The provision of Essential medicine is one of the eight pillars of WHO’s primary health care strategy. According to WHO, essential medicines are those drugs that fulfill the priority health care need of people. Essential drug is defined as the appropriate medicine intended to be available in the content of functioning health system every time in adequate amount in the appropriate dosage form with assured quality and adequate information at affordable price that each and every individual can afford.

1. PREPARED BY- AJAY KUMAR SAH

2.  The provision of Essential medicine is one of the eight
pillars of WHO’s primary health care strategy. According to
WHO, essential medicines are those drugs that fulfill the
priority health care need of people. Essential drug is
defined as the appropriate medicine intended to be
available in the content of functioning health system every
time in adequate amount in the appropriate dosage form
with assured quality and adequate information at
affordable price that each and every individual can afford.
This is the basis of the Essential medicine concept that was
launched in 1977. This concept needs to flexible and
adaptable to different situations and nation should have
responsibility to determine the essential medicines and
release their own essential medicine list. The essential
medicine list should be prepared on the basis of common &
prevalent disease exists in their regions and nations .The
aim of the essential medicine is to support the rational use
of the drugs by each individual and every communities of
the world.

3.  Most rational prescribing and use of drugs
 Environmental condition
 Pattern of prevalent disease
 Level of treatment facility available in their
regions
 Efficacy and safety profile of drug
 Quality, price, and local availability

4.  are those common diseases/infections which
are widespread in each and every group of
populations in particular zones/nations for
longer period. In India, hypertension,
diabetes, ischaemic heart diseases are the
most common diseases found across the
whole country. Occasional outbreak of
dengue fever also prevails its dominance over
the years.

5.  Rational use of drugs requires that "patients
receive medications appropriate to their
clinical needs, in doses that meet their own
individual requirements, for an adequate
period of time, and at the lowest cost to them
and their community" Irrational use of
medicines is a major global problem. WHO
estimates that more than half of all medicines
are prescribed, dispensed or sold
inappropriately, and that half of all patients
fail to take them correctly.

6. The irrational use of drugs is due to:
 use of too many medicines per patient ("poly-
pharmacy")
 inappropriate use of antimicrobials
 often in inadequate dosage, for non-bacterial
infections
 over-use of injections when oral formulations
would be more appropriate
 failure to prescribe in accordance with clinical
guidelines
 inappropriate self-medication,
 Often of prescription-only medicines; non-
adherence to dosing regimes

7. WHO advocates 12 key interventions to promote more rational use:
 Establishment of a multidisciplinary national body to coordinate policies
on medicine use
 Use of clinical guidelines
 Development and use of national essential medicines list
 Establishment of drug and therapeutics committees in districts and
hospitals
 Inclusion of problem-based pharmacotherapy training in undergraduate
curricula
 Continuing in-service medical education as a licensure requirement
 Supervision, audit and feedback
 Use of independent information on medicines
 Public education about medicines
 Avoidance of perverse financial incentives
 Use of appropriate and enforced regulation
 Sufficient government expenditure to ensure availability of
medicines and staff.

8.  Of the 414 eligible medicines on WHO’s
model list, 73 (18%) medicines were listed by
only 27 (20%) or fewer countries and 23 (6%)
medicines were listed by 7 (5%) or fewer
countries. Medicines recently added to WHO’s
model list were generally listed by fewer
countries than those medicines added earlier
(available from a data repository). Only
velpatasvir, a Hepatitis C treatment, which
was added to the 2017 WHO model list , was
not listed by any country.

9.  No country included all medicines on WHO’s
model list; eight countries included over 300
WHO essential medicines on their list (Ethiopia,
Iran [Islamic Republic of], Kenya, Pakistan,
Republic of Moldova, Slovakia, Syrian Arab
Republic and Thailand). Of these, Kenya, Pakistan
and the Republic of Moldova listed WHO essential
medicines without adding many (less than 150)
other medicines.
 Portugal, Slovakia and Syrian Arab Republic
added more than 600 medicines to their list that
were not on WHO’s model list; while Angola,
Bosnia and Herzegovina, Bulgaria, Cambodia and
Somalia omitted more than 300 WHO essential
medicines.

10.  There were differences across therapeutic
areas and for both communicable and no
communicable diseases (available from a data
repository). Countries with lower health-care
expenditures appear to have omitted more
medicine of WHO’s Essential list.
 Essential medicine not only saves life and
prevents epidemics and diseases too.

11.  India
Prevalent diseases and their essential medicines :
Prevalent diseases Essential medicines as per rational use
Hypertension Amlodipine, atenolol, enapril,
hydrocholorothiazide, labetalol, methyl
dopa, ramipril, telmisartan
Diabetes Glimpiride, insulin, metformin
Dengue Paracetamol, dengue vaccine
Hyperlipidemia Atorvastatin

12. Tuberculosis Capreomycin, cycloserine, ethambutol,
ehionamide, isoniazid, kanamycin, levofloxacin,
linezolid, moxifloxacin, PAS, pyrazinamide,
rifabutin, rifampicin, streptomycin
Malaria Artemether+lumefantrine, artesunate,
artesunate+sulfadoxim-pyrimethamine,
chloroquine, clindamycin, primaquine, quinine
Bacterial infections Amoxicilline+clavulanic acid, ampicillin,
cefexime, ceftriaxone, azithromycin,
ciprofloxacin, gentamycin, metronidazole
Fungal infection Amphotericin B, Clotrimazole, fluconazole,
griseofulvin
Hepatitis C Entecavir, pegylated interferon alfa 2a & 2b,
ribavirin, sofosbuvir, tenofovir, lamivudine

13. Ulcer Omeprazole, pantoprazole,
ranitidine, sucralfate
Gout Allopurinol, colchicines
Rheumatoid arthiritis Azathioprine,
hydroxychloroquine,
leflunomide, methotrexate,
sulfasalazine

14. China
Prevalent disease Essential drugs as per rational use
Diabetes Insulin, glicalizide, intermediate
acting insulin
Ischaemic heart disease Bisoprolol, glyceryl trinitrite,
isosorbide dinitrite, verapamil
Lung cancer Etiopoioside , methotrexate
,carboplatin ,nivolumab
,topotecan, seretinive ,avastin,
affinitor
Liver cancer Cabometyx, ramucirumab,
lenvatini mesylate, nivorumab,
regorafenib

15. United States of America
Prevalent Diseases Essential drugs as per rational use
Alzhemiers disease
Aricept, namenda, donepezil,
mementein, Exelon ,rivastigmine,
gallantamine
Diabetes Insulin, glicalizide, intermediate acting
insulin
Parkinsonism Biperiden ,levodopa+carbidopa
Septicemia Cloxacillin, ampicillin, benzyl
penicillin , gentamicin, procaine
benzyl penicillin, cefotaxime,
ceftriaxone, amikacin, amoxicillin
Cardiovascular disease like stroke Simbuvastatin, losartan ,digoxin

16. Prevalent disease Essential drugs as per
rational use
Lung cancer Etiopoioside , methotrexate
,carboplatin ,nivolumab
,topotecan, seretinive
,avastin, affinitor
Dementia Donezepil ,rivastigmine,
gallantamine, mementin
Alzhemiers disease Aricept, namenda, donepezil,
mementein, Exelon
,rivastigmine, gallantamine
Australia

17. Germany
Prevalent disease Essential drugs as per
rational use
Diabetes Insulin, glicalizide,
intermediate acting insulin
Cardiovascular disease Bisoprolol, enalpril,
simbuvastatin,losartan,
digoxin, telmisartan

18. Prevalent disease Essential drugs as per rational use
Chronic liver disease Disulfiram, naltrexone,
acamprostate, dexamethasone,
penicillamine, ciprofloxacin
Stroke Digoxin , simbuvastatin,losartan
Cancer Cisplatin, methotrexate, docetaxal,
bleomycin, avastin, azacitidine ,
Tubercuiosis Capreomycin, cycloserine,
ethambutol, ehionamide, isoniazid,
kanamycin, levofloxacin, linezolid,
moxifloxacin, PAS, pyrazinamide,
rifabutin, rifampicin, streptomycin
Respiratory diseases Salbutamol, ipratropium bromide,
budesonide, beclomethasone,
salmeterol
United Kingdom

19. Nepal
Prevalent Diseases Essential drugs per rational uses
Gastritis (ulcer) Omeprazole, pantoprazole, ranitidine, sucralfate
Hypertension Amlodipine, atenolol, enapril,
hydrocholorothiazide, labetalol, methyl dopa,
ramipril, telmisartan
Tuberculosis Capreomycin, cycloserine, ethambutol,
ehionamide, isoniazid, kanamycin, levofloxacin,
linezolid, moxifloxacin, PAS, pyrazinamide,
rifabutin, rifampicin, streptomycin
Rheumatoid arthiritis Azathioprine, hydroxychloroquine,
leflunomide, methotrexate, sulfasalazine
Diabetes Metformin, gliclazide, insulin

20. Prevalent disease Essential drugs as per rational use
Pneumonia Clofloxacin, cloxacillin, chloramphenicol
Typhoid Ceftriaxone, azithromycin, ciprofloxacin
Anthrax Ciprofloxacin, doxycycline, ofloxacin,
chloramphenicol, vibramycin, obiltoxaximab
Malaria Mefloquine, proguanil, doxycyline
Trachoma Azithromycin
Hiv aids Rifabutin, abacavir (ABC), lamivudine (3TC),
atazanavir + ritonavir, lamivudine + zidovudine
Ghana

21. Russia
Prevalent disease Essential drugs as per rational use
Diphtheria Procaine , penicillin, penicillin G
potassium
Sexually transmitted disease Doxycycline, benzathiacine
benzacycline, azithromycin,
procaine benzyl penicillin,
ciprofloxacin

22. Mongolia
Prevalent diseases Essential drugs as per rational use
Hepatitis B & C Entecavir, pegylated interferon alfa
2a & 2b, ribavirin, sofosbuvir,
tenofovir
Brucellosis Doxycycline, tetracycline,
minocycline,gentamycin,chloramph
enicol
Sexually transmitted
diseases
Doxycycline,benzathiacine
benzacycline, azithromycin,
procaine benzyl penicillin,
ciprofloxacin
Plague Streptomycin, chloramphenicol
,tetracycline ,floroquinolones

23. Bangladesh
Prevalent diseases Essential drugs as per rational use
Diabetes Metformin, gliclazide, insulin
Chronic respiratory disease Albuterol, ipratropium bromide,
budesonide,fluticasone, theophylline,
aclidinium,tiotropium,salmeterol
Tetanus Methocarbamol, diazepam,
chlorpromazine,penicillin g, potassium
Cardiovascular disease Simbuvastastin, losartan, digoxin,
diltiazem, amlodipine

24. Srilanka
Prevalent diseases Essential drugs as per rational
use
Malaria Artemether, choloroquine,
primaquine, quinine
Dengue fever Paracetamol, dengue vaccine

25. Pakistan
Prevalent diseases Essential drugs as per rational use
respiratory disease Aminophyllin, beclomethasone,
salbutamol, theophyllin
Neonatal encephalopathy Phenobarbital, phenytoin,
levetiracitam, lidocaine,
benzodiazepine
Diarrhoea Aluminium hydroxide, potassium
chloride, metoclopramide, ORS

26. Argentina
Prevalent diseases Essential drugs as per rational use
Obesity Fenterimine, topiramate,
naltrexone, methamphetamine,
orlistat, phendimethazine
Diabetes Metformin, gliclazide, insulin
Cancer Etiposide , topotecan, carboplatin,
bleomycin, avastin, methotrexate

27. Brazil
Prevalent disease Essential drugs as per rational use
Rikettssia Doxycycline,chloramphenicol
Leptospirosis Ampicillin, penillin g. potassium,
penicillin g. sodium
Parasitic infection Mebendazole, albendazole,
ivermectin, avermectin
Rabies HDCV & PCEC Vaccines, HRIG

28. Morocco
Prevalent disease Essential drugs as per rational use
Gastritis Omeprazole, pantoprazole,
rantidine, sucralfate
Diarrhea Aluminium hydroxide, potassium
chloride, metoclopramide, ORS
Typhoid Ceftriaxone, azithromycin,
ciprofloxacin

29. Prevalent disease Essential drugs as per rational use
Leshmaniasis Alupurinol, amphotericin B, pentamidine,
miltefosine
Malaria Artemether+lumefantrine, artesunate,
artesunate+sulfadoxim-pyrimethamine,
chloroquine, clindamycin, primaquine, quinine
Oman

30. Yemen
Prevalent disease Essential drugs as per rational
use
Viral hemorrhage Symptomatic treatment with
Rivavarin

31. Qatar
Prevalent disease Essential drugs as per rational use
Cancer Methotrexate, topotecan, etopioside,
carboplatin, cisplatin
Ischemic disease Bisoprolol, glyceryl trinitrite, isosorbide
dinitrite, verapamil
Respiratory disease Salbutamol, salmeterol, Albuterol, ipratropium
bromide

32. Saudi Arab
Prevalent disease Essential drugs as per rational use
Stroke Simbuvastatin, digoxin, diltiazem
Chronic kidney disease Furesemide, toresemide, ethacryanic
acid
Liver cirrhosis Ursodiol,actigall

33. U.A.E
Prevalent disease Essential drugs as per rational use
Cancer Methotrexate, bleomycin, avastin, cisplatin,
etopioside, topotecan
Obesity Fenterimine, topiramate, naltrexone,
methamphetamine, orlistat ,phendimethazine

34. Vatican city
Prevalent disease Essential drugs as per rational use
Parasitic Infections Mebendazole, albendazole,
ivermectin, avermectin,piperazine
Cancer Methotrexate, bleomycin, avastin,
cisplatin, etopioside, topotecan

35. Belgium
Prevalent disease Essential drugs as per rational use
Heart disease Diltiazem, nifidem, simbuvastatin, losartan,
digoxin, propranolol, amlodipine
Arthritis Azathioprine, hydroxychloroquine,
leflunomide, methotrexate, sulfasalazine
Athetosis Reserpine, terbenazine

36. Spain
Prevalent disease Essential drugs as per rational use
Ischaemic heart disease Bisoprolol, glyceryl trinitrite, isosorbide
dinitrite, verapamil
Alzhemiers disease Aricept, namenda, donepezil, mementein,
Exelon ,rivastigmine, gallantamine,
COPD Aminophyllin, beclomethasone, salbutamol,
theophyllin

37. Uruguay
Prevalent disease Essential drugs as per rational use
Cardiovascular disease Diltiazem, nifidem, simbuvastatin,
losartan, digoxin, propranolol,
amlodipine

38. Panama
Prevalent disease Essential drugs as per rational use
Rabies Rabies vaccine(rabD)
Typhoid Ceftriaxone, azithromycin, ciprofloxacin
yellow fever Yellow fever vaccine

39. Mexico
Prevalent disease Essential drugs as per rational use
Zika virus Symptomatic treatment with
acetaminophen
Chickenguinea Symptomatic treatment with
acetaminophen, Ibruprofen
Parasitic infections Pyrantel pamoate, mebendazole,
thiabendazole, ivermectin,
avermectin, diethyl carbamezepine,
piparizine

40. Italy
Prevalent disease Essential drugs as per rational use
Cerebrovascular diseases Propranolol, simbuvastatin, losartan,
diltiazem, amlodipin
Ischaemic heart diseases Bisoprolol, glyceryl trinitrite, dinitrite,
verapamil

41. France
Prevalent disease Essential drugs as per rational
use
Boils Cefazoline, tetracycline,
cefixime, erythromycin,
doxycycline
Breast cancer Abimaciclib, palclitaxel, afinitor,
toremifene, taxotere, vinblastin

42. North Korea
Prevalent disease Essential drugs as per
rational use
Tb Capreomycin, rifampicin,
streptomycin, ethambutol
Viral hepatitis Entecavir, pegylated interferon
alfa 2a & 2b, ribavirin,
sofosbuvir, tenofovir
Malaria Chloroquine, artesunate,
arthemether+lumefantrine,
hydroxychloroquine

43. Afghanistan
Prevalent disease Essential drugs as per rational
use
Leprosy Rifampin, nalidixic acid,
dapsone, lamprene

44. Portugal
Prevalent disease Essential drugs as per rational
use
Typhus Ciprofloxacin, azithromycin,
ceftotriaxone
Small pox Codofovir, linsidovir,
topovirinate
Tuberculosis Rifampicin, streptomycin, PAS,
capreomycin, ethambutol,
isoniazid

45. Prevalent disease Essential drugs as per rational use
Heart disease Diltiazem, nifidem, simbuvastatin,
losartan, digoxin, propranolol,
amlodipine
Pneumonia Benzyl penicillin, cloxacillin,
Clofloxacin, chloramphenicol
Stroke Digoxin, simbuvastatin, diltiazem
Alzheimer Aricept, namenda, donepezil,
mementein, Exelon ,rivastigmine,
gallantamine,
Japanese encephalitis Japanese encephalitis vaccine(SA14-
14-2 Live attenuated)
Japan

46. New Zealand
Prevalent disease Essential drugs as per rational use
Lung cancer Methotrexate, bleomycin, avastin,
cisplatin, etopioside, topotecan
Coronary kidney disease Furesemide, toresemide, ethacryanic
acid
Stroke Digoxin, simbuvastatin, diltiazem
Eschemic heart disease Bisoprolol, glyceryl trinitrite, isosorbide
dinitrite, verapamil

47. Finland
Prevalent disease Essential drugs as per rational use
Polyendocrinopathy syndrome Fluconazole, ketoconazole
Amilodiosis Cyclophosphamide, dexamethasone,
bortezomib, daretumumab, lenalidomide,
thalidomide
Hypoplasia Hydrocortisone

48. Canada
Prevalent disease Essential drugs as per rational use
Autism Aripiprazole, risperidone, venelafaxine,
ziprasidone, paliperidone, bumetanide
Influenza Peramivir, zanavir, oseltamivir phosphate,
baloxavir
Cancer Methotrexate, bleomycin, avastin, cisplatin,
etopioside, topotecan
Diabetes Insulin, metformin, gliclazide

49. Iraq
Prevalent disease Essential drugs as per rational use
Malaria Artesunate, chloroquine,
arthemether+lumefantrine,
Brusselosis Ciprofloxacin, doxycycline, ofloxacin,
chloramphenicol, vibramycin,
obiltoxaximab
Campylobacter jejuni Erythromycin, azithromycin,
levofloxacin, ciprofloxacin
Q-fever Doxycycline , minocycline

50. Iran
Prevalent disease Essential drugs as per rational use
Dengue Acetaminophen, dengue vaccine
T cell leukemia Bendamustin, bortezomib, brentuximumab
Crimean congo hemorrhagic fever Ribavarin

51. Manmayar
Prevalent disease Essential drugs as per rational use
Filariasis Albendazole, mebendazole, ivermectin,
avermectin, DEC
Anthrax Ciprofloxacin, doxycycline, ofloxacin,
chloramphenicol, vibramycin,
obiltoxaximab
Avian influenza Osaltamivir, zanamivir, peramivir

52. Laos
Prevalent disease Essential drugs as per rational use
LRTI Salbutamol, salmeterol, budesonide, Albuterol,
ipratropium bromide
Ischemic heart disease Bisoprolol, glyceryl trinitrite, isosorbide dinitrite,
verapamil
Diarrhea Metronidazole, ORS Solution

53. Philippines
Prevalent disease Essential drugs as per rational use
Hepatitis A Hepatitis A vaccine
Japenese Encephelitis Japanese encephalitis vaccine(SA14-14-2
Live attenuated)
Leptospirosis Ampicillin, penillin g. potassium, penicillin
g. sodium

54. Somalia
Prevalent disease Essential drugs as per rational use
Cholera Doxycline, erythromycin ,vaxchora vaccine
Meningitis Amoxiclin ,vancomycin, ciprofloxacin,
metronidazole
Malaria Chloroquine, arthemether+lumefantrine,
artesunate
Measles Ibuprofen, acetaminophen, naproxen Na

55. Holland
Prevalent disease Essential drugs as per rational use
Neoplasm Methotrexate, cisplatin, carboplatin, topotecan,
etopioside
Respiratory diseases Aminophyllin, beclomethasone, salbutamol,
theophyllin

56. REFERENCES:
1.WHO,The Pursuit of Responsible Use of
Medicines: Sharing and Learning from Country
; October 2012;WHO reference
number: WHO/EMP/MAR/2012.
2.Comparison of essential medicines lists in 137
countries; Bulletin of World Health Organ 2019