Core functions for essential drugs and medicines policy are summarized in Table 1. They largely parallel those set out for WHO as a whole in the new corporate strategy for the WHO Secretariat. 19 An additional core function - support to countries - is described separately in Chapter 4, and is carried out in parallel with the other core functions.
Table 1 Core functions - how WHO operates in pharmaceuticals
Creation, synthesis and dissemination of knowledge |
Articulating and advocating policy options |
Develop and disseminate needs-driven, ethical, evidence-based and action-oriented policy options to help countries confronted with many difficult decisions in a changing global context manage their pharmaceutical sector and increase its contribution to public health. |
Working in partnership |
Ensure productive, mutually beneficial relationships within WHO, with UNICEF and other UN agencies, the World Bank, nongovernmental organizations, universities, industry, and all other international actors in pharmaceuticals through mechanisms such as the Interagency Pharmaceutical Coordination group and the Director-General’s roundtable process. |
Producing guidelines and practical tools |
Provide policy-makers and essential drugs managers with practical guidelines and tools for implementing the components of a national drug policy and to promote capacity-building, particularly when national pharmaceutical experts are lacking. |
Developing norms and standards |
Develop norms and standards as a foundation for effective regulation, control, manufacture and sale of drugs, and to guide international harmonization of the pharmaceutical trade. |
Stimulating strategic and operational research |
Create new knowledge, through networking and collaboration, to meet present and future challenges relating to pharmaceuticals, and identify innovative and viable approaches to ensure access to, and quality and appropriate use of drugs. |
Developing human resources |
Build country capacity to effectively implement the various components of a national drug policy by developing clear guidelines on the human resources required, ensuring that undergraduate and postgraduate curricula for all health professions incorporate the essential drugs concept, and developing and promoting in-service training and supervision for health staff at all levels. |
Managing information |
Synthesize and disseminate information on pharmaceutical issues, including assessing trends, comparing performance and monitoring the potential impacts on health of global developments, be these economic, social or political. |
Figure 5: Increasing the health impact of pharmaceuticals - WHO international partners in pharmaceuticals and their principal areas of operation
The core functions outlined in Table 1 have always been perceived as part of WHO's mandate. Countries, development agencies, NGOs, health professionals and the public all look to WHO for data and statistics concerning health, expert advice on the widest range of health issues imaginable, and new and innovative approaches to solving long-standing and newly emerging health problems. This is especially true in relation to medicines. No other agency or institution has the equivalent depth, range and length of experience in this field, irrespective of the precise issue in question. Pharmaceutical production, quality and efficacy, recommended treatment or use, drug financing and procurement, and research tools and methods for investigating problems relating to pharmaceuticals, are all areas in which WHO's knowledge is unsurpassed. Advice on developing human resources in pharmaceuticals is equally dependent on such depth of knowledge.
Creation, synthesis and dissemination of knowledge are also key to WHO's role in articulating and advocating policy options. This was well illustrated by WHO's activities in the area of drug donations. Whether a rapid response in an acute emergency or an element of development aid, supply must match demand - otherwise drug donations risk becoming their own disaster. In 1996 WHO issued the Guidelines for Drug Donations. A 1998 survey showed that they had had a very positive impact. Yet examples of bad drug donations continued, including expired drugs, unidentifiable drugs and inappropriate drugs. WHO adopted three approaches to meet the continuing challenge of improving unsatisfactory donation practices. It revised the 1996 guidelines, reissuing them in 1999, in collaboration with 15 international agencies. It asked private and voluntary organizations and pharmaceutical companies to underwrite those guidelines. And it updated the New Emergency Health Kit 98 to take account of changes in the WHO Model List of Essential Drugs, and to bring the kit into line with a new UN list of drugs recommended for use in acute emergencies.
But as the above example clearly shows, the complexity of today's world means that WHO cannot succeed alone. So although it is the UN organization with primary responsibility for health, it can be fully effective only by developing partnerships with other organizations and agencies, based on real needs and existing capacities at country, regional and global levels. WHO's principal partners in pharmaceutical activities are shown in Figure 5. Working with these partners helps WHO not only maintain but also further develop its knowledge base and expertise in all areas of pharmaceuticals.
Various innovative mechanisms have already been established to strengthen such partnerships. They include the Interagency Pharmaceutical Coordination (IPC) group and the Director-General's roundtable process. WHO, UNFPA, UNICEF and the World Bank are all IPC members and the group addresses issues such as global and country-level coordination, improving drug donations and pharmaceutical procurement practices. It has met twice-yearly since 1996 and has a rotating secretariat. Roundtables are also ongoing and working to bring about sustained improvements in public health. So far, roundtables have been held with public-interest NGOs, the research based pharmaceutical industry, the generic drug industry and the self-medication industry. The roundtables have led to new projects and approaches for tackling problems such as increasing access to antimalarials, improving drug quality and fighting unethical drug promotion.
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