No public sector or health insurance system can afford to supply or reimburse all medicines that are available on the market. The selection of essential medicines helps setting priorities for all aspects of the pharmaceutical system. When linked to national clinical guidelines, it is a crucial step in ensuring access to essential medicines and in promoting rational use of medicines. Key policy issues are:

• adoption of the essential medicines concept to identify priorities for government involvement in the pharmaceutical sector;

• selection of essential medicines in a two-step process: (1) market approval; (2) selection of essential medicines relevant to the national morbidity pattern;

• defining the selection criteria (i.e. sound and adequate evidence, cost-effectiveness, etc.);

• defining the selection process (i.e. appointment of a standing committee, etc.);

• ensuring a selection mechanism for traditional and herbal medicines.