priority health care needs of
the population
Criteria for Selection of Essential Medicines
Essential medicines are selected with due regard to disease prevalence,
evidence on efficacy and safety, and comparative cost-effectiveness
Essential Medicines Lists
Essential medicines are intended to be available within the context of
functioning health systems at all times in adequate amounts, in the
appropriate dosage forms, with assured quality, and at a price the
individual and the community can afford.
The Model List is a guide for the development of national and institutional
essential medicine lists. It was not designed as a global standard. However,
for the past 28 years the Model List has led to a global acceptance of the
concept of essential medicines as a powerful means to promote health equity.
By the end of 1999, 156 Member States had official essential medicines
lists, of which 127 had been updated in the previous five years. Most
countries have national lists and some have provincial or state lists as
well. National lists of essential medicines usually relate closely to
national guidelines for clinical health care practice which are used for the
training and supervision of health workers.
Current list
The 14th is the current Model List of Essential Medicines, prepared by the
WHO Expert committee in March 2005. It contains 312 individual medicines,
including antiretroviral medicines for the prevention and treatment of
HIV-AIDS.
:: Lists: WHO Model List of Essential Medicines see
http://www.who.int/medicines/publications/essentialmedicines/en/index.html
:: Selection: The Expert Committee on the Selection and Use of Essential
Medicines (see
http://www.who.int/medicines/services/expertcommittees/essentialmedicines/en
/index.html)
:: Library: The Essential Medicines Library (EMLib) (see
http://mednet3.who.int/EMLib/ (currently being renovated))
Web-based seachable database for Essential medicines and WHO Model
Formulary. Search for medicine details, disease and treatment references,
and various resources, WHO Essential Medicines.
Essential mediciness are one of the most cost-effective elements in modern
health care and their potential health impact is remarkable. This year
alone, there will be over 40 million deaths in developing countries,
one-third among children under age five. Ten million will be due to acute
respiratory infections, diarrhoeal diseases, tuberculosis, and malaria --
all conditions for which safe, inexpensive, essential drugs can be
life-saving. Simple iron-folate preparations can reduce maternal and child
mortality from anaemia of pregnancy; treatment of sexually transmitted
diseases reduces transmission of the AIDS virus; and treatment of
hypertension reduces heart attacks and strokes.
A global concept
The concept of essential medicines is forward-looking. It incorporates the
need to regularly update medicines selections to reflect new therapeutic
options and changing therapeutic needs; the need to ensure drug quality; and
the need for continued development of better medicines, medicines for
emerging diseases, and medicines to meet changing resistance patterns.
The evolution of medicine and the WHO Model list of essential medicines
In 1897, aspirin was introduced as the first synthetic pharmaceutical. In
the 100 years since, the world has seen the introduction of the first modern
antibiotic (1941), the first commercially formulated antimalarial (1943),
and the first antitubercular (1944). The 1950s saw the first clinical use of
oral contraceptives, of drugs for diabetes and of drugs for mental illness.
The development of drugs for other infectious diseases, for cardiovascular
diseases and for a wide range of other conditions quickly followed. When WHO
published the first Model List of Essential Drugs in 1977, it identified 208
individual medicines which together could provide safe, effective treatment
for the majority of communicable and non-communicable diseases.
Access, quality and rational Use of Medicines and Essential medicines
The economic impact of pharmaceuticals is substantial -- especially in
developing countries. While spending on pharmaceuticals represents less than
one-fifth of total public and private health spending in most developed
countries, it represents 15 to 30% of health spending in transitional
economies and 25 to 66% in developing countries. In most low income
countries pharmaceuticals are the largest public expenditure on health after
personnel costs and the largest household health expenditure. And the
expense of serious family illness, including drugs, is a major cause of
household impoverishment. Despite the potential health impact of essential
drugs and despite substantial spending on drugs, lack of access to essential
drugs, irrational use of drugs, and poor drug quality remain serious global
public health problems:
Lists of Essential Medicines also guide the procurement and supply of
medicines in the public sector, schemes that reimburse medicine costs,
medicine donations, and local medicine production. Many international
organizations, including UNICEF and UNHCR, as well as nongovernmental
organizations and international non-profit supply agencies, have adopted the
essential medicines concept and base their medicine supply system mainly on
the Model List.
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Wilbert Bannenberg, E-drug moderator
Email: wjb@planet.nl
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