Essential medicines save lives and improve health when they are available, affordable, of assured quality and properly used. Still, lack of access to essential medicines remains one of the most serious global public health problems. Although considerable progress in terms of access to essential medicines has been made in the last twenty-five years since the introduction of the essential medicines concept (Figure 1) not all people have benefited equally from improvements in the provision of health care services, nor from low cost, effective treatments with essential medicines. Through a combination of public and private health systems, nearly two-thirds of the world’s population are estimated to have access to full and effective treatments with the medicines they need, leaving one-thirds without regular access. It is estimated that by improving access to existing essential medicines and vaccines, about 10 million lives per year could be saved.
Figure 1. The total number of people with access to essential medicines has increased from around 2.1 billion in 1977 to an estimated 3.8 billion in 1997
Essential medicines are only one element in the continuum of health care provision but they are a vital element. The major access challenges which can be obstacles for health improvement are:
• Inequitable access - about 30% of the world’s population lacks regular access to essential medicines; in the poorest parts of Africa and Asia this figure rises to over 50%.
• Health reforms - in many low- and middle-income countries, health sector reforms have led to insufficient public funding for health.
• Medicine financing - in many high-income countries, over 70% of pharmaceuticals are publicly funded whereas in low- and middle-income countries public medicine expenditure does not cover the basic medicine needs of the majority of the population. In these countries 50% to 90% of medicines are paid for by patients themselves.
• Treatment costs - high costs of treatments with new essential medicines for tuberculosis, HIV/AIDS, bacterial infections and malaria will be unaffordable for many low- and middle-income countries.
• Globalization - global trade agreements can threaten access to newer essential medicines in low- and middle-income countries.
Box 1. Definition 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.”
Box 2. Key points for policy makers: Access to medicines is supported by the principles of the essential medicines concept
• Common health problems for the majority of the population can be treated with a small number of carefully selected medicines;
• Individual health professionals routinely use fewer than 50 different medicines; the WHO Model List of Essential Medicines contains about 300 active substances;
• Training and clinical experience should focus on the proper use of these few medicines;
• Procurement, distribution and other supply activities can be carried out most efficiently for a limited number of pharmaceutical products;
• Patients can be better informed about the effective use of medicines by health professionals.
Access to health care and therefore to essential medicines is part of the fulfilment of the fundamental right to health. All countries have to work towards the fulfilment of equitable access to health services and commodities, including essential medicines necessary for the prevention and treatment of prevalent diseases. Appropriate policies and action plans need to be put in place to achieve this aim.