Title: WHO Essential Drugs Strategy
125 Years of Essential Medicines 1977 - 2002
Jonathan D. Quick, MD, MPH Hans V. Hogerzeil, MD,
PhD WHO Essential Drugs and Medicines Policy May
2002
2Overview of the presentation
Overview
- 1. Achievements 1977 - 2002
- 2. Unfinished agenda
- 3. The selection of essential medicines
- 4. Promising developments
3National drug policies are being introduced at a
growing pace in every region - guides for
collective action
Achievements
Includes countries with current NDPs, draft
policies or policies or policies gt 10 years old.
4The essential drugs concept is nearly universal
a floor, not a ceiling - applied differently in
different settings
Achievements
By Dec.1999 156 countries with EDLS 1/3 within
2 years 3/4 within 5 years
Countries with an official selective list for
training, supply, reimbursement or related health
objectives. Some countries have selective
state/provincial lists instead of or in addition
to national lists.
5Treatment guidelines and formulary manuals put
the essential drugs concept into clinical practice
Achievements
? 135 countries have treatment guidelines,
formularies
6Training in rational prescribing has expanded in
universities throughout the world
Achievements
DAPs role
- Problem-based pharmacotherapy
- In 18 languages
- For medical students, clinical officers
- Measurable improvement in prescribing
- Now also Teachers Guide to Good Prescribing
7The number of people with access to essential
drugs has nearly doubled in 20 years
Achievements
8Much has been achieved in 25 years...
9Substandard drugs are common - over half are
antibiotics, antimalarials, other anti-infectives
Unfinished agenda
Percent breakdown - 325 cases of substandard
drugs
10Irrational use of drugs is a widespread hazard to
health
Unfinished agenda
- Half of 102 countries surveyed regulate drug
promotion - By age 2 children in some areas have had gt 20
injections - 15 billion injections per year - half of them
unsterile - 25-75 of antibiotic prescriptions are
inappropriate
11Financing, delivery, and other constraints still
limit access to essential drugs
Unfinished agenda
Percentage of population with regular access to
essential drugs (1997)
Source WHO/DAP (1998)
12Example of challengeNew essential drugs are
expensive
Selection
- Antibiotics for gonorrhoea 50-90x price of
penicillins - Antimalarial drugs chloroquine 0.10 per
treatment artemether-lumefantrine 2.50/pp
(25x) atovaquone-proguanil 40/pp (400x) - Antituberculosis 15 for DOTS vs 300 for MDR
(20x) - Antiretrovirals 300-600/year but 38 countries
with a drug budget lt2 pp/year
13The Essential Medicines Target
Selection
National list of essential medicines
Registered medicines
All the drugs in the world
Levels of use
CHW
S
S
dispensary
Health center
Supplementary specialist medicines
Hospital
Referral hospital
Private sector
14Clinical guidelines and a list of essential
medicines lead to better prevention and care
Selection
List of common diseases and complaints
Treatment choice
Treatment guidelines
Essential medicines list / National formulary
Training and Supervision
Financing and Supply of drugs
Prevention and care
Health Technology and Pharmaceuticals
15History of the WHO Model List of Essential Drugs
Selection
- 1977 First Model list published, 200 active
substances - List is revised every two years by WHO Expert
Committee - Last revision (April 2002) contains 325 active
substances - 2002 Revised procedures approved by WHO
The first list was a major breakthrough in the
history of medicine, pharmacy and public health
Médecins sans Frontières, 2000
16Use of the WHO Model List of Essential Drugs
Selection
- 156 countries have a national list of essential
drugs - Major agencies (UNICEF, UNHCR, IDA) base their
catalogue on the WHO Model List - Sub-sets of the Model List
- UN list of essential drugs for emergencies 85
drugs - New Emergency Health Kit 55 drugs for 10,000
people/3m - Normative tools follow the Model List
- WHO Model Formulary
- International Pharmacopoea
- Basic Quality Tests and reference standards
17The WHO Model List of Essential Medicines is
amodel product, model process and public health
tool
Selection
- Independent Membership of the Committee, careful
consideration of conflict of interest - Transparent process, standard application, web
review - Link to evidence-based clinical guidelines
- Systematic review of comparative efficacy,
safety, cost-effectiveness and public health
relevance - Rapid dissemination, electronic access
- Regular review
18WHO Essential Medicines LibraryCombining
information from various partners
Selection
WHO clusters
WHO/EDM
Summary of clinical guideline
Clinical guideline
BNF
WHO Model Formulary
WHO/EC, Cochrane
Reasons for inclusion Systematic reviews Key
references
WHO Model List
WHO/EDM
MSH UNICEF MSF
Cost - per unit - per treatment - per month -
per case prevented
Statistics - ATC - DDD
Quality information - Basic quality tests -
Intern. Pharmacopoea - Reference standards
WCCs Oslo/Uppsala
19Practical implications of the access framework
Promising developments
20Indicative price information promotestransparency
and competition
Promising developments
- MSH-WHO essential drugs price indicator
- Drugs and diagnostics for HIV/AIDS
- Pharmaceutical starting materials
- Antiretroviral drugs in the Americas
- AFRO Essential Drugs
21Advocacy, corporate responsiveness and
competition have reduced antiretroviral prices
95 in 3 years
Promising developments
??
22Expanding drug financing options - increasing
number of countries with drug benefits in health
insurance
Promising developments
- Public funds - Insurance - Global fund -
Out-of-pocket - Donations
23Successful experiences with local supply systems
and regional bulk procurement
24The essential drugs concept -more valid than ever
Conclusion
- Much has been achieved in 25 years
- Yet the unfinished agenda is large - quality,
access, use - The Model List of Essential Medicines remains a
strong public health tool - There are promising developments for access -
pricing, financing, supply systems and quality