Intended for healthcare professionals

Education And Debate

The concept of essential medicines: lessons for rich countries

BMJ 2004; 329 doi: (Published 11 November 2004) Cite this as: BMJ 2004;329:1169
  1. Hans V Hogerzeil, director ad interim1 (
  1. 1 Drugs and Medicines Policy, World Health Organization, Geneva, Switzerland

    Rich countries should follow the lead of poor countries and adopt a more systematic way of controlling the cost of drugs


    Industrialised countries, faced with increasing demands for quality health care by ageing populations and ever increasing costs of medicines, can learn from low income countries how to respond to pharmaceutical policy issues in a comprehensive way.

    Since the 1970s many developing countries have started national programmes for essential drugs to promote the availability, accessibility, affordability, quality, and rational use of medicines. The cornerstones of such programmes are the careful selection of essential medicines for public supply and reimbursement, based on a systematic review of comparative efficacy, safety, and value for money; evidence based national clinical guidelines as the basis for training and rational prescribing; and a national medicines policy to balance conflicting policy objectives and to express government commitment to a common goal. Industrialised countries would do well to consider and adopt these approaches, which have been so beneficial to developing countries.

    The concept of essential medicines

    The concept of essential medicines was launched in 1977 with the publication of the first World Health Organization's Model List of Essential Medicines. Since then the list has been revised every two years. Both its content and the process by which it is updated are intended as a model for developing countries. Twenty five years later the original concept is seen as a breakthrough in international public health.w1 By the turn of the century, 156 mostly developing countries have a national list of essential medicines, two thirds of which have been updated in the past five years. Lists of essential medicines are also used by Unicef, the United Nations high commissioner for refugees, and many non-governmental organisations.

    Selection is a two step process

    Within a country, the selection of essential medicines is a two step process. Regulatory approval is usually based …

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