(2004; 98 pages)
Essential medicines are one of the vital tools needed to improve and maintain health. However, for too many people throughout the world medicines are still unaffordable, unavailable, unsafe and improperly used. An estimated one-third of the world’s population lack regular access to essential drugs, with this figure rising to over 50% in the poorest parts of Africa and Asia. When available, the medicines are often used incorrectly: around 50% of all medicines are prescribed, dispensed or sold inappropriately, while 50% of patients fail to take their medicines appropriately (WHO 2002).
Since the beginning of the 1980s the essential drugs concept has become one of the cornerstones of international and national health policy - influencing decision-making in not only developing but also industrialized countries. The selection and rational use of medicines are accepted as key principles of health service quality and management in both the public and private sectors. WHO has vigorously promoted the essential drugs concept and the rational use of drugs - at first through the Action Programme on Essential Drugs, which became a powerful advocate for the new policies. National drug policies were promoted by WHO and others as a guide to action and a key framework within which to coordinate the various policy components needed to guarantee access to and rational use of medicines.
For essential medicines to contribute to improved health, countries need to develop national medicines policies, ensure access to these essential drugs, strengthen drug regulation, and improve rational use of drugs in both the public and private sectors, and by both health professionals and consumers. Although much progress has been made in all these areas, health policy-makers have tended to focus more on the provision and regulation of medicines, and on efforts to improve health workers’ prescribing, than on efforts to ensure rational use of drugs by consumers. What is rational use? WHO’s definition is, “Patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community” (WHO 1985).
Rational drug use interventions that focus on health worker prescribing can only partly improve the use of drugs. This is because, as studies on medicines use by consumers have shown, self-medication is the most common form of therapy choice and people often rely on informal drug distribution channels as much as on pharmacies. To address the problem of irrational use of medicines, health planners and administrators need specific information on:
• the types of irrational use that occur in their country or district, so that strategies can be targeted towards changing specific problems
• the amount of irrational use, so that the size of the problem is known and the impact of the strategies can be monitored
• the reasons why medicines are used irrationally, so that appropriate, effective and feasible strategies can be chosen. People often have very rational reasons for using medicines “irrationally”.