Quick compilation of essential medicine list related facts

1. ESSENTIAL MEDICINE LIST
Presented By: Dr. Kunwar Shailen Dev Singh Guleria
J.R.1 Department of Pharmacology, Dr. RPGMC Tanda
Date: 23rd May, 2018

2. Objectives of this presentation
• Analyze the rationale for the creation of the World
Health Organization (WHO) Essential Medicines List.
• To know the brief history of Essential Medicine
Concept.
• To have an overview of the components of the list
in brief.
• To know how and why a medication is added to the
WHO Essential Medicines List.
• Benefits of having an Essential Medicine List.
• Some interesting observations.

3. Recall The Days Of Field Posting

4. Gdo pic

5. Handful of medicines/vaccines saved the
day

6. WHO Directive 1975
• Such medicines should be available in all hospitals
and at all times (1975)
• In 1977, they defined Essential Drugs
• In 1978 Alma Ata
declaration on 1⁰ Health
Care, essential medicines
concept was mentioned
in one of the 10 points

7. Essential Medicine Concept
• So, with this aim to guide member countries,
WHO brought out its 1st Model List of
Essential Drugs along with dosage forms and
strengths in 1977
• List of 212 medicines

8. Defining Essential Medicines
• The original 1977 WHO definition was that they
were medicines "of utmost importance, basic,
indispensable, and necessary for the healthcare
needs of the population". (212 medicines)
• In 2002 definition was changed to:
“Essential medicines are those that satisfy the
priority health care needs of the population.”
(433 medicines)

9. Defining Essential Medicines
• These medicines are intended to be available within
the context of functioning health systems at all
times and :
In adequate amounts
In appropriate dosage form
With assured quality
With adequate information
At a price the individual & the community can
afford

10. Defining Essential Medicines
• These drugs are selected with due regards to :
Public Health Relevance
Evidence on Efficacy & Safety
Comparative Cost Effectiveness

11. History of WHO EML
• The 1st list was published in 1977 with 212
medications.
• WHO updates the list every 2 years
• The latest edition is of 2017 which contains 433
medicines
• WHO Model List of Essential Medicine for Children
(upto 12 years) was created in 2007 and is in its 6th
Edition, as in 2017

12. EML, Indian Context
• In India, the 1st National Essential Drug List was
released by Directorate General of Health Services-
MOHFW in 1996.
• List revised in 2003 & then in 2011 with 348
medicines
• 1st state level EDL was prepared by Tamil Nadu in
1994 but the 1st state to come up with a
comprehensive policy was Delhi in same year.

13. Historical Timeline of EML
• 1975 – WHO DIRECTIVE
• 1977 – 1st definition of Essential Drug List/Model Drug List
• 1978 – Special reference at Alma Ata Declaration
• 1994 – 1st State level EDL by Delhi State Govt.
• 1996 – 1st National Essential Drug List by MoHFW
• 2002 – WHO changed the definition of Essential Drugs
• 2003 – WHO changed the name from Essential Drug List to
Essential Medicine List (to avoid confusion with drugs of
abuse)
• 2007 – 1st edition of Children’s list
• 2017 – Latest Essential Medicine List

14. Essential Medicine List
• The WHO Model list is not a permanent list but just
a guideline.
• WHO suggests nations to prepare their own EML
according to:
Their own requirement.
Changing medical needs
Availability of newer & better drugs
Thus, it is a mutable list which is revised every 2-3 years,
with provision for addition & deletion of medicines.

15. Why different list for different nations ?
List of Snake Free Nations List of Nations with
Maximum Snake Bite Cases
1. New Zealand 1. India
2. Ireland 2. Pakistan
3. Iceland 3. Bangladesh
4. Greenland 4. Indonesia
5. Hawaiian Archipelago 5. Myanmar

16. Why different list for different nations ?
List of Mosquito Free Nations List of Mosquito Prevalent Nations
1. Iceland 1. Brazil
2. New Caledonia 2. Indonesia
3. French Polynesia 3. India
4. The Seychelles 4. Philippines

17. Why EML is needed ?
• Therapeutic Jungle >6 lakh drugs.
• Irrational Fixed Drug Dose Combinations.
• Me too drugs.
• Substandard, Spurious Drugs.
• Costs of drugs.
• Limited Health Budget.
• Credible source of information. Universal.
• NOT Pharma Industry Endorsed. (No “prescribe my
drug” mania)

18. Why EML is needed ?
• Means of restricting the Pharmaceutical Industry.
• Serves as a list of formulation of medicines with
varying amounts of added information about
nationally licensed medicines.

19. Contents of “the list”
• There are 2 components of the Essential Medicine List :
• Some drugs are listed in both
CORE LIST COMPLIMENTARY LIST
 Contains the list of minimum
medicines needed for a basic
health care system.
 Cost effective solution for key
health problems.
 For Priority Conditions.
 About 3/4th of all drugs on list.
 Essential medicines for Priority
Diseases.
 Diseases for which special
diagnostic or monitoring
facilities or trained health care
providers are needed.
 About 1/4th of all drugs on list

20. Example of Therapeutic Equivalent, Core &
Complimentary Medicine

21. Therapeutic Equivalence
• Similar clinical performance within a
pharmacological class.
• Listed medicine should be an example of the
therapeutic class
May have best evidence for efficacy and safety
May be 1st licensed compound
When no difference between efficacy & safety between
agents, may be least expensive option.

22. Classification of Essential Medicine List
• Divided into 30 therapeutic categories with further sub-categories.
• 1 Anaesthetics
• 1.1 General anaesthetics and oxygen
• 1.2 Local anaesthetics
• 1.3 Preoperative medication and sedation for short-term procedures
• 2 Medicines for pain and palliative care
• 2.1 Non-opioids and non-steroidal anti-inflammatory drugs (NSAIDs)
• 2.2 Opioid analgesics
• 2.3 Medicines for other common symptoms in palliative care
• 3 Antiallergics and medicines used in anaphylaxis
• 4 Antidotes and other substances used in poisonings
• 4.1 Non-specific
• 4.2 Specific
• 5 Anticonvulsants/antiepileptics
• 6 Anti-infective medicines
• 6.1 Antihelminthics

28. WHO criteria for selection of an essential
medicine
1. Adequate data on its efficacy and safety should be
available from clinical studies.
2. It should be available in a form in which quality,
including bioavailability, and stability on storage
can be assured.
3. Its choice should depend upon pattern of previous
diseases; availability of facilities and trained
personnel; financial resources; genetic,
demographic & environmental factors.

29. 4. In case of two or more similar medicines, choice
should be made on the basis of their relative
efficacy, safety, quality, price and availability. Cost-
benefit ratio should be a major consideration.
5. Choice may be influenced by comparative
pharmacokinetic properties and local facilities for
manufacture & storage.
WHO criteria for selection of an
essential medicine contd…

30. 6. Most essential medicines should be single
compounds. Fixed ratio combination products
should be included only when dosage of each
ingredient meets the requirement of a defined
population group and when the combination has a
proven advantage in therapeutic effect, safety,
adherence or in decreasing the emergence of drug
resistance.
WHO criteria for selection of an essential
medicine contd…

31. 7. Selection of essential medicines should be a
continuous process which should take into account
the changing priorities for public health action,
epidemiological conditions as well as availability of
better medicines/formulations and progress in
pharmacological knowledge.
8. Recently, it has been emphasized to select
essential medicines based on rationally developed
treatment guidelines.
WHO criteria for selection of an essential
medicine contd…

32. Benefits of EML
1. Powerful tool to promote health equity.
2. Proved to be most cost effective element in
healthcare.
3. Flexible & Adaptable, NOT Imposed.
4. Rationalize purchasing & distribution of medicines.
5. Standard Treatment Guidelines.
6. Used by : UNICEF, UNHCR, NGO’s, International
non-profit supply agencies; they base their
medicine supply system on Model List.

33. Benefits of EML
7. Guide procurement & supply of drugs in public
sector, ex. Schemes that reimburse medicine costs,
medicine donations, Health Insurance Schemes.
8. Promotes “Rational Use Of Medicines”.
9. Facilitates : Regulation, Quality, Rationality,
Procurement & Supply.

34. Some interesting facts/observation
List of few drugs included in our National List but not in WHO List :
1. Alprazolam 14. Hormone releasing IUD
2. Atorvastatin 15. Hydrogen Peroxide
3. Albumin 16. Losartan
4. Cetrizine 17. Metoprolol
5. Clopidogrel 18. Midazolam
6. Colchicine 19. Multivitamins
7. DPT vaccine 20. Pheniramine
8. Diclofenac 21. Pantoprazole
9. Dicyclomine 22. Promethazine
10. Domperidone 23. Ringer lactate solution
11. Ether 24. Silver Sulphadiazine
12. Fentanyl 25. Tramadol
13. Fresh Frozen Plasma 26. Raloxifene

35. Some interesting facts (contd…)
• List of drugs included in WHO List but not in our National List
1. Abacavir 13. Efavirenz+Emtricitabine+Tenofovir
2. Amiloride 14. Immunoglobulin (human normal)
3. Artemether 15. Ethionamide
4. Budesonide 16. Ivermectin
5. Caffiene 17. Kanamycin
6. Capreomycin 18. Lactulose
7. NaCl/NaF 19. Levonorgestrel
8. Clarithromycin 20. Mebendazol
9. Cyclizine 21. Propylthiouracil
10. Ethosuximide 22. Xylometazoline
11. Tranexamic Acid 23. ATT drugs in combination
12. Trimethoprim 24. Nicotine Replacement Therapy

36. Some Interesting Facts (contd…)
• Some vaccines included only in WHO List and NOT
in National List
1. Varicella 9.
2. Rubella
3. Rotavirus
4. Pneumococcal
5. Pertussis
6. Mumps
7. Meningococcal
8. H. inflenzae

37. Take Home Points…
•Essential Medicines are an indispensible
component of a healthcare system
•WHO provides an Essential Medicines List that
may be used as a framework for developing a
national, regional or NGO formulary
•The WHO list is updated biannually by expert
committee and takes into account new
medicines, efficacy, safety and cost-effectiveness

38. Thank You