Essential medicines and health products

Essential medicines

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 and public health relevance, evidence of clinical efficacy and safety, and comparative costs and 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 30 years the Model List has led to a global acceptance of the concept of essential medicines as a powerful means to promote health equity. 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 19th is the current Model List of Essential Medicines, prepared by the WHO Expert Committee in April 2015.

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.

Once thought of as relevant only in resource-constrained settings, the WHO Model Lists are now seen as equally relevant to high-, middle- and low-income countries, particularly with the inclusion of new, highly effective and expensive medicines in more recent years.

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, UNHCR and UNFPA 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.