Essential medicines and health products

The WHO Essential Medicines List (EML): 30th anniversary

THREE DECADES OF VITAL HEALTH CARE

• In 1977, nearly a dozen countries had what would now be considered an essential medicines list or an essential drugs programme. Today, four out of five countries - at least 156 countries in total - have adopted national essential medicines lists.

• Thirty years ago, the concept of a national drug policy was unknown to most countries. Today, over 100 countries have such policies in place or under development.

• In 1977, objective information on the rational use of medicines was extremely limited, especially in developing countries. Today, at least 135 countries have their own therapeutic manuals and formularies, which provide health professionals with up to date, accurate and unbiased advice on the rational use of drugs.

• When the first Essential Medicines List appeared, the WHO Programme for International Drug Monitoring was just being formally established. Today, a network of 83 countries provides global monitoring for adverse drug reactions and regularly picks up signals on potential safety problems.

• Thirty years ago, there was virtually no publicly available price information and few countries actively encouraged generic substitution. Today, at least 33 countries have carried out availability and pricing surveys and provide that information publicly. In addition, the wider use of quality assured generic medicines since the 1990's have brought down prices through increased demand and competition.

Countries that set the example

Bhutan

The Essential Drugs Programme of Bhutan began in 1987, when the government adopted a National Drug Policy and supporting legislation. While access to medicines was very limited in the country prior to that date, it is estimated that 90% of the population now enjoys access to quality assured essential medicines.

In 1995, retail prices were on average 6% lower than those in 1985 and the prices paid by the Programme in the course of procurement are currently some 50% below world market prices. Monitoring is intensive, with facilities reporting twice yearly on their stocks and use of medicines.

Only 0.75% of the overall budget is wasted as a result of drug expiry in Bhutan. Standard Treatment Guidelines have strengthened rational prescribing practices and the Programme has invested heavily in ongoing development of human resources and formalization of working procedures.

Mozambique

In 1977, a few months before WHO published the first EML, Mozambique had already created its national pharmacopeia, a list consisting of 430 essential medicines. The country has managed to increase local access to medicines from 10% of the population in 1975 to 80% in 2007.

A WHO survey carried out in 2006, reports that patients interviewed at the dispensing area of public facilities were paying a median of 2 800 Metical for their medicines plus fees — equivalent to a half hour’s wage for the lowest paid unskilled government worker.

According to the same survey, among 465 medicine samples tested for regulatory purposes only 34 (7.4%) failed identity or assay.

Peru

In 1960, Peru created a list of basic medicines in an attempt to address at least the most pressing pharmaceutical needs of the population.

In 1971, the country promoted the Basic Medicines Program, stimulating the creation and use of the first national list of essential medicines. The country's initiative, 36 years ago, provided an example for WHO and contributed to establishing the organization's first model list of essential medicines.

Sri Lanka

Sri Lanka (then Ceylon) created a medicines list for purchase by the state health care system in 1959. In addition, the Ceylon Hospitals Formulary was published providing information for the use of these medicines. They also set up an international procurement system which decreased costs and at the same time increased the availability of these medicines.

In spite of industry opposition, Sri Lanka introduced a state controlled monopoly in 1972, to procure medicines for the entire country through the creation of the State Pharmaceutical Corporation (SPC) thus extending the initiative to the private sector. Up to date, there has been sufficient availability of free essential medicines to the population through public sector facilities.

Until 1977, SPC was responsible for importing and distributing medicines to both the public and private sectors. After 1977, due to pressure from the private sector, the Sri Lankan government granted permission to companies to import multiple brands of medicines. However, the government remains in charge of choosing the types of medicines to be imported to ensure that priority health care issues are covered.

In 1987, Sri Lanka created the State Pharmaceutical Manufacturing Corporation (SPMC) with the aim of importing raw materials and manufacturing generic essential medicines. Ever since, government resistance to privatization and monopoly on procurement has kept quality as well as prices under control even in the private sector.

A critical factor of Sri Lanka's success is universal education, which has resulted in greater awareness of the importance of health and a strong demand for health services in general. Health professionals’ education and training are tailored to the national medicine supply policy and system, including the essential medicines concept.

THE FIRST STEPS

The manufacture of medicines on an industrial scale is nearly 100 years old. It started with the emergence of antibiotics, in the late 1930s, which made it possible to treat diseases considered fatal at the time.

The WHO Model List of Essential Medicines (EML) came three decades later - in 1977. The document presented a compilation of essential medicines that could be adapted to countries and served as a guideline for establishing national lists.

The following year, 1978, the World Health Assembly passed a Resolution urging Member States to establish national lists of essential medicines and adequate procurement systems. In that same year, the Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care, Alma-Ata, Kazakhstan.

The Declaration expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world. It was the first international declaration underlining the importance of primary health care and to include the provision of essential medicines and vaccines as a major component of primary health care.

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