The Selection and Use of Essential Medicines - WHO Technical Report Series, No. 914
(2003; 132 pages) View the PDF document
Table of Contents
View the documentWHO Expert Committee on the Selection and Use of Essential Medicines
View the document1. Introduction
View the document2. Open session
Open this folder and view contents3. The new procedures for updating and disseminating the Model List
Close this folder4. Other outstanding technical issues
View the document4.1 Change of name of the Expert Committee
View the document4.2 Description of essential medicines
View the document4.3 Role of treatment costs in relation to the Model List
View the document4.4 Inclusion of additional items in the Model List
Open this folder and view contents5. Format and presentation of the 12th Model List
Open this folder and view contents6. Changes made in revising the Model List
Open this folder and view contents7. Future reviews of sections of the Model List
Open this folder and view contents8. Recommendations
View the documentAcknowledgements
View the documentReferences
View the documentAnnex 1 The 12th WHO Model List of Essential Medicines
View the documentAnnex 2 Additional notes on the medicines recommended for inclusion in the 12th WHO Model List of Essential Medicines
View the documentAnnex 3 The Anatomical Therapeutic Chemical (ATC) classification system1
View the documentAlphabetical list of essential medicinces (with ATC classification codes)
 

4.2 Description of essential medicines

In 1975, the World Health Assembly by resolution WHA28.66 requested the Director-General to advise Member States on “the selection and procurement, at reasonable cost, of essential drugs of established quality corresponding to their national health needs” (14). Subsequently, in 1978, resolution WHA31.32 stressed “the need to provide essential drugs of adequate quality, in sufficient quantity and at reasonable cost to meet the health needs of countries”, and endorsed the aim of, “ensuring access of the whole population to essential drugs at a cost the country can afford” (15).

At its first meeting held in 1977, the WHO Expert Committee on the Selection of Essential Drugs described essential drugs as medicines that “are of utmost importance, and are basic, indispensable and necessary for the health needs of the population” (11). In 1982, at its third meeting, the Expert Committee modified the description of essential drugs to, “those that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in the appropriate dosage forms” (13). This description was endorsed and used at all subsequent meetings of the Committee, up until its meeting in 1999.

At its meeting held in 1999, the Committee decided to combine this description with the affordability concept from resolution WHA31.32, and stated that, “Essential drugs are those that satisfy the health care needs of the majority 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” (2). This was the description that was used in the information paper submitted to the Executive Board in May 2001 (see section 3.1) (3).

Most reviewers who took part in the 2001 review of the proposals for new procedures for updating the Model List (see section 3.1) expressed their satisfaction with the description of essential medicines that was agreed in 1999. However, some reviewers questioned the inclusion of the phrase on affordability while others had reservations about the expression, “the majority of the population”. In addition, there were concerns that the need for sustained financing for essential medicines and the need for essential medicines of adequate quality, were not adequately reflected in the description.

In its report to the Executive Board of January 2002 (6), the WHO Secretariat stated that the description of essential medicines should include three components: a definition, a description of the selection criteria and a description of the purpose for which such a list is developed, as follows:

Definition. Essential medicines are those that satisfy the priority health care needs of the population.

Selection criteria. Essential medicines are selected with due regard to disease prevalence, evidence on efficacy and safety, and comparative cost-effectiveness.

Purpose. 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 at a price the individual and the community can afford.


This description is similar to that formulated at the first meeting of the Expert Committee in 1977, i.e. essential medicines are those that “are of utmost importance, and are basic, indispensable and necessary for the health needs of the population” (11). The purpose of the Model List was articulated by the Committee at its third meeting held in 1982 in the statement, “they should therefore be available at all times in adequate amounts and in the appropriate dosage forms” (13). A combination of the definition and its implications has been used to describe the essential medicines concept at all subsequent meetings of the Committee.

The WHO Secretariat in its report to the Executive Board (2001) highlighted one further element that hitherto had not been reflected in the descriptions of essential medicines used to date, namely the need for countries and institutions to develop their own list of essential medicines. As stated by the Expert Committee at its meeting in 1999, “the concept of essential drugs...is intended to be flexible and adaptable to many different situations; exactly which drugs are regarded as essential remains a national responsibility (2).

The open session provided the Committee with a further opportunity to seek opinions about the wording of the description of essential medicines. It was noted that the current phrasing states that essential medicines are selected, “with due regard to disease prevalence, evidence on efficacy and safety, and comparative cost-effectiveness. However, several participants felt that the term “disease prevalence” did not cover the use of preventive medicines and items for family planning and therefore suggested that the aspect of prevention be added to the “selection criteria” part of the description.

The Committee endorsed the suggestion made during the open session regarding the wording of the description of essential medicines and thus recommended the replacement of “disease prevalence” by “public health relevance” in the section on selection criteria, and the addition of “with adequate information” to the section on purpose and “implementation of” to the last sentence. With these amendments, the full description would read as follows:

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.

 

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