We did comprehensive literature searches using Medline and EMBASE. Emphasis was placed on articles published from 1975-2002 containing information on the implementation, use, effect, and relevance of essential drug lists in developing countries.
Review25 years of the WHO essential medicines lists: progress and challenges
Section snippets
History
The 1975 World Health Assembly5 asked WHO to assist member states in selecting and procuring essential medicines, assuring good quality and reasonable cost (panel 1).2, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 The first list of 205 items (186 medicines) was published 2 years later.2 At the 1978 Alma Ata conference, provision of essential medicines was identified as one of eight key components of primary health care.6 The 1985 Nairobi conference resulted in the development of WHO's
Evolution of the EML
The structure of the WHO model EML has remained largely unchanged since first published; medicines are divided into two categories: core, defined as efficacious, safe, and cost-effective medicines for priority conditions (selected on the basis of current and estimated future public-health relevance and potential for safe and cost-effective treatment); and complementary, defined as “medicines for priority diseases which are efficacious, safe and cost-effective but not necessarily affordable, or
Relevance of the EML to countries
A cross-sectional analysis of 17 national EMLs, shows that 68% contain fewer than 300 medicines (range 108-389), compared with 309 on the WHO EML in 1999 (table 2).
The ratio of dosage forms to medicines ranged from 1 -03 to 1-63.
Some differences between WHO and national lists are expected and justifiable (table 3). Local and regional morbidity patterns will result in certain medicines, such as pentamidine and eflornithine, appearing on few national EMLs. Likewise, medicines newly added to the
South Africa and essential medicines
South Africa's experience in many ways mirrors global challenges. In 1994, the country emerged from decades of isolation and a political system geared to meet the needs of an affluent elite. Among the first new health strategies was the 1996 national drug policy, which was firmly committed to the use of an essential medicines list.26 Although a limited list had been used in the public sector from the mid-1980s, this list had expanded to include some 2600 items. In the immediate political
Revising the Eritrean national list of drugs
The first Eritrean national list of drugs was defined in 1993 and contained 305 medicines, the second (in 1996) contained 315, and the third (2001) contained 325. All three editions underwent exhaustive review involving most health professionals in the country. The WHO model list served as the basis for the first edition, which was produced by about 30 health professionals. For the second and third revisions, comments were reviewed at national workshops attended by more than 100 people,
Implementation and advocacy: the role of NGOs
The first director of the WHO Action Programme on Essential Drugs described the essential medicines concept as a peaceful revolution in international public health. Others characterised the EML as “a brilliant symbolic strategy on the part of WHO for mobilising opinion and resources”.31 However, pharmaceutical companies have consistently opposed the concept. In 1987, the International Federation of the Pharmaceutical Manufacturers Associations (IFPMA) called the medical and economic arguments
EML and intellectual property
The AIDS crisis has highlighted the grave inequity in access to essential medicines and has drawn attention to the potential consequences of WTO agreements on the availability of medicines. Most AIDS medicines are fairly new and are produced in what is effectively a monopoly. Once the TRIPS agreement is fully implemented (by 2016 for least-developed countries) the cost of all new medicines worldwide will largely depend on price setting by the patent holder.
In 1996, an Assembly resolution
Future perspectives
The 25-year-old essential medicines concept serves as the basis for the WHO medicines strategy in operation today.50 It has become a global concept used by governments and health-care providers worldwide.
The development of an evidence-based list within WHO will be mirrored in countries attempting to implement the essential medicines concept, which poses major challenges. Evidence used by WHO to add or remove a drug might provide some basis for change in country-level decision-making, but in
Search strategy
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