Essential Drug Concept and its Implication in Nepal

The world health organization defines essential drugs as:

“those that satisfy the priority health care needs of the majority of the population; they should
therefore be available at all times in adequate amounts and in the appropriate dosage forms.”

Criteria for assuring peoples access to Essential Drugs

• Efficacy

• Safety

• Affordability

• Accessibility

• Relevant to prevalent disease

• Benefit/risk ratio

• Treatment facilities

• Training and experience of the available personnel

• Financial resources

The concept of essential medicines

The essential medicines concept was stimulated by three factors:

• Limited access to medicines essential to meet the health needs of the majority of the
population

• Limited public funding for pharmaceutical and health

• The implementation of WHO health for all strategy

Principles of essential medicines concept are

• Common health problems of the majority of the population can be treated with small,
carefully selected number of medicines.

• Health professionals routinely use less than 200 medicines. Training and clinical
experience should focus on the proper use of these selected medicines.

• Procurement, distribution and other supply activities can be carried out most
economically and efficiently for a limited number of drug products.
 • Patients can be better informed about the effective use of medicines by the health professionals.

Model list of essential drugs

• The first model list of Essential Drugs was published by WHO in 1977 and has since
been updated every 2 years.

• The model list guide and assist countries to identify their own priorities, to make their
own selection and to develop their national list of Essential medicines.

Implementation of Essential Drug List in Nepal

The main events for the introduction of essential drug concept were:
1. Promulgation of Drug act in 1978

2. First publication of National list of EDL in 1986

 3. Adoption of National Drug Policy in 1995

4. Publication of Nepalese National Formulary in 1997.

5. The first list of essential drugs includes 245 drugs but dosage forms were not included in
it.

6. Short list of drug for Health Post and still shorter list for primary treatment level were
also included.

7. First revision in 1992 further included List for district level and sub-health post level.

8. Drugs were categorized as main drugs and complimentary drugs.

9. Drugs in main list are drugs that satisfy health care needs of the majority of population
and complimentary drugs are for treating rare disorders or when drugs in main list cannot
be made available or becomes ineffective or inappropriate for a given individual.

10. Similarly EDL was revised in 1997, 2002, 2009 and 2016.

National list of Essential Medicines (Fifth Revision) 2016

Some of the examples of essential drugs that were included in EDL 2016 as fifth revision
includes:

Main list Complementary list Dosage form

General anaesthetics

Halothene Inhalation

Isofurane Inhalation

Ketamine Injection, Vial

Nitrous oxide Inhalation

Oxygen Inhalation

Thiopental Ampoule

Propofel Ampoule, injection

 Sevoflurane Inhalation

Medicines for pain and palliative care

• Opioid analgesics

Main drugs Complementary drugs Dosage forms

Ibuprofen Tablet 200mg, 400mg

Paracetamol Tablet 500mg

Aspirin Tablet 500mg

Diclofenac sodium Tablet 50mg, injection 25

• Non-opioid analgesics

codeine Tablet 30mg

Fentenyl Injection 50mcg/ml

Morphine Injection 10mg

Pethidine Injection 50mg

Antihistamines

Main complementary Dosage form

Cetrizine Tablet 10mg

Dexamethasone injection

Epinephrine injection
 Hydrocortisone powder

Pherniramine Tablet 25, 50mg

Prednisolone Tablet 5mg

Fexofenadine Oral solution, 30mg/5m

Antileprosy medicines

Drugs Dosage form

Clofazimine Capsule, 50mg, 100mg

Dapsone Tablet, 50mg, 100mg

Rifampicin Capsule or tablet 150,300mg

Conclusion
• Over the years, the essential medicines concept has become a global concept and is a
powerful tool to promote health equity.

• The concept focus on those medicines that have the best balance of quality, safety,
efficacy and cost for a given health services.

• It also stimulates research and development for better pharmaceutical formulation and for
more efficient response to new or re-emerging diseases.