Essential Drugs

Essential medicines, as defined by the World Health

Organization (WHO), are the medicines that "satisfy the
priority health care needs of the population".

Access to essential medicines are part of the Sustainable

Development Goals, specifically goal 3.8.
 The definition of essential medicines has changed over time.
The original WHO definition in 1977 was that they were medicines
"of utmost importance, basic, indispensable, and necessary for the
healthcare needs of the population".
The concept was mentioned in one of the ten points of the 1978
Alma Ata Declaration on primary health care.
In 2002 definition was changed to:
“Essential medicines are those that satisfy the priority health care
needs of the population”.
They should therefore be available at all times in adequate amounts
and in the appropriate dosage forms, and at a price that individuals
and the community can afford.
This concept is intended to be flexible and adaptable to many
different situations; exactly which drugs are regarded as essential
remains a national responsibility.
The prices should be at generally affordable levels.
The model list now contains many medications which require a high
degree of expertise to ensure safe and effective use. Adequate
specialist skills and complementary resources are needed before the
introduction of some classes of drugs. Examples of situations where
specialist control of drug use is necessary are:
The use of reserve antimicrobials for multidrug-resistant bacteria.
Establishing adequate regimens for treatment of tuberculosis and
leprosy.
The use of antineoplastic and immunosuppressive drugs.
The use of antiretroviral drugs.
The use of antimicrobial, antifungal and antiviral agents for the
treatment of opportunistic infections in immunocompromised
patients.
 Since 1977, the WHO has published a model list of essential
medicines, with the current (2019) list for adult patients containing
over 400 medicines.
Since 2007, a separate list of medicines intended for child
patients has been published.
Both the WHO adult and children's lists contain a notation indicating
that a particular medication is "complementary", thus essentially
there are two lists, the "core list" and the "complementary list".
The core list presents a list of minimum medicine needs for a basic
health care system, listing the most efficacious, safe and cost-
effective medicines for priority conditions.
Priority conditions are selected on the basis of current and estimated
future public health relevance, and potential for safe and cost-
effective treatment.
The complementary list presents essential medicines for priority
diseases, for which specialized diagnostic or monitoring facilities are
needed.
In case of doubt medicines may also be listed as complementary on
the basis of higher costs or less attractive cost-effectiveness in a
variety of settings.
Children's list
The first edition of the "WHO Model List of Essential Medicines for
Children", was published in 2007, while the 7th edition was
published in 2019.
It was created to make sure that the needs of children were
systematically considered such as availability of proper formulations.
The first edition contained 450 formulations of 200 different
medications.
Significance:
The list is important because it forms the basis of national drugs
policy in more than 155 countries, both in
the developed and developing world.
Many governments refer to WHO recommendations when making
decisions on health spending.
Countries are encouraged to prepare their own lists taking into
consideration local priorities.
Over 150 countries have published an official essential medicines list.
Key factors for development of an essential
medicines list:
Establishing a transparent process for creating and updating the list
of essential medicines, provide a voice for key stakeholders, but
ensure a scientific, evidence-based process
Linkage with standard clinical guidelines and involvement of both
specialists and primary care providers
Garner support from senior clinicians, academic institutions, public
health professionals, professional organizations, non-governmental
organizations and community members
Making the list available (essential medicines, formulary manuals
and clinical guidelines) in all health care facilities/health care
providers in both printed and electronic format
Consider launching of new or revised lists with the involvement of
concerned government officials with adequate publicity
Making clear the specific legal or administrative authority of the
essential medicines list for training, procurement, reimbursement
and public information
Establishing an administrative or budgetary “safety valve” for the
limited supply and use of non-listed medicines
Regular Updating of the list so that it reflects therapeutic advances
and changes in cost, resistance patterns and public health relevance
Selection
Items are chosen as essential medicines based on how common the
disease that is being treated, evidence of benefit, the degree of side
effects and the cost compared to other options.
Cost-to-benefit ratio

Cost effectiveness is the subject of debate between producers

(pharmaceutical companies) and purchasers of drugs (national
health services). It is estimated that access to essential medicines
could save 10 million people a year.
Rationale use of drug- definition
“Patients receive medications appropriate to their clinical needs, in
doses that meet their own individual requirements, for an adequate
period of time, and at the lowest cost to them and their community.”

Irrational use occurs when one or more of these conditions are not
met. The use of too many medicines per patients; inappropriate use
of antimicrobials, often in inadequate dosage, for non-bacterial
infections; over use of injections, are few common types of irrational
use of medicines.
The selection of essential medicines is only one step towards the
improvement of the quality of health care; selection needs to be
followed by appropriate use.
Each individual should receive the right medicine, in an adequate
dose for an adequate duration, with appropriate information and
follow-up treatment, and at an affordable cost.
Worldwide more than 50% of all medicines are prescribed,
dispensed, or sold inappropriately, while 50% of patients fail to take
them correctly.
Moreover, one-third of the world's population lacks access to
essential medicine.
The situation is alarming. Unfortunately, because of inappropriate
use, the effective medicines of yesterday become ineffective today. A
classic example is antimicrobial medicines.
Thus, in addition to achieve improved accessibility of essential
medicines (availability and affordability); it is equally necessary to
use the medicines appropriately, known as using rationally.
Strategies to Promote Rational Use of Medicines
The following strategies have been advocated by WHO for promoting
rational use of medicines.
There is 3 M concept in Rational Use of Medicines (RUM): Medicines
Mean Money.
Thus, RUM means less profit and income for those dealing with
medicines; prescribers, and sellers.
This conflict of interest is particularly relevant in our country where
just only 3-5% of population are covered under any form of health
insurance.
‫يجب معرفة كيفية وصف الدواء بطريقة صحيحة من زيارات المراكز و كذلك التعرف‬
‫علي برنامج وصفتي‬