(EDM/PAR, 3 April 2002)
Agenda Item 2 : Outstanding technical issues: description of essential drugs
Resolution WHA28.66 (1975) requests the Director-General to advise Member States on “the selection and procurement, at reasonable cost, of essential drugs of established quality corresponding to their national health needs”. Resolution WHA31.32 (1978) stressed “the need to provide essential drugs of adequate quality, in sufficient quantity and at reasonable cost to meet the health needs of countries” and endorsed the aim of “ensuring access of the whole population to essential drugs at a cost the country can afford”.
The first Expert Committee on the Selection of Essential Drugs in 1977 described essential drugs as medicines that “are of utmost importance, and are basic, indispensable and necessary for the health needs of the population”.[1]In 1983 the Expert Committee described essential drugs as “those that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in the appropriate dosage forms”. This description has been endorsed and used by all subsequent Committees until 1999.

To further enhance clarity the 1999 Committee combined this description with the affordability concept from the 1978 resolution, stating that “essential drugs are those that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in the appropriate dosage forms, and at a price that individuals and the community can afford.”[2] This same description was used in the information paper to the Executive Board of May 2001 (EB108/INF.DOC./2).

During the consultation processes in 2001, most reviewers agreed with the 1999 Expert Committee’s description. However, some reviewers questioned the inclusion of the phrase on affordability and others wondered whether the expression “the majority of the population” is useful. There were other concerns that the needs for sustained financing for essential medicines, and for essential medicines of adequate quality, were not dealt with.

In its report to the Executive Board of January 2002 (EB109/8) the Secretariat stated that the description should include three components: a definition, a description of the selection criteria and a description of the purpose for which such a list is developed, as follows:

Definition: Essential medicines are those that satisfy the priority health care needs of the population

Selection criteria: Essential medicines are selected with due regard to disease prevalence, evidence on efficacy and safety, and comparative cost-effectiveness

Purpose: 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 at a price the individual and the community can afford.

This description is similar to that formulated by the first Expert Committee on the Selection of Essential Drugs in 1977: medicines that “are of utmost importance, and are basic, indispensable and necessary for the health needs of the population”. The purpose for which the list has been developed was spelt out by the 1983 Expert Committee on the Use of Essential Drugs (“they should therefore be available at all times in adequate amounts and in the appropriate dosage forms”). A combination of the definition and its implications has been used to describe the essential medicines concept by all subsequent Expert Committees.

One additional element that needs to be stressed is that countries and institutions should develop their own list of essential medicines. As stated by the last Expert Committee in November 1999: (the concept of essential drugs) … is intended to be flexible and adaptable to many different situations; exactly which drugs are regarded as essential remains a national responsibility.

The Expert Committee is invited to comment on the above description.

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[1] WHO Technical Report Series, No. 615, 1977, p. 9.

[2] WHO Technical Report Series, No. 895, 2000, p. 1.