WHO Essential Drugs Strategy - PowerPoint PPT Presentation

1 / 24
About This Presentation
Title:

WHO Essential Drugs Strategy

Description:

National drug policies are being introduced at a growing pace in every region ... 1977 First Model list published, 200 active substances ... – PowerPoint PPT presentation

Number of Views:76
Avg rating:3.0/5.0
Slides: 25
Provided by: whodr58
Category:
Tags: who | drug | drugs | essential | list | strategy

less

Transcript and Presenter's Notes

Title: WHO Essential Drugs Strategy


1
25 Years of Essential Medicines 1977 - 2002
Jonathan D. Quick, MD, MPH Hans V. Hogerzeil, MD,
PhD WHO Essential Drugs and Medicines Policy May
2002
2
Overview of the presentation
Overview
  • 1. Achievements 1977 - 2002
  • 2. Unfinished agenda
  • 3. The selection of essential medicines
  • 4. Promising developments

3
National 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.
4
The 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.
5
Treatment guidelines and formulary manuals put
the essential drugs concept into clinical practice
Achievements
? 135 countries have treatment guidelines,
formularies
6
Training 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

7
The number of people with access to essential
drugs has nearly doubled in 20 years
Achievements
8
Much has been achieved in 25 years...
  • ...but..

9
Substandard drugs are common - over half are
antibiotics, antimalarials, other anti-infectives
Unfinished agenda
Percent breakdown - 325 cases of substandard
drugs
10
Irrational 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

11
Financing, 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)
12
Example 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

13
The 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
14
Clinical 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
15
History 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
16
Use 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

17
The 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

18
WHO 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
19
Practical implications of the access framework
Promising developments
20
Indicative 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

21
Advocacy, corporate responsiveness and
competition have reduced antiretroviral prices
95 in 3 years
Promising developments
??
22
Expanding drug financing options - increasing
number of countries with drug benefits in health
insurance
Promising developments
- Public funds - Insurance - Global fund -
Out-of-pocket - Donations
23
Successful experiences with local supply systems
and regional bulk procurement
24
The 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
Write a Comment
User Comments (0)
About PowerShow.com