How essential is an essential drugs policy?

Dr Hiroshi Nakajima
Director-General, World Health Organization

The rational use of medicinal drugs is critical to the most important primary and preventive health care measures. At the same time, unless there is a regular supply of safe and effective drugs, public trust-and interest-in primary health care will rapidly deteriorate.

Yet half the world's population lacks regular access to the most-needed medicines. Over the past decade, progress has been particularly difficult in the developing world because of adverse economic conditions and at the same ineffective legislation and regulations poorly coordinated drug policies and strategies, inefficient procurement, uneven distribution, unaffordable prices and inappropriate drug use. Although some 75% of the world's population live in those countries, they consume less than 20% of the total pharmaceutical market, valued at US$170 000 million. The more developed a country is, the more drugs it consumes.

Of course the need for drugs in poor countries is just as great as, if not greater than, the need in the richer countries. The only difference is that the developing world lacks the finances to pay for the medicines it needs.

Just over a decade ago, WHO-through its Action Programme on Essential Drugs - began to provide technical and financial support to developing countries seeking to improve the availabilty and rational use of drugs. In addition to its operational work, the Action Programmes has played a major advocacy role in promoting the essential drugs concept as a tool to make the most of scarce resources, to improve health care, and to contribute to greater social equity. At present 64 developing countries have operational essential drugs programmes, and another 28 are in the process of drawing up national programmes. Many other development and relief agencies now also apply the essential drugs concept to their health activities.

An increasing number of countries are setting up comprehensive national drug policies, with clearly defined objectives, which draw together the different components in the chain of drug supply and use. Such policies will typically include: legislation to ensure drug safety and quality and to regulate marketing and dispensing; centralized procurement on the basis of a national esential drugs list; the provision of non-commercial drug information; and strategies to improve the education of both prescribes and the public in rational drug use.

But despite significant progress in many parts of the world, the need remains for stricter and enforceable legislative control, greater coverage of the population, lower prices, improved quality and better use of drugs. Unfortunately, widespread social and economic deterioration in the developing countries stands in the way of effective, efficient and sustainable programmes. The public domain has been especially hard hit, seriously jeopardizing the goal of universal access to essential drugs.

If these difficulties, the drug situation also can only deteriorate. In such circumstances, the essential drugs concept, with its focus on equity and meeting real health needs, becomes even more convincing. National drug policies and essential drugs programmes are now, and in the foreseeable future, the best means we have available of pursuing and eventually attaining the dual objectives of rational management of drug resources and better health for all.

Source: World Health, Mar-Apr 1992, p.3

Charter for equity in essential drugs
  • access for all people to necessary medicines
  • prices which society and the individual can afford
  • priority for drugs which meet the real health needs of the majority of the population
  • fair distribution between cities and rural areas
  • assurance that drugs are safe, effective and of good quality
  • adequate training of all prescribers
  • access to objective information
  • real dialogue between patient and prescriber
  • empowerment of consumers through education and information
  • community involvement and participation
  • development of drugs that meet health needs in the third world and not only those of rich countries
  • responsible manufacture and export
  • ethical promotion and marketing
  • a stop to "donations" of hazardous or ineffective products

Source: Action Programme for Essential Drugs, Geneva: WHO