“Essential medicines are those that satisfy the priority health care needs for
the population. They are selected with due regard to disease prevalence, 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, in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford. The implementation of the concept of essential medicines is intended to be flexible and adaptable to many different situations; exactly which medicines are regarded as essential remains a national responsibility.” (WHO, 2002)
Essential medicines were originally defined by the World Health Organization (WHO) as those which: “satisfy the needs of the majority of the population and therefore should be available at all times, in adequate amounts, in appropriate dosage forms and at a price the individual and community can afford.”
The idea of defining essential medicines – and establishing a list of them – was developed from a report made to the 1975 World Health Assembly. These efforts were aimed to increase the range and availability of medicines for populations with poor access.
An Expert Committee on the Use of Essential Medicines was established to assist member states to select and procure essential medicines. In 1977, the first report of the Expert Committee included (a) criteria for determining if a medicine fit the definition of an essential medicines and (b) the first model Essential Medicines List (EML) as two examples of how the concept of essential medicines could be implemented. Since then WHO has updated the model EML every two years. In 2007, 30 years after introduction of the essential medicines concept, a model EML for children was also introduced.
Adapting the concept at national level
The model EML is expected to be adapted at national level based on the local public health context of the country. Most countries have published a national EML. Most national lists have been updated in the past five years; this exercise is crucial to reflect new therapeutic options and changing therapeutic needs.
There should be clear links between the national EML, standard treatment guidelines, national expenditure on essential medicines, and procurement practices within the country.
Uganda has a national EML, which was last updated in 2007. However, two thirds of government health centres do not have the EML, according to the 2008 Pharmaceutical Situation Assessment survey (MoH).
The Stop Stock-outs campaign is supported by funds from Open Society Institute
Selection of medicines for the national EML
Within a country, the selection of essential medicines is usually a two-step process. The first involves regulatory approval, which is based on a review of efficacy, safety, and quality of medicines (without comparison between medicines). From these registered products, essential medicines within a therapeutic class are then selected on the basis of comparative efficacy, safety, and cost. To best ensure the widest acceptance of the list, the selection process for essential medicines needs the involvement of a number of stakeholders, including prescribers, dispensers, academia, health facilities, civil society, professional organizations, and others.
Before 2002, relatively expensive medicines were basically not found on the WHO model EML. This was successfully challenged by public health advocates and treatment activists. With the issue abolished, traditionally more expensive medicines (such as antiretrovirals) were quickly included on the WHO model EML and the official definition of essential medicines was updated to: “Essential medicines are those that satisfy the priority health care needs of the population. They are selected with due regard to disease prevalence, 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, in adequate amounts, in the appropriate dosage forms, with assured quality, and at a price the individual and the community can afford. The implementation of the concept of essential medicines is intended to be flexible and adaptable to many different situations; exactly which medicines are regarded as essential remains a national responsibility.”
It is also important to stress that essential medicines represent the most cost effective treatments for a given condition in a country.
Challenges
The Uganda EML has established priorities for selection of, and expenditure on medicines to meet the needs of the population. However, it does not adequately provide for key medicines which might not be needed for the majority of the population, but are crucial for the treatment of certain diseases (such as cancer) and specific age groups (such as the elderly and children).
A renewed commitment to availability of essential medicines in the Uganda Minimum Health Care Package is urgently needed in order to realize the spirit and intention of the second national Health Sector Strategic Plan (HSSP II).
References
World Health Organization. 1 The selection and use of essential medicines. Report of the WHO Expert Committee, 2002 (including the 12th Model List of Essential Medicines). Technical Report Series No 914. Geneva: WHO,
Hans V Hogerzeil 2 The concept of essential medicines: lessons for rich countries
Laing R, Waning B, Gray A, Ford N, van t ‘Hoen E.3 25 years of the WHO essential medicines lists: progress and challenges. Lancet 2003 May 17;361(9370):1723-9
Stolk P,Willemen MJC, Leufkens HGM. 4 “Rare essentials” : drugs for rare diseases. Essential Medicines. Lancet 2003; 361:1723-9. 4.
J Robertson1 and SR Hills. 5 The Essential Medicines List for a Global Patient population
World Health Organization. Backgrounder and Facts for launch of the United Nations report Delivering on the Global Partnerships for Achieving 6 the Millennium Development Goals: WHO
World Health Organization. 7 World medicines situation. 2004. Geneva: WHO
The importance of an EML
An EML serves the following important functions:
to guide the procurement and supply of • medicines in the public sector
to inform reimbursement schemes •
to inform medicine donations •
to define training of health workers •
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