The 20th Century witnessed revolutionary progress in improving human health, leading to dramatic declines in mortality and equally dramatic increases in life expectancy. Income growth, higher educational levels, improved sanitation conditions and better food intake all contributed to this progress. Development of drugs, particularly essential drugs, also played a significant role.1.2.
“Essential drugs are those that satisfy the health care needs of the majority of the population; they should therefore be available at all times, in adequate amounts and in the appropriate dosage forms.”
The Use of Essential Drugs. 6th Report of the Expert Committee. WHO Technical Report Series 850.3
The essential drugs concept (Box 1) was introduced to accelerate the positive impacts of drugs on health status, particularly for developing countries. The impacts of essential drugs fall into three categories, outlined below.
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Box 1. The essential drugs concept
First introduced in 1975, the essential drugs concept is now widely accepted as a highly pragmatic approach to providing the best of modern, evidenced-based and cost-effective health care. It is as valid today as it was 25 years ago when first introduced. The essential drugs concept does not exclude all other drugs, but rather focuses therapeutic decisions, professional training, public information, and financial resources on those drugs that represent the best balance of quality, safety, efficacy and cost for a given health setting.
The essential drugs concept is also a global concept. Health systems of all types, from basic health systems in the poorest countries to highly developed national health insurance schemes in the wealthiest have recognized its therapeutic and economic benefits. Moreover, the concept is forward-looking. It promotes the need to regularly update drug selections in light of new therapeutic options and changing therapeutic needs, the need to ensure drug quality, and the need for continued development of better drugs, drugs for emerging diseases and drugs for coping with changing resistance patterns.
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Health impact
Essential drugs save lives and reduce suffering, especially for impoverished populations:
Potentially, every individual can live a long and substantially healthy life. Effective drug treatment exists for most of the leading infectious diseases, including acute respiratory infections, HIV/AIDS, malaria, diarrhoeal diseases, tuberculosis and the complications of measles. Life-saving drugs have also been developed for the leading noncommunicable diseases, including ischaemic heart disease and cerebrovascular disease. Increasing access to essential drugs would therefore contribute significantly to reducing poverty which does so much to delay development.
Conversely, substandard and counterfeit drugs can kill: Although high drug regulation and quality standards exist, less than one in three developing countries benefit from effective drug regulation. Government cutbacks have undermined the ability of existing authorities to safeguard public health, while increasing global trade in drugs has brought global quality assurance challenges.
Health system impact
Essential drugs increase the credibility of a health system and promote patient participation: Confidence in health care facilities depends on their having the resources to provide health care when needed. The availability of essential drugs encourages patients to attend health care facilities where they can also benefit from preventive services and public health messages. Conversely, if essential drugs are known to be out of stock, attendance levels fall.
Effective and transparent drug procurement increases the confidence of governments, ministries of finance and donors in a country’s health system: If drugs are procured efficiently and cost-effectively, governments and others are more likely to make financial and other resources available for health system development.
Economic impact
Medicines represent the second largest government public health expenditure: For most ministries of health in developing and transitional economies, public spending on pharmaceuticals represents the largest health expenditure after staff salaries. Indeed, in some countries, drug expenditure - as a percentage of public health care spending - can be as high as 40%. 4 By focusing on essential drugs, rational drug selection, good procurement practices, reliable quality assurance and efficient distribution systems, best health care value for public pharmaceutical expenditure can be assured.
In low-and middle-income countries, medicines represent the largest out-of-pocket household health expenditure: Focusing on essential drugs can also increase the impact of “out-of-pocket” pharmaceutical expenditure. In high-income countries, two-thirds of medicines are prepaid through government revenues and social health insurance programmes. In other words the cost of medicines is not borne by the patient. But in developing countries, 50 to 90% of medicines are paid for out-of-pocket at the time of illness. Indeed, in poorer countries, payments for medicines represent the largest out-of-pocket household health expenditure. 5 But at least if this money is spent on effective medicines that represent best value for money, its health impact is maximized.
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