WHO technical briefing session- Essential medicines
and health policies 2016. WHO headquarters, Geneva, Switzerland. 17th
Oct to 22nd 2016.
Dr Dilip Chandrasekhar.
Professor and Head
Dept of Pharmacy Practice/Clinical Pharmacy
(
Kims Alshifa pvt Ltd)
Alshifa college of Pharmacy,
Perinthalmanna
Email- dillu7@gmail.com
Essential
medicines are still essential.(World Health Organization)
Essential medical product (EMP) is the largest
department of WHO with 160 staff and the primary objective of Technical briefing session (TBS )was to
discuss the topics related to essential medicines and health products-
universal health coverages as well as to discuss the challenges faced by member
states to improve the access to medicines and quality. The first Essential medicine list (EML) was released in
1977 with + 200 active substances. The WHO expert committee on the
selection of essential drugs met in
Geneva from 17th to 21 October 1977. The meeting was opened on
behalf of the director general and very recently the 19th EML has been released
by WHO in the year 2015 with 409 medicines included in the list. The list is
revised every two years by WHO expert committee.
The model list
was revised in april-2003 with 315
active substance and in 2007, separate list for children up to 12 years was
included and the latest 19th edition for adults and 5th
edition for children were released in 2015 with 294 medicines , 586 pages with
1082 references. There are around 156 countries with Essential drug list(EDL). As
per WHO definition, essential medicines are those that satisfy the priority
health care needs of the population and the medicines are selected with due
regard to prevalence of disease ,evidence on efficacy and safety and
comparative cost effectiveness.
Essential medicine concept in India
The first national list of essential medicines
of India was prepared and released way back in 1996 and then subsequently the
list was revised in 2003 followed by release of revised list in 2011 with 348
drugs. 43 medicines was added to the new list and 47 medicines got deleted from
the previous list.
Concept of EML
is relatively new to India and Tamilnadu is the first state to develop the
essential medicine list in 1994, followed by Govt of Delhi. Many individual
states in India have their own essential medicines list and the current
national list was compiled during 2003. The list is not regularly updated
except for Tamilnadu. As the list needs to be developed locally and entirely
based on the evidences, and not merely
on individuals experiences, it is a prerequisite to develop clinical guidelines called standard
treatment guidelines.(STG) Based on standard the list is compiled. Delhi took
the lead in developing a comprehensive drug policy in 1994 and was the only
Indian state to have such a comprehensive Policy. The policies main objective
is to improve the availability and accessibility of quality essential drugs for
all those in need . Now many state governments too have developed STG for use
with in the state government health facilities.
The list of essential
medicines guides the hospital drug policies, procurement and supply of
medicines in public sector. Medicine
reimbursement and medicine donations
thus helps in monitoring the pricing of medicines. The essential list
serves as reference document for correct dosage form and strength for
prescribing. The
Essential Medicines List aims to identify cost-effective medicines for priority
conditions, together with the reasons for their inclusion, linked to
evidence-based clinical guidelines and with special emphasis on public health
aspects and considerations of value of money. Hence
the use of National List of Essential
Medicines(NLEM) is expected to improve the
prescribing practices as well as the health outcomes. Careful selection
of limited range of essential medicines results in higher quality of care,
better management of medicines and more
cost effective use of health resources.
There are seven
steps to get a new medicine on WHO model
list of essential drugs:
1. Identification of public health need for
a medicine
2.
Development of the medicine( Phase-1, Phase11, phase 111 trials)
3. Regulatory approval in a number of countries( Effective and safe
medicine on the market)
4 More experience under
different filed circumstances. Post
marketing surveillance
5 Price indication for public sector
use
6. Review by WHO disease programme, define
comparative effectiveness- safety in real life situations,
comparative cost effectiveness and public health
relevance
7. Submission to WHO expert committee on essential drugs(
Medicine included in WHO model list.)
Conclusion
Essential
medicines are those that satisfy the priority health care 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 in adequate amounts, in the
appropriate
dosage
forms, with assured quality and adequate information, and at a price the
individual and
the
community can afford.
The essential medicine concept is
relevant to other health programs as well and results not only in better use of
resources but also in better practice of medicine. It addresses several other
issues such as good therapeutics and reduced side-effects of medicines, and
saves money for individuals, hospitals, health care providers, and the country.
Professional development programs need to be
developed and extended among all medical practioners to re equip them, being in
the stream line as highly skilled professionals. These programme should be
backed up by sources including
independent publications or drug information centers for drug-related
information, but not from the medical representatives or pharmaceutical industries,
which are often susceptible to issues of conflict of interests. The hospital
formulary is a relevant source of information to promote rational use of
medicines. The selection of essential medicines is only one step towards the
improvement of the quality of health care; and this selection needs to be
followed by appropriate use of these drugs too. Each individual should receive
the precise drug, in an adequate dose for an adequate duration, with
appropriate information and follow-up treatment, and at an affordable cost.
Thus the essential medicines should be the first choice during medical
practice.
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