ESSENTIAL MEDICINES (DRUGS) CONCEPT
The WHO has defined Essential Medicines (drugs) as “those that satisfy the priority healthcare needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost effectiveness. Essential medicines are intended to be available within the context of functioning
health systems at all times and in adequate amounts, in appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford.
It has been realized that only a handful of medicines out of the multitude available can meet the health care needs of majority of the people in any country, and that many well tested and cheaper medicines are equally (or more) efficacious and safe as their newer more expensive congeners. For optimum utilization of resources, governments (especially in developing countries) should concentrate on these medicines by identifying them as Essential medicines. The WHO has laid down criteria to guide selection of an essential medicine.
- Adequate data on its efficacy and safety should be available from clinical studies.
- It should be available in a form in which quality, including bioavailability, and stability on storage can be assured.
- Its choice should depend upon pattern of prevalent diseases; availability of facilities and trained personnel; financial resources; genetic, demographic and environmental factors.
- In case of two or more similar medicines, choice should be made on the basis of their relative efficacy, safety, quality, price and availability. Cost-benefit ratio should be a major consideration.
- Choice may also be influenced by comparative pharmacokinetic properties and local facilities for manufacture and storage.
- Most essential medicines should be single compounds. Fixed ratio combination products should be included only when dosage of each ingradient meets the requirements of a defined population group, and when the combination has a proven advantage in therapeutic effect, safety, adherence or in decreasing the emergence of drug resistance
- Selection of essential medicines should be a continuous process which should take into account the changing priorities for public health action, epidemiological conditions as well as availability of better medicines / formulations and progress in pharmacological knowledge.
- Recently, it has been emphasized to select essential medicines based on rationally developed treatment guidelines.
To guide the member countries, the WHO brought out its first Model List of Essential Drugs along with their dosage forms and strengths in 1977 which could be adopted after suitable modifications according to local needs. This has been revised from time to time and the current is the 19th list (2019). Nepal produced its National Essential Drugs List in 1986 and has revised it in fifth time 2016 with the title “National List of Essential Medicines”. This includes 359 medicines which are considered to be adequate to meet the priority healthcare needs of the general population of the country. An alphabetical compilation of the WHO as well as National essential medicines.
Adoption of the essential medicines list for procurement and supply of medicines, especially in the public sector healthcare system, has resulted in improved availability of medicines, cost saving and more rational use of drugs.
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