Essential medicines are those that satisfy the priority health care needs of a population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness. Essential medicines are intended to be available in functioning health systems at all times, in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford. These drugs are supported as safe, effective and of high quality. Efforts are focused on their correct prescription and rational use (rational use of drugs).
The implementation of the concept of essential medicines is intended to be flexible and adaptable to many different situations; exactly which medicines are regarded as essential remains a national responsibility. The essential medicines concept can be applied in the following areas:
- Basic and in-service training of health care providers
- Public-sector procurement and distribution
- Medicine benefits as part of health insurance
- Drug donations and international aid
- Monitoring systems on availability and pricing
- Public education.
Careful selection of a limited range of essential medicines results in a higher quality of care, better management of medicines (including improved quality of prescribed medicines), and more cost-effective use of health resources. Numerous studies have documented the impact of clinical guidelines and lists of essential medicines on the availability and proper use of medicines within health care systems.
Which treatment is recommended and which medicines are selected depend on many factors, such as the pattern of prevalent diseases, treatment facilities, the training and experience of available personnel, financial resources, and genetic, demographic, and environmental factors.
It can be argued that access to essential medicines is a human right. However, many of these drugs or medicines are too expensive for those in the poorest countries or communities to buy or are unavailable because manufacturers have abandoned production because they were not considered profitable enough. Even when they are available, there may not be the capacity in the country to deliver them to those in need.
In 1975, WHO recognized the urgent problem of a lack of access to medicines in many countries and provided the impetus for the first WHO Model List of Essential Drugs (EDs), published in 1977. WHO was responding to concerns about the proliferation of inappropriate, useless and dangerous drugs in the developing world and a lack of advice on what drugs should be available. WHO's work also aims to:
- Reduce spending on and donation of expensive and non-essential drugs
- Encourage prioritization of the needs of the majority, often poor, populations
- Provide information, training, research and advocacy support to countries, not only for rational drug procurement at national levels but also to establish drug requirements at various levels in the health care system.
Experience has shown that about 30 to 40 drugs are sufficient for the delivery of primary health care. This does not mean that no other drugs are useful, but simply that, in a given situation, those drugs are the most needed to provide health care for the majority. The WHO Model List of Eds is an example of the benefits of globalization as advice, regulation, research and advocacy are globally available.
In a move to enable wider use of anti-retroviral (ARV) treatment for HIV/AIDS, WHO has included 12 such drugs in its Model List of EDs. These products simplify the treatment of HIV/AIDS, thus making it easier to deliver treatment to the estimated 6 million people living with HIV who need equitable access to care and support, including ARVs. WHO believes that at least 3 million people could receive treatment by 2005 - a more than 10-fold increase on current figures.
The Campaign for Access to Essential Medicines, led by Médecins Sans Frontières, aims to improve access to essential medicines, especially the poorest, by working:
- To lower the prices of existing medicines
- To bring abandoned drugs (also known as orphan drugs) back into production
- To stimulate research and development for diseases that primarily affect the poor (also known as neglected diseases)
- To overcome other barriers to access.