This special edition of the Essential Drugs Monitor celebrates twenty-five years of the essential medicines concept. The historic first meeting of the WHO Expert Committee on the Selection of Essential Drugs took place in Geneva from the 17-21st October 1977. Today, more than 150 countries have adopted the concept and developed their own national lists of essential medicines.
This issue includes a keynote address given by the Director-General of WHO, Gro Harlem Brundtland, at the 25th anniversary celebrations in Geneva, affirming the Organization’s commitment to the essential medicines concept. Stressing the concept’s relevance for all countries, developed and developing, she spoke of WHO’s two critical functions for essential medicines - global normative guidance and technical support for Member States. Promoting equity and sustainability would be the focus of medicines work. Dr Brundtland went on to emphasise the Organization’s need to remain evidence-based and totally independent from commercial interests and from individual donor decisions. (See p 12 for the full speech). Margaretha Helling-Borda, who attended the first Expert Committee meeting (and later became Director of the EDM programme), shares some of her memories of that important occasion in 1977. Both these articles stress the point that selection is only one component of assuring access and ensuring rational use.
Other articles in our special issue focus on some of these different aspects. Francis Burnett from St. Lucia writes of a long-term, successful system in the Caribbean in which a group of small island countries have banded together to pool their drug procurement activities to reduce prices and guarantee a reliable supply. Sri Suryawati describes a community level programme in Indonesia to ensure that mothers understand about the medicines they purchase. This innovative approach has been carefully evaluated and has been shown to be very effective in changing knowledge and behaviour. On the other side of the world, Birna Trap and Ebba Holme Hansen report on a study of dispensing doctors in Zimbabwe, showing that if prescribers dispense medicines themselves there are significant differences in their practices! Articles from India and Latin America focus on drug utilization research in the two regions.
“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 Selection and Use of Essential Medicines. Report of the WHO Expert Committee, 2002, including the 12th Model List of Essential Medicines. WHO Technical Report Series No. 914.
The challenge of addressing AIDS in Africa is described by a team working in Cape Town, South Africa. This is one of the first articles to describe the effect of using antiretroviral medicines in a poor community, with nurses delivering most of the care. Measuring the price of medicines is the subject of another article from South Africa, by Aarti Kishuna. She reports on the use of a new drug pricing survey methodology that will be described in more detail in the next issue of the Monitor. We also feature a 10-country study of drug regulation, and a description of the Global Drug Facility’s work to increase access to TB medicines.
The range and geographical diversity of these articles reflect that what started at a meeting in 1977 to select an essential drugs list has blossomed into a global movement to ensure access to well selected medicines to treat common diseases in the most rational way. We can only hope that the next 25 years sees such progress continued.