Transcript WHO Model List of Essential Drugs/Programme

WHO Model List of Essential Drugs/Programme –
start and evolution
Global Perspective and Reflections
Margaretha Helling Borda
21 October 2002, Cambodia
M. Helling Borda October 2002 - 25 years
anniversary
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Overview of the presentation
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Introduction and background
History and major events up to 1977
After first EDL-what? (78-82)
Action and evolution (83-88)
Increased country impl.of EDC and NDP (89-96)
Expansion-new challenges (96-present)
Achievements today
Conclusion
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Birth of Essential Drugs Concept (EDC)
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Complaints in the early seventies:
No links between drugs and health needs
No access to most essential drugs
Rising costs of pharmaceuticals
Uneven rural-urban distribution
Protests against industry marketing practice
No comprehensive NDP to support PHC etc.
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Against this background birth of EDC
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Early years up to first WHO model EDL
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1975 –1976:
WHO era of essential drugs with WHA res. 28.66
Informal WHO consultation on selection 1976
Comments from countries and elsewhere stressing:
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Any final list should be a local responsibility
Importance and need for well-established criiteria to guide
in selection
Education of physicians and public through information
system must accompany any essential drugs list
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1977 – WHO first model EDL
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Comments from 1976 working paper and three
other major working papers was background for the
WHO first Expert Committee on Selection of
Essential Drugs
WHO Expert Committee on the Selection of
Essential Drugs held 17 –21 October 1977
A little blue booklet of about 35 pages –TRS 615
became an instant WHO bestseller
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The WHO first Expert Commite report TRS
615, the Selection of Essential Drugs
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a model list of around 250 main and complementary
drugs with criteria and guidelines for establishing
the list
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WHO had produced a vital tool for public health
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According to Médecins sans Frontières (2000)
« The first list was a major breakthrough in the
history of medicine, pharmacy and public health ».
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Not all « smooth sailing » in 1977 and after
but…
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Some complaints and objections
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But…
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TRS 615 started an evolution - became a central
tool in the aim and process to assure regular
access to essential drugs
the text in the first expert committee report has
stood its test of time
Still is very much quoted and was used as basis for
implementation of the essential drugs concept
worldwide
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After publication of first EDL – what?
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1978-82
EDL became the technical tool and HFA/Primary
Health Care the policy context
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Finding a way in a constrained, complex and
confrontational atmosphere
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Provision of essential drugs one of the 8 key elements in
the aims to attain Health For All by the year 2000
Funds and human resources constraints
Searching for strategies
Lobbying for/against aWHO marketing code for pharm.
On the way to action –EDL must be part of NDP
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Action and consolidation period
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1983 –1988: Milestones:
1983: New DAP head -direct reporting to DG
1984: WHA calls for meeting on RUD
1985: Nairobi Conference of Experts on RUD
1986: WHA adopts WHO Revised Drug Strategy
1988: WHO publishes: Ethical Criteria for Medicinal
Drug Promotion; Estimating Drug Requirements;
World Drug situation; Guidelines for Developing
National Drug Policies; and fifth WHO Model EDL
« The Use of Essential Drugs « (title changed in
third report 1982 to stress use)
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Reflections on a very exciting action period
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Countries started implementing ED programmes and NDPs
Close country and WHO collaboration– funds started coming
« Spirited marketing of the concept of essential drugs »:
national and global advocacy
Nairobi conference – a mile stone for general acceptance of
the EDC
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Sharing of responsibilities outlined
Conference set the tone for years to come and reinforced WHO
mandate as lead agency on pharmaceutical matters
Many lessons learnt from operationalizing the EDC concept
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Increased country implementation of EDC
and NDP: 1989 -1996
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EDC more widely known, accepted and implemented in
developing countreis
Break up USSR created alarming shortage of essential
medicines: adoption of EDL and NDP in the newly
independant states (NIS)
WHO produced more « how to » methodologies and
gudelines: e.g. NDP indicators; how to investigate drug use,
good prescribing and teaching guides, regulatory and QA
guides, donation guidelines etc., – all reported in the
EDMonitor
First NDP Expert Commitee in 1995 to update 1988 guidelins
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Expansion – new complex issues: 1996 –
present
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Catastrophic increases in HIV/AIDS, Malaria, TB
New expensive essential drugs – but advocacy,
corporate responsiveness and competition have
reduced antiretroviral prices 95% in 3 years
New partnerships
Much expanded mandates for WHO and
department of Essential Drugs and Medicines
Policy (EDM)
Comprehensive WHO/EDM documentation on
websites and in publications (NDP, EDL, TRIP,
Prices, QA, pharmaco-economics, WHO Formulary)
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Summary of Achievements in 25 years
Use of the WHO Model List of Essential Drugs
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156 countries have a national list of essential drugs,
of which 81% have been updated in the last 5 years and one
third within two years
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Major international agencies (UNICEF, UNHCR,
IDA) base their catalogue on the WHO Model List
Sub-sets: UN list of recommended essential drugs for
emergency relief (85 drugs); interagency New Emergency
Health Kit (55 drugs for 10,000 consultations)
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Normative tools: WHO Model Formulary, International
Pharmacopoea, Basic Quality Tests, and development of
reference standards follow the WHO Model List
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Source: WHO Department Essential Drugs and Medicines Policy 2002
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Achievements: Number of countries with a
National Drug Policies1985 - 1999
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In 1999 one hundred and one (101) countries had a
National Drug Policy
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Among these about half (54) were low-income countries,
43 were middle – income countries and 4 were highincome countries
In 1995 there were fourty seven (47) countries with
a NDP
In 1990 ten (10) countries had a NDP
In 1985 only five (five) countries had adopted a
national drug policy
Source: WHO Department Essential Drugsand Medicines Policy 2002
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Achievements: Number of people with
access to essential drugs: 1977 -1997
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In 20 years from 1977 to 1997, when world pop. went from
around 4 to close to 6 billion people regular access to
essential drugs nearly doubled; from around two to just
under four billion people
In spite of this, as much as one-third of the world’s six
billion people in 1997 lacked access and still lacks regular
access
Worst situation in Africa where 320 million people have less
than 50% access to essential medicines
Financing, delivery and other constraints limit access to
essential drugs and these problems worsen with economic
pressures and poverty
Source: WHO Department Essential Drugs and Medicines Policy 2002
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Conclusion
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The content in TRS 615 of 1977 with the model
essential drug list triggered of an evolution- a
revolution- to increase access to essential drugs
The WHO Model list of Essential Medicines remains
a powerful public health tool
Drug selection is a start – a core element in a
succesful EDP and NDP implementation
The concept of essential medicines has global
relevance for today’s challenges
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Today – 25 th Anniversary of the first
WHO Model list Essential Drug List-
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Is a Tribute to the achievements of
all countries with EDL, NDP and
improvements in access to
essential medicines
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Thank you
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