The New Straits Times, August 29, 1997
Q: I would like to know what is meant by "essential drugs"?
A: Essential drugs relate to an international concept proposed by the World Health Organisation in 1977.
This year celebrates the 20th anniversary of the Essential Drugs Concept (EDC). Under the concept, essential drugs are defined as a limited number of drugs that should be available at any times to the majority of the population in appropriate dosage forms and at affordable prices. In other words, it meets the criteria generally abbreviated as SANE, that is safety, availability, need, and efficacy.
Because of this, the EDC is important in ensuring that the vast majority of the population is accessible to drugs of high quality, safety and efficacy relevant to their health care needs, and at reasonable cost.
In a nutshell, it eliminates the proliferation of "useless" and "wasteful" drugs of dubious claims and standards. Only drugs proven and well-studied are given preference for inclusion in the list, ensuring further protection for the public.
In support of this concept, the WHO issued a model drug list that provided examples of essential drugs. The list is drawn up by a group of experts based on clinical and scientific merits, and provides an economical basis of drug use. This list is regularly revised and, since 1997, eight editions have been published. This ensures that the need for essential drugs is always kept up-to-date with additions and deletions. Despite such rigorous revision, the number of drugs in the list remains at about 300, although the initial list comprised less. Most of the drugs are no longer protected by patents and can therefore be produced in quantity at a lower cost without comprising standards.
This is indeed important for countries like Malaysia not only because health care costs are rapidly escalating, but also because the country is still very dependent on imports of strategic commodities like drugs. The EDC will enable Malaysia to focus on becoming self-reliant where generic equivalents of essential drugs can be manufactured and popularised to meet the health needs of the majority of the people.
The limited number of drugs regarded as essential on the list offers a useful guide for practitioners as well as consumers. It underscores the general principle that a majority of diseases can be treated by similar drugs regardless of national boundaries and geographical locations.
Moreover, certain self-limiting diseases may not need "drug treatment" as such. For example, in the case of diarrhoea, certain so-called potent anti-diarrhoeal drugs (including antibiotics) are not generally recommended. The more preferred treatment is oral rehydration salt that could easily be obtained or prepared at a fraction of the cost while giving the most optimum outcome.
As such, many countries have drawn up their own essential drug list based on the WHO model but tailored to their needs. This is an important point to emphasise because each country can tailor-make its own list based on the type of disease pattern and other health considerations. According to WHO, more than 60 countries have operationalised essential drug programmes, with about 30 more, including Malaysisa, in the process of drafting such schemes.
This not surprising because underlying the EDC is the principle of equity that cannot be overemphasised. Towards this end, WHO has come out with a "Charter for Equity in Essential Drugs" which in essence includes:
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Access for all people to necessary medicines;
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Prices which society and the individual can afford;
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Priority for drugs which meet the real health needs of the majority of the population;
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Fair distribution between cities and rural area;
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Assurance that drugs are safe, effective and of good quality;
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Adequate training of prescribers;
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Access to objective information;
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Real dialogue between patient and prescriber;
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Empowerment of consumers through education and information;
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Community involvement and participation
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Development of drugs the meet health needs in the Third World and not only those of the rich countries;
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Responsible manufacture and export;
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Ethical promotion and marketing; and
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A stop to "donations" of hazardous and ineffective products.
Thus the EDC, and the charter in particular, seem relevant to Malaysia in view of the trend towards privatisation of the health care system where "equity" is fast becoming an issue of great concern, especially to the poor and needy.
