By Dzulkifli Abdul Razak
TWENTY-FIVE years ago in 1977, the World Health Organisation (WHO) took a bold initiative by introducing a Model List of Essential Drugs.
The list consists of 208 active ingredients in support of WHO’s mission in essential drugs and medicines policy.
The aim is to save lives and improve health by bridging the gap between the potential that essential drugs have to offer and the reality that for millions of people particularly the poor, medicines are unavailable, unaffordable, unsafe or improperly used.
Accordingly, WHO works to fulfil its mission in essential drugs and medicines’ policy by providing global guidance on essential drugs and medicine. It also works with countries to implement national drug policies to ensure equity of access to essential drugs, drug quality and safety, and rational use of drugs.
As a result by 1999, 156 countries had official essential drug lists. This is more than double the number in 1992, where about 60 countries worldwide have initiated essential drug programmes.
Such an increase indicates the growing acceptance of the idea of such a list, including in many developed countries.
Apart from national governments, many international organisations such as Unicef and UNHCR as well as NGOs and international non-profit supply agencies, have adopted similar list and concept for their drug supply system. Malaysia adopted its own list in 1996.
What is an essential drug list and why is it important?
Simply put, essential drugs and medicines are those that satisfy the priority healthcare needs of the population. They are selected with due regard to public health and evidence on efficacy and safety.
In fact, a committee of experts was appointed by WHO to determine how many drugs were regarded as “essential”, especially in ensuring a reasonable level of healthcare for as many people as possible.
Each country is expected to draw its own list based on similar criteria.
As specified by WHO, essential drugs are intended to be available with the context of functioning health systems at all times in adequate amounts, in appropriate dosage forms, with assured quality and adequate information, and at a price the individual and community can afford.
Since no health system can afford to supply or reimburse all medicines that are available in the market, the use of an essential drug list offers practical solutions to ensure a fair, efficient and effective drug delivery system.
What makes essential drug list more relevant is the inter-related use of national guidelines for clinical healthcare practice.
Numerous studies have documented the impact of clinical guidelines and lists of essential drugs on the availability and proper use of medicines in healthcare systems.
The emergence of new epidermics such as HIV/AIDS, widespread increase in infectious diseases such as malaria and tuberculosis have made the concept of essential drugs more relevant than ever before.
This is compounded by the emergence of anti-microbial resistance and an increase of chronic diseases in many parts of the globe recently.
WHO noted that total drug expenditure was rising by 10 to 18 per cent per year, much faster than the Consumer Price Index or the annual growth in GNP.
Malaysia, thought economically quite well off, however is no different. The rise in healthcare cost has caused a lot of concern.
The question is how has Malaysians benefited from its own essential drug list? Since its implementation more than five years ago, little was heard about it.
Based on the firm political and social will shown then, many are expecting a significant improvement in the drug use process in the country in both the public and private sector.
For example, how successful has it been in promoting access and empowerment of the consumers in ensuring rational and ethical use of affordable medicine?
So as we celebrate the 25th anniversary of the WHO Model List of Essential Drugs, which is now in its 12th edition, it is time to review our commitment to fully implement our own National List.
To quote the WHO director-general Dr. Gro Harlem Bruntland, “A country’s health service cannot respond to people’s needs unless it enables people to access essential drugs of assured quality.
“Indeed, this access represents a very important measure of the quality of the health service. It is one of the key indicators of equity and social justice.”
More recently she was quoted as saying: “Health is in itself opportunity-for each individual and the community we live in. In a world torn by economic, ethnic, religious and cultural divisions, health remains as one of the few truly universal values”.
Therein lies the added value of an essential drug list and the concept that supports it. Our efforts and commitment to see that is fully realised must be thorough and unrelenting.
Recommended site: www.who.int/medicines
