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SETTING THE SCENE:
THE ESSENTIAL DRUGS CONCEPT
SESSION NOTES
PURPOSE AND CONTENT
A growing number of pharmaceutical products are available on the world market
and there has been an increase, both in the consumption of drugs, and in expenditure
on them. In spite of this, many people throughout the world cannot obtain the drugs
they need. There are also many people who have access to drugs but who do not get
the right drug, in the right dosage, when they need it. The essential drugs concept
was developed in response to these problems and continues to be central to policies
and strategies which aim to address them. The essential drugs concept is central to
the development of a national drug policy.
This session provides an introduction to the essential drugs concept. A short
overview of the context in which it was developed and adopted is given. This
includes a brief description of the main elements of primary health care (PHC) and
the role of essential drugs. A short account of the current world drug situation
follows, which includes problems relating to access to essential drugs and to
irrational use. Current trends and challenges are discussed including the growing
role of the private sector; changes in disease patterns; and the roles and interests of
different actors.
OBJECTIVES
Upon completion of the module participants will be able to:
1. Understand the essential drugs concept in an historical perspective and in
relation to primary health care.
2. Recognise the main components of national drug policy.
3. Identify the major actors in the pharmaceutical context and discuss the roles they
play.
4. Recognise some of the main trends and challenges in the world drug situation
today.
PREPARATION
1. Read the Session Notes.
© World Health Organization 2002
Setting the scene: the essential drugs concept
Session Notes
A. ESSENTIAL DRUGS – AN HISTORICAL PERSPECTIVE
A1. Pharmaceuticals in history
Pharmaceuticals are relatively new. Evidence-based medicine is even newer. The
history of medicine goes back thousands of years and varies from continent to
continent. But people have always (as long as records go back) attempted to
influence their health and avoid or cure illness through the use of traditional
medicine and herbal medicines. Many people all over the world turn to alternative,
complementary and traditional medicine to maintain health or combat illness.
However this course concentrates, to a large extent, on the use of pharmaceutical
products – industrially produced medicines.
Pharmaceuticals and pharmacotherapeutics are relatively new. If we go back just a
hundred years we enter an age in which modern therapeutic medicine, as we know
it, was in its infancy. When discussing drug use and drug policy today it is useful to
have some idea of the historical development of the pharmaceutical industry and the
place which pharmaceutical products have in health care. Current debates about
drug policy and drug use are easiest to understand if we look at them in the context
of:
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Changing ideas about health and health care services and systems;
The development of the pharmaceutical industry from small beginnings at the
start of the 20th century into one of the most powerful industrial sectors by its
end.
In the West, during the 19th century, there was an increasing concern with hygiene
and a growing understanding of public health principles. However, the
understanding of pharmacotherapy was very limited and there were few effective or
safe medicines. Many common therapeutic interventions were hazardous and most
were without any scientific basis.
A2. The development of modern pharmacotherapy
Before World War II there were relatively few effective medicines. Pharmaceuticals as
we know them now hardly existed.
Smallpox vaccination was one of few effective measures available before the turn of
the century. Around that time aspirin became available and was mass-produced. The
pharmaceutical industry has its origins in pharmacy, chemistry and microbiology
(see Chetley (1990) A Healthy Business. Zed Books, London).
Historically:
Pharmacy started with herbal medicines and patent remedies.
Chemical innovation during the 19th century (centred around the dye industry in
Germany) led to the extraction of alkaloids and synthesis of organic compounds.
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Setting the scene: the essential drugs concept
Session Notes
Increased understanding of germs and bacteria led to the development of
compounds, which could kill bacteria and cure disease. (Salvarsan, an arsenic
compound, was synthesised in 1910 and used to treat syphilis). Penicillin was
identified in 1928 but not really recognised until 1939 when it ushered in the era of
antibiotics.
After World War II developments came rapidly.
Early landmarks in drug development
1941 1943 1944 1948 1954 1955 -
Penicillin
Chloroquine
Streptomycin
Tetracycline and chloramphenicol
Sulphonylureas (diabetes)
First oral contraceptive trials
A3. Problems in providing access
The new breakthrough drugs were only available to a privileged minority. In spite of
the rapid growth of the industry and the rapid proliferation of brand name drugs
most people lacked the means to buy them. This led to the development of a market
characterised by the following factors:
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Differences between rich and poor countries;
Differences between urban and rural populations;
Proliferation of brand name products;
Lack of information/evidence about therapeutic value.
A4. Miracles turn into disasters
In addition to these elements there was almost no regulation of drugs, little
understanding of how to measure their efficacy, and scant appreciation of potential
risks. High expectations coupled with an optimistic view of possible benefits and
ignorance about side effects created a dangerous situation.
Lack of regulation and adequate safety measures resulted in a series of disasters,
including:
1930s Sulphanilamide scandal resulted in the establishment of US Food and Drug
Administration (FDA). In 1937 at least 73 people died as a result of taking a
sulphanilamide elixir containing ethylene glycol. The resulting public outcry
resulted in the establishment of the US Food and Drug Administration and to
requirements for drug safety testing. (Only in 1962 were regulations tightened
to require proof of efficacy)
1960s Thalidomide (8,000 children in 46 countries seriously handicapped)
1950 - 1970s Diethylstilbestrol (DES) tragedy
1970s Clioquinol caused widespread neurological disease in Japan.
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Setting the scene: the essential drugs concept
Session Notes
A5. Major challenges became evident
This situation brought out a number of distinct challenges to be met. The first was to
make useful drugs widely available. Secondly to make sure that drugs were properly
used in such a way that their benefits can be maximised and risks minimised. Thirdly
to harness drug development to serve the needs of public health and the people who
need them most.
These challenges have stayed with us and are at the core of the drug policy debates
occurring during the last three decades.
“Thirty years ago modern health technology had just awakened and was full of
promise. Since then its expansion has surpassed all dreams, only to become a
nightmare. For it has become over sophisticated and over costly. It is dictating our
health policies unwisely; and what is useful is being applied to too few.”
Halfden Mahler, then WHO Director-General addressing the World Health Assembly in 1978.
Frustration about proliferation of pharmaceutical products and inequitable access led
to the development of the Essential Drugs Policy.
A6. Essential drugs
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 (WHO).
The essential drugs concept was not any one person’s discovery but was developed
out of a number of experiences in countries seeking to meet the challenges described
above.
1940s
Norway defined a list of priority drugs which should be made available to everyone
by state health services.
1960s and early 70s
Sri Lanka, Cuba, and Costa Rica experimented with lists of essential drugs and bulk
procurement.
1974
The UN adopted a resolution and programme of action of a New International
Economic Order which introduced a new concept of, and commitment to
development.
The International Labour Organization (ILO) adopted the idea of defining basic
needs. This concept provided a focus for countries trying to ensure equitable access
to essential goods and services.
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Setting the scene: the essential drugs concept
Session Notes
1975
WHO defined ‘essential drugs’ – this was a response to the ILO challenge to
multilateral organisations and countries to prioritise basic needs.
1976
First Model List of Essential Drugs produced and promoted by WHO.
1978
Declaration of Alma Ata – calling for focus on Primary Health Care. This was a
logical progression. The focus on basic needs drew on the experience of countries
such as China that had tried to promote access to health care through community
involvement and barefoot doctors.
WHO called for “a virtual revolution to bring about changes in the distribution of
power, in the pattern of political decision-making, in the attitude and commitment of
health professionals and administrators in ministries of health and universities and
in people's awareness of what they are entitled to”.
Primary health care was defined as including (at least):
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education about prevailing health problems and how to control and prevent
them;
promotion of food supply and proper nutrition;
adequate supply of safe water and basic sanitation;
maternal and child health care (including family planning);
immunisation against major infectious diseases;
prevention and control of locally endemic diseases;
appropriate treatment of common diseases and injuries;
provision of essential drugs.
1981
WHO Action Programme on Essential Drugs is established. This action is a result of
the recognition within WHO that the essential drugs concept could revolutionise
access and use of drugs. There was also the understanding at WHO that it was an
idea that would need support and promotion at the international level and at the
national level to assist countries in implementing it.
1982
Bangladesh adopted a national drug policy. One of the poorest countries in the world
embarked on a bold experiment to tackle the double problems of irrational use and
lack of access to essential drugs.
1985
Rational Use of Drugs - WHO Conference of Experts in Nairobi. At this meeting the
need for both prescribers and consumers to know about and use drugs appropriately
was the central theme - an important shift given that, until Nairobi, attention had
gone mainly to strengthening selection, supply and distribution systems.
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Setting the scene: the essential drugs concept
Session Notes
Gaining ground
Since the beginning of the 1980s the essential drugs concept has become one of the
cornerstones of international and national health policy - influencing decisionmaking in not only developing but also industrialised countries. The selection and
rational use of drugs is accepted as a key principle of health service quality and
management in both the public and private sectors. WHO has vigorously promoted
the essential drugs concept and the rational use of drugs - at first through the Action
Programme on Essential Drugs which became a powerful advocate for the new
policies. National Drug Policies were promoted by WHO and others as a guide to
action and a key framework within which to coordinate the various policy
components needed to guarantee access to and rational use of drugs. The next
section of this module deals in more detail with National Drug Policies and looks at
some country examples.
Figure 1. Access to essential drugs
Percentage of population with regula access to essential drugs
(1997)
Access to essential drugs
1 = <50%
2 = 50-80%
3 = 80-95%
4 = >95%
5 = No data available
(36)
(68)
(33)
(41)
(1)
B. NATIONAL DRUG POLICY
Some of the early attempts to implement the essential drugs concept focused on
supply and technical aspects such as procurement, storage and distribution. At the
same time, there was a growing awareness of the problems of rational use. These
involved their complexity, the need for an integrated approach and for a
comprehensive national drug policy as part of health policy. A drug policy is needed
to:
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determine standards and values which will guide actions in the drug sector;
define global objectives which should be met;
identify which strategies will be pursued to meet these objectives.
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Setting the scene: the essential drugs concept
Session Notes
B1. Goals of a national drug policy
The general goals of a national drug policy are to ensure:
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Access:
Quality:
Rational
use
equitable availability and affordability of essential drugs
the quality, safety and efficacy of all medicines
the promotion of therapeutically sound and cost-effective use of drugs
by health professionals and consumers.
The more specific goals and objectives of a national policy will depend upon the country
situation, the national health policy, and political priorities set by the government. In
addition to health-related goals there may be others, such as economic goals. For
example, an additional objective may be to increase national pharmaceutical production
capacity. The policy should be concerned with efficiency, equity and sustainability.
Objectives of the South African National Drug Policy
Health objectives
availability of essential drugs
ensure the safety, efficacy, and quality of drugs
ensure good dispensing and prescribing
promote rational use through the provision of necessary training, education and information
promote the concept of individual responsibility for health, preventive care and informed
decision-making
Economic objectives
lower cost of drugs in private and public sectors
promote the cost-effective and rational use of drugs
establish a partnership between government bodies and private providers
optimise the use of scarce resources
Development objectives
improve knowledge, efficiency and management skills
reorient medical, pharmacy and paramedical education
support the development of local industry and local production of essential drugs
promote the acquisition, documentation and sharing of knowledge and experience.
Source: National drug policy for South Africa, Department of Health, 1996
B2. Components of national drug policy
Selection of essential drugs
Drug selection, preferably linked to national clinical guidelines, is a crucial step in
ensuring access to essential drugs and in promoting rational drug use, because no public
sector or health insurance system can afford to supply or reimburse all drugs that are
available on the market. Key policy issues are:
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Setting the scene: the essential drugs concept
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Session Notes
the adoption of the essential drugs concept to identify priorities for government
involvement in the pharmaceutical sector, and especially for drug supply in the
public sector and for reimbursement schemes;
procedures to define and update the national list(s) of essential drugs;
selection mechanisms for traditional and herbal medicines.
Affordability
Affordable prices are an important prerequisite for ensuring access to essential drugs
in the public and private sectors. Key policy issues are:
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government commitment to ensuring access through increased affordability;
for all drugs: reduction of drug taxes, tariffs and distribution margins; pricing
policy;
for multi-source products: promotion of competition through generic policies,
generic substitution and good procurement practices;
for single-source products: price negotiations, competition through price
information and therapeutic substitution, and Trade-related aspects of intellectual
property rights (TRIPS) compliant measures such as compulsory licensing, “early
workings” of patented drugs for generic manufacturers and parallel imports.
Drug financing
Drug financing is another essential component of policies to improve access to
essential drugs. Key policy issues are:
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commitment to measures to improve efficiency and reduce waste;
increased government funding for priority diseases, and the poor and
disadvantaged;
promotion of drug reimbursement as part of public and private health insurance
schemes;
use and scope of user charges as a (temporary) drug financing option;
use of and limits of development loans for drug financing;
guidelines for drug donations.
Supply systems
The fourth essential component of strategies to increase access to essential drugs is a
reliable supply system. Key policy issues are:
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public-private mix in drug supply and distribution systems;
commitment to good pharmaceutical procurement practices in the public sector;
publication of price information on raw materials and finished products;
drug supply systems in acute emergencies;
inventory control, prevention of theft and waste;
disposal of unwanted or expired drugs.
Regulation and quality assurance
The drug regulatory authority is the agency that develops and implements most of
the legislation and regulations on pharmaceuticals, to ensure the quality, safety and
efficacy of drugs, and the accuracy of product information. Key policy issues are:
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Setting the scene: the essential drugs concept
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Session Notes
government commitment to drug regulation, including the need to ensure a sound
legal basis and adequate human and financial resources;
independence and transparency of the drug regulatory agency; relations between the
drug regulatory agency and the ministry of health (MoH);
stepwise approach to drug evaluation and registration; definition of current and
medium-term registration procedures;
commitment to good manufacturing practices (GMP), inspection and law
enforcement;
access to drug control facilities;
commitment to regulation of drug promotion;
regulation of traditional and herbal medicines;
need and potential for systems of adverse drug reaction monitoring;
international exchange of information.
Rational use
The rational use of drugs means that patients receive medicines appropriate for their
clinical needs, in doses that meet their individual requirements, for an adequate
period of time, and at the lowest cost to them and their community. Irrational drug
use by prescribers and consumers is a very complex problem, which calls for the
implementation of many different interventions at the same time. Efforts to promote
rational drug use should also cover the use of traditional and herbal medicines. Key
policy issues are:
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development of evidence-based clinical guidelines, as the basis for training,
prescribing, drug utilisation review, drug supply and drug reimbursement;
establishment and support of drugs and therapeutics committees;
promotion of the concepts of essential drugs, rational drug use and generic
prescribing in basic and in-service training of health professionals;
the need and potential for training informal drug sellers;
continuing education of health care providers and independent, unbiased drug
information;
consumer education, and ways to deliver it;
financial incentives to promote rational drug use;
regulatory and managerial strategies to promote rational drug use.
Research
Operational research facilitates the implementation, monitoring and evaluation of
different aspects of drug policy. It is an essential tool in assessing the drug policy's
impact on national health service systems and delivery, in studying the economics of
drug supply, in identifying problems related to prescribing and dispensing, and in
understanding the sociocultural aspects of drug use. Key policy issues are:
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the need for operational research in drug access, quality and rational use;
the need and potential for involvement in clinical drug research and
development.
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Setting the scene: the essential drugs concept
Session Notes
Human resources development
Human resources development includes the policies and strategies chosen to ensure that
there are enough trained and motivated personnel available to implement the
components of the national drug policy. Lack of motivation and appropriate expertise
has been a decisive factor in the failure to achieve national drug policy objectives. Key
policy issues are:
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government responsibility for planning and overseeing the development and
training of the human resources needed for the pharmaceutical sector;
definition of minimum education and training requirements for each category of
staff;
career planning and team building in government service;
the need for external assistance (national and international).
Monitoring and evaluation
Monitoring and evaluation are essential components of a national drug policy, and
the necessary provisions need to be included in the policy. Key policy issues are:
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explicit government commitment to the principles of monitoring and evaluation;
monitoring of the pharmaceutical sector through regular indicator-based surveys;
independent external evaluation of the impact of the national drug policy on all
sectors of the community and the economy.
C. INTERESTS OF DIFFERENT STAKEHOLDERS
The development and implementation of drug policies is a complex and difficult
process. It is also a process that is highly political and can become very polarised.
Enormous stakes are involved in the pharmaceuticals arena. The financial interests
are huge but there are also other factors that make the area a difficult one in which to
work. People’s beliefs, traditions and cultural preferences can be a major determinant
of how they treat drugs and make health care choices. These are not necessarily
factors that can be changed. The medical profession has, over the centuries,
developed a system of power and authority that can exert a powerful influence on
society and the organisation of health care. There are a variety of factors such as
these that cannot easily be ignored when developing pharmaceutical policy or when
planning interventions to change drug use.
The main actors in the pharmaceutical field include:
C1. National governments
The Ministry of Health will of course be very important, but other ministries such as
the Ministry of Finance and the ministry responsible for industrial development are
likely to have strong views on developments in the pharmaceuticals area. Often they
will have objectives that are hard to reconcile.
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Setting the scene: the essential drugs concept
Session Notes
C2. Pharmaceutical industry
Drugs are big business. The global pharmaceutical market is expected to be worth
US$400 billion by 2002. The ten largest drug companies control over a third of this
market, several of them have sales of more than US$10 billion per year and profit
margins of approximately thirty percent. Six of these giants are based in the US and
four in Europe (Panos, Health and the New Millennium).
The pharmaceutical industry is itself far from homogeneous. While multinational
companies have been generally unsupportive of the essential drugs concept and
maintain that it is only relevant to the least developed countries, generic companies
and local producers may be supportive.
C3. International organisations
WHO has been the most important international advocate of the essential drugs
concept and continues to give support to many countries. Other international
agencies such as the World Bank and UNICEF also play an important role. The
World Bank finances many country programmes and it is also a major voice in
national and international health policy. UNICEF has been a major actor in
developing cost recovery systems for essential drugs.
Drug selection and essential drugs
The need for drug selection is not restricted to developing countries. Health care costs in general, and
drug costs in particular, are rising everywhere. Most of the increased drug cost is due to the use of
new medicines, and many of these are for chronic diseases. In order to ensure an optimal use of
limited resources a careful evaluation is needed of their cost-effectiveness in relation to existing
treatment alternatives. Some industrialised countries have developed very detailed procedures for this
difficult process. One example is the pharmaceutical benefit scheme in Australia, which requires proof
that a drug is more cost-effective than existing treatments before it is approved for reimbursement. It
is interesting to note that the list used in the Australian scheme contains approximately the same
number of active ingredients as the national list of essential drugs in Zimbabwe.
Another example is the Scottish Intercollegiate Guidelines Network, which is developing national
treatment protocols entirely on the basis of evidence. For every treatment recommendation, the
strength of the supporting scientific evidence is indicated according to four levels - the strength of the
evidence defines the strength of the recommendation. The main objective of the Scottish guidelines is
to attain the highest standards in health care, rather than cost-containment. Some of the
recommendations lead to increased health care cost, for example, in the treatment of diseases which
are generally known to be underdiagnosed and undertreated.
These two examples show that essential drugs are not for poor countries only or for rural areas only.
The concept of essential drugs is just as valid in developed countries, in teaching hospitals, and in
health insurance schemes. It is as valid for the treatment of cancer, cardiovascular diseases and
metabolic disorders as it is for malaria, acute diarrhoea and pneumonia.
The World Health Report 1997. World Health Organization, Geneva, 1997.
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Setting the scene: the essential drugs concept
Session Notes
C4. Health professionals
The term “health professionals” covers a broad spectrum. The influence and the
interests of health professionals will depend on their degree of organisation, on the
resources available for health care and on how the system is divided between private
and public sectors.
C5. NGOs
In many countries (most notably in Africa) NGOs have become important in health
care delivery. NGOs often provide a way to stimulate community involvement and
participation.
C6. Consumers
Consumers are themselves the users of drugs and health services. Consumer
organisations are increasingly seen as important partners in the development of
health and drug policy and in some countries have played an important role.
However in many countries there is little in the way of an organised consumer
movement. Over the last twenty years there has been considerable attention on the
need to address irrational drug use by prescribers and dispensers but relatively little
effort has been made to change drug use in communities and to alter the behaviour
of consumers. The vast majority of drugs in developing countries are bought in the
private sector by consumers without any medical consultation. This is an increasing
trend. If we are to have a real impact on irrational drug use then it is essential that
community drug use be addressed.
C7. Insurers
In countries with a high level of health insurance, health insurers have a major
influence on drug policy. Decisions about whether or not a particular drug is
reimbursed act effectively as a selection mechanism.
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Setting the scene: the essential drugs concept
Session Notes
D. CURRENT TRENDS AND CHALLENGES
In spite of the progress made during the last twenty years, a large proportion of the
world’s population still lacks access to essential drugs. Estimates suggest that onethird of the world’s population lacks access to essential drugs. In developing
countries the proportion is much higher; in Africa and many parts of Asia more than
half the population does not have access to essential drugs. Essential drugs are not
costly and their provision is a cost-effective intervention as well as one which is
essential to maintain confidence in health services. In spite of this many people do
not have access (geographical or financial) to drugs when they need them. Many of
the drugs that are available are paid through private out-of-pocket expenditure.
Many of the drugs that are prescribed or purchased over the counter are not used
appropriately. Changing patterns of drug use is complex and time-consuming.
D1. Reduced role of government
Reductions in spending in the public sector make it difficult for governments to
provide quality health care and the essential drugs which people need. It also
becomes more difficult to control the way in which drugs are used. The current focus
on private/public partnerships makes it much harder for governments (or
international agencies) to promote policies which may not be consistent with the
interests of major players in the private sector or with ‘free market’ philosophies.
Social solidarity and support to the public sector is less of a priority and the solutions
to lack of access are increasingly sought in terms of stimulating the private sector and
partnership with the industry rather than in strengthening basic services and
reallocation of resources. In some countries, particularly in Latin America, this move
from public to private has been accompanied by reduced government regulatory
control of pharmaceuticals. In fact, as WHO has pointed out, an increasing role of the
private sector requires stronger not weaker central, i.e. government regulatory
control.
D2. Increased role of the private sector
The reduction in public sector provision is matched by a growth in the private sector.
The private sector includes private pharmacies and drug sellers, private not-forprofit NGOs (e.g. the Church is a major provider in many African countries) and the
informal or illegal sector (many drugs exchange hands through market stalls or are
sold again after being prescribed by a health worker). The private sector is harder to
regulate/control and influence than the public sector. Improving drugs use and
implementing the essential drugs concept in the informal and illegal sectors is very
hard.
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Setting the scene: the essential drugs concept
Session Notes
D3. Changing morbidity and mortality patterns
People are living longer and this means that more people survive to experience ill
health in old age. In 1955 average life expectancy was 48 years; in 1995 it was 65
years. Longer life expectancy is one of the reasons for the increase in chronic diseases
that can be seen in both developing and industrialised countries. Additional reasons
include the increase of smoking, changes in diet and reduction in exercise. Chronic
diseases often require long-term drug therapy. Many of the drugs used in the
treatment of chronic diseases are relatively expensive. New diseases have also
emerged as major problems.
HIV /AIDS
This viral disease is the most important of these. The overwhelming majority of
people living with HIV - some 95% of the global total – live in the developing world.
That proportion is set to grow even further as infection rates continue to rise in
countries where poverty, poor health systems and limited resources for prevention
and care fuel the spread of the virus. As of June 2001, there were an estimated 36.1
million people living with HIV/AIDS. Sub-Saharan Africa continues to bear the
brunt of HIV and AIDS and is home to nearly 70% of the global total of HIV-positive
people.
Providing good care for AIDS patients puts enormous economic pressure on health
services and family budgets. Providing care and access to drugs (both basic essential
drugs and new drugs such as antiretrovirals [ARVs]) for the care of people with
AIDS is one of the most important challenges facing the health services in many
countries. This single issue has enormous repercussions for all aspects of drug policy.
Tuberculosis
It is estimated that between now and 2020 nearly one billion people will be newly
infected, 200 million will get sick and 70 million will die of tuberculosis (TB) if
current trends continue. Treatment of TB can put great pressure on health budgets
and multi drug resistent TB is a major potential public health threat.
D4. Changing relationships between professionals and consumers
In industrialised, and in some developing countries, the last fifty years have seen a
revolution in consumer and patient expectations. People have more access to
information about drugs and their health. They know more about treatment options
and about new drugs on the market and expect to be involved in treatment choices.
They have come to expect access to drugs and health care as a right. On the one hand
this leads to a sense of assertiveness, a confidence and a feeling of responsibility for
health. On the other hand these changes have fostered a tendency to look for
technological solutions, to medicalise problems which are not purely medical, and to
turn to new wonder drugs to solve these problems.
Reconciling the divergent interests of these actors, channelling their strengths and
involving them in decisions and their implementation can be crucial to the success of
drug policy.
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Setting the scene: the essential drugs concept
Session Notes
ADDITIONAL READING
Essential Drugs Monitor (no. 27). Geneva, World Health Organization.
Essential Drugs Monitor (no. 30). Geneva, World Health Organization.
Chetley A (1990) A Healthy Business. London, Zed Books.
WHO (2001) How to develop and implement a national drug policy 2 nd ed. Geneva, World Health
Organization.
World Pharmaceutical Situation. Geneva, World Health Organization (in preparation).
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Setting the scene: the essential drugs concept
Session Notes
ACTIVITY 1 (1 HOUR)
You are going to watch a video on Essential Drugs.
You should make a note of every “drug problem” you see referred to in this video.
There will be a considerable number – try to identify as many as possible.
When the film is finished you will work in country/regional groups.
You should try to sort the problems into types of problem.
Then take the problems one by one and consider:
1. How they could be tackled, i.e. by legislation, by education, by improving
distribution.
2. Whether resources and energy are being spent in their country primarily on efforts
to ensure rational procurement and adequate supply of medicines or whether the
rational use of drugs (RUD) is also given adequate attention.
3. If RUD is part of the national drug policy, are efforts directed at prescribers mainly
or are programmes to promote rational use of drugs by consumers also
implemented? If yes, what is being done? and
4. To what extent do the participants – in their country situation – have the potential
to influence or have already some influence on rational use of drugs by
consumers? What kind of influence do they have?
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Setting the scene: the essential drugs concept
Session Notes
ACTIVITY 2 (40 MINUTES)
A complicated range of actors - conflicting interests
This is a short exercise, 15 minutes and 3 minutes report back per group. It is
intended to encourage discussion rather than to be an in-depth discussion
Discuss with each other (in country or regional groups) who are the important actors
in their country in relation to pharmaceutical policy. Give the following actors marks
out of 10 (for power and influence):
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National governments
Pharmaceutical industry
International organisations (WHO, World Bank, UNICEF etc)
Health professionals (doctors, pharmacists, nurses etc)
NGOs
Consumers
Insurers
One rapporteur should feed back from each group and then groups should compare
notes and comment on differences.
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