This paper reviews the major health and pharmaceutical developments in developing countries for the past 25 years and suggest what may occur over the next 25 years. Major health, social, economic and development changes have occurred during this period. The Alma Ata declaration was pronounced in 1978 suggesting an approach to health and health services. An integral part of this approach was the essential drugs concept which has had a global impact. The International Dispensary Association (IDA) has been a major influence in this development. Before considering pharmaceutical issues it is necessary to consider the underlying health and development situation of countries where essential drugs are of critical importance...