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The Selection of Essential Medicines - WHO Policy Perspectives on Medicines, No. 004, June 2002
(2002; 6 pages) [French] [Spanish] View the PDF document
Table of Contents
View the documentThe concept of essential medicines
View the documentSelection of essential medicines
View the documentHow to develop a national list of essential medicines
View the documentHow to implement a national list of essential medicines
View the documentReference materials available from WHO
View the documentContacts at WHO Headquarters
View the documentContacts in WHO Regional Offices
 

The concept of essential medicines

Essential medicines are those that satisfy the priority health care needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness. Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford. The implementation of the concept of essential medicines is intended to be flexible and adaptable to many different situations; exactly which medicines are regarded as essential remains a national responsibility.

After immunization for common childhood illnesses, appropriate use of essential medicines is one of the guidelines. most cost-effective components of modern health care. The selection of essential medicines is one of the core principles of a national drug policy because it helps to set priorities for all aspects of the pharmaceutical system. This is a global concept which can be applied in any country, in private and public sectors and at different levels of the health care system.

Box 1 Key policy issues

• Access to essential medicines depends on four factors: rational selection, affordable prices, sustainable financing and reliable health systems.

• The selection of essential medicines, preferably linked to standard clinical guidelines, is a crucial step in ensuring access to health care and in promoting rational use by health professionals and consumers.

• Official adoption of the essential medicines concept identifies priorities for government involvement in the pharmaceutical sector in general, and for medicine supply in the public sector and medicine benefits as part of health insurance in particular.

• Establishment of systematic and transparent procedures for defining the national list(s) of essential medicines, on the basis of evidence-based treatment

Advantages

Careful selection of a limited range of essential medicines results in a higher quality of care, better management of medicines (including improved quality of prescribed medicines), and more cost-effective use of health resources. Numerous studies have documented the impact of clinical guidelines and lists of essential medicines on the availability and proper use of medicines within health care systems. All of this is even more important in resource-poor settings where the availability of drugs in the public sector is often erratic. Under such circumstances measures to ensure a regular supply of essential medicines will result in real health gains and in increased public confidence in the health services.

A global concept

By the end of 1999, 156 countries had official essential medicines lists, of which 127 had been updated in the previous five years (Figure 1). Most countries have national lists and some have provincial or state lists as well. National lists of essential medicines usually relate closely to national guidelines for clinical health care practice which are used for the training and supervision of health workers. No public sector or health insurance system can afford to supply or reimburse all medicines that are available on the market. Therefore, lists of essential medicines also guide the procurement and supply of medicines in the public sector, schemes that reimburse medicine costs, medicine donations, and local medicine production. Many international organizations, including UNICEF and UNHCR, as well as non-governmental organizations and international non-profit supply agencies, have adopted the essential medicines concept for their supply systems. Several developed countries also use the same approach (Box 3).

The essential medicines concept is relevant to the challenges of today

The emergence of new epidemics such as HIV/AIDS, widespread increase in infectious diseases such as malaria and tuberculosis, the emergence of anti-microbial resistance and an increase of chronic diseases in many parts of the world have made the essential medicines concept more relevant than ever. In many developed countries total medicine expenditure is rising by 10-18% per year, much faster than the consumer price index or the annual growth in GNP. This rise is mostly linked to the introduction of newer higher priced medicines and to an overall increase in consumption. In developing countries, newer combination anti-malarial medicines may be 30-200 times more expensive than chloroquine; medicines to treat multi-drug resistant tuberculosis may cost 20-30 times more than the usual DOTS treatment; and treatment of HIV/AIDS with anti-retroviral medicines may cost between $400-2500 per year.

Box 2 Practical applications of the essential medicines concept

• Basic and in-service training of health care providers
• Public-sector procurement and distribution
• Medicine benefits as part of health insurance
• Drug donations and international aid
• Monitoring systems on availability and pricing
• Public education.

Most medicine budgets in developing countries are below $30 per person per year, with 38 countries having less than $2 per person per year. Hence, it is vital that countries work both to increase drug financing within overall health financing and that they apply the essential medicines concept to achieve the best possible health outcomes within available resources.


Figure 1. Countries with a national essential medicines list* (EML)

* Countries with an official selective list for training, supply, reimbursement. Some countries have state/provincial lists instead of or in addition to national lists. Source: WHO, World Drug Situation Survey, 1999

Box 3 Example of the essential medicines concept in a developed country

In Australia the Pharmaceutical Benefit Scheme ensures full or partial reimbursement of over 80% of all medicines prescribed in primary care settings. Over the years the scheme has developed a very systematic procedure to decide which medicines will be reimbursed, including systematic reviews of efficacy, safety and comparative cost-effectiveness. As a result, only around 650 active ingredients in around 1100 dosage forms (1600 products) are reimbursed under the scheme.

 

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