The selection of essential drugs is one of the core principles of a national drug policy because it helps to set priorities for all aspects of the pharmaceutical system.
WHO has defined essential drugs as “those that satisfy the needs of the majority of the population and therefore should be available at all times, in adequate amounts in appropriate dosage forms and at a price the individual and the community can afford”. 15 This is a global concept that can be applied in any country, in the private and public sectors and at different levels of the health care system.
Essential drugs concept
The concept of essential drugs is that a limited number of carefully selected drugs based on agreed clinical guidelines leads to more rational prescribing, to a better supply of drugs and to lower costs. The reasons are obvious:
• Essential drugs which are selected on the basis of safe and cost-effective clinical guidelines lead to more rational prescribing,16 and therefore to higher quality of care and better value for money;
• Training of health workers and drug information in general can be more focused;
• Prescribers gain more experience with fewer drugs, and recognize drug interactions and adverse reactions more easily;
• Quality assurance, procurement, storage, distribution and dispensing are all easier with a reduced number of drugs;
• The procurement of fewer items in larger quantities results in more price competition and economies of scale.
All of this is even more important in resource-poor situations where the availability of drugs in the public sector is often erratic. Under such circumstances measures to ensure a regular supply of essential drugs will result in real health gains and in increased confidence in health services.
Practical implications of the essential drugs concept
National essential drugs lists and national drug formularies, together with clinical guidelines, should serve as the basis of formal education and in-service training of health professionals, and of public education about drug use. They should also serve as the main basis for public sector drug procurement and distribution, as well as for drug donations.
Insurance schemes often use a limited list of drugs, the costs of which they will reimburse. This is one of the most common applications of the principle of selection in developed countries. In developing countries health insurance is less widespread, but coverage is growing and schemes are generally based on reimbursement for essential drugs. In view of the rapidly rising cost of drugs in most countries it can safely be stated that any health insurance scheme would need a process of drug selection one way or another.
Essential drugs lists and teaching about the benefits of drug selection could also be used to influence practice in the private sector, for example through the basic training of medical students, and programmes of continuing medical education with universities and professional associations.