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WHO Model List of Essential DrugsProgramme start and evolution Global Perspective and Reflections


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Title: WHO Model List of Essential DrugsProgramme start and evolution Global Perspective and Reflections

WHO Model List of Essential Drugs/Programme
start and evolution Global Perspective and
  • Margaretha Helling Borda
  • 21 October 2002, Cambodia

Overview of the presentation
  • Introduction and background
  • History and major events up to 1977
  • After first EDL-what? (78-82)
  • Action and evolution (83-88)
  • Increased country impl.of EDC and NDP (89-96)
  • Expansion-new challenges (96-present)
  • Achievements today
  • Conclusion

Birth of Essential Drugs Concept (EDC)
  • Complaints in the early seventies
  • No links between drugs and health needs
  • No access to most essential drugs
  • Rising costs of pharmaceuticals
  • Uneven rural-urban distribution
  • Protests against industry marketing practice
  • No comprehensive NDP to support PHC etc.
  • Against this background birth of EDC

Early years up to first WHO model EDL
  • 1975 1976
  • WHO era of essential drugs with WHA res. 28.66
  • Informal WHO consultation on selection 1976
  • Comments from countries and elsewhere stressing
  • Any final list should be a local responsibility
  • Importance and need for well-established
    criiteria to guide in selection
  • Education of physicians and public through
    information system must accompany any essential
    drugs list

1977 WHO first model EDL
  • Comments from 1976 working paper and three other
    major working papers was background for the WHO
    first Expert Committee on Selection of Essential
  • WHO Expert Committee on the Selection of
    Essential Drugs held 17 21 October 1977
  • A little blue booklet of about 35 pages TRS 615
    became an instant WHO bestseller

The WHO first Expert Commite report TRS 615, the
Selection of Essential Drugs
  • a model list of around 250 main and complementary
    drugs with criteria and guidelines for
    establishing the list
  • WHO had produced a vital tool for public health
  • According to Médecins sans Frontières (2000)
     The first list was a major breakthrough in the
    history of medicine, pharmacy and public health .

Not all  smooth sailing  in 1977 and after but
  • Some complaints and objections
  • But
  • TRS 615 started an evolution - became a central
    tool in the aim and process to assure regular
    access to essential drugs
  • the text in the first expert committee report has
    stood its test of time
  • Still is very much quoted and was used as basis
    for implementation of the essential drugs concept

After publication of first EDL what?
  • 1978-82
  • EDL became the technical tool and HFA/Primary
    Health Care the policy context
  • Provision of essential drugs one of the 8 key
    elements in the aims to attain Health For All by
    the year 2000
  • Finding a way in a constrained, complex and
    confrontational atmosphere
  • Funds and human resources constraints
  • Searching for strategies
  • Lobbying for/against aWHO marketing code for
  • On the way to action EDL must be part of NDP

Action and consolidation period
  • 1983 1988 Milestones
  • 1983 New DAP head -direct reporting to DG
  • 1984 WHA calls for meeting on RUD
  • 1985 Nairobi Conference of Experts on RUD
  • 1986 WHA adopts WHO Revised Drug Strategy
  • 1988 WHO publishes Ethical Criteria for
    Medicinal Drug Promotion Estimating Drug
    Requirements World Drug situation Guidelines
    for Developing National Drug Policies and fifth
    WHO Model EDL  The Use of Essential Drugs
     (title changed in third report 1982 to stress

Reflections on a very exciting action period
  • Countries started implementing ED programmes and
  • Close country and WHO collaboration funds
    started coming
  •  Spirited marketing of the concept of essential
    drugs  national and global advocacy
  • Nairobi conference a mile stone for general
    acceptance of the EDC
  • Sharing of responsibilities outlined
  • Conference set the tone for years to come and
    reinforced WHO mandate as lead agency on
    pharmaceutical matters
  • Many lessons learnt from operationalizing the EDC

Increased country implementation of EDC and NDP
1989 -1996
  • EDC more widely known, accepted and implemented
    in developing countreis
  • Break up USSR created alarming shortage of
    essential medicines adoption of EDL and NDP in
    the newly independant states (NIS)
  • WHO produced more  how to  methodologies and
    gudelines e.g. NDP indicators how to
    investigate drug use, good prescribing and
    teaching guides, regulatory and QA guides,
    donation guidelines etc., all reported in the
  • First NDP Expert Commitee in 1995 to update 1988

Expansion new complex issues 1996 present
  • Catastrophic increases in HIV/AIDS, Malaria, TB
  • New expensive essential drugs but advocacy,
    corporate responsiveness and competition have
    reduced antiretroviral prices 95 in 3 years
  • New partnerships
  • Much expanded mandates for WHO and department of
    Essential Drugs and Medicines Policy (EDM)
  • Comprehensive WHO/EDM documentation on websites
    and in publications (NDP, EDL, TRIP, Prices, QA,
    pharmaco-economics, WHO Formulary)

Summary of Achievements in 25 years Use of the
WHO Model List of Essential Drugs
  • 156 countries have a national list of essential
    drugs, of which 81 have been updated in the last
    5 years and one third within two years
  • Major international agencies (UNICEF, UNHCR, IDA)
    base their catalogue on the WHO Model List
  • Sub-sets UN list of recommended essential drugs
    for emergency relief (85 drugs) interagency New
    Emergency Health Kit (55 drugs for 10,000
  • Normative tools WHO Model Formulary,
    International Pharmacopoea, Basic Quality Tests,
    and development of reference standards follow the
    WHO Model List
  • Source WHO Department Essential Drugs and
    Medicines Policy 2002

Achievements Number of countries with a
National Drug Policies1985 - 1999
  • In 1999 one hundred and one (101) countries had a
    National Drug Policy
  • Among these about half (54) were low-income
    countries, 43 were middle income countries and
    4 were high-income countries
  • In 1995 there were fourty seven (47) countries
    with a NDP
  • In 1990 ten (10) countries had a NDP
  • In 1985 only five (five) countries had adopted a
    national drug policy
  • Source WHO Department Essential Drugsand
    Medicines Policy 2002

Achievements Number of people with access to
essential drugs 1977 -1997
  • In 20 years from 1977 to 1997, when world pop.
    went from around 4 to close to 6 billion people
    regular access to essential drugs nearly doubled
    from around two to just under four billion people
  • In spite of this, as much as one-third of the
    worlds six billion people in 1997 lacked access
    and still lacks regular access
  • Worst situation in Africa where 320 million
    people have less than 50 access to essential
  • Financing, delivery and other constraints limit
    access to essential drugs and these problems
    worsen with economic pressures and poverty
  • Source WHO Department Essential Drugs and
    Medicines Policy 2002

  • The content in TRS 615 of 1977 with the model
    essential drug list triggered of an evolution- a
    revolution- to increase access to essential drugs
  • The WHO Model list of Essential Medicines remains
    a powerful public health tool
  • Drug selection is a start a core element in a
    succesful EDP and NDP implementation
  • The concept of essential medicines has global
    relevance for todays challenges

Today 25 th Anniversary of the first WHO Model
list Essential Drug List-
  • Is a Tribute to the achievements of all countries
    with EDL, NDP and improvements in access to
    essential medicines
  • Thank you
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