The document discusses the history and development of essential medicines. It outlines key events like the growth of new drugs post-WWII, the thalidomide tragedy of 1960, and the 1978 Alma-Ata declaration which established primary health care and inclusion of essential drugs. The WHO defines essential medicines as those that satisfy the majority of a population's health needs. Selection criteria include disease patterns, treatment facilities, and financial resources. National drug policies aim to ensure appropriate access to and use of essential medicines.

1. Essential Medicine
Monday Seminar of Public Health Department
Faculty of Medicine –Assiut University
Egypt

2. By:
Alyaa Hassan Abo-Rahma
Demonstrator of Public Health and
Community Medicine
Faculty of Medicine- Al-Azhar University

4. Following the Second
World War there was
great growth in the
development of new
medicine products

5. 1960s…… wide range of medicines was
available including antibiotics,
analgesics, antihistamines, sedatives,
cardiovascular medicines as well as
vitamin supplements and growth
hormones with little control in many
countries. Anything could be sold
and bought by anyone who could
afford it.

6. 1960 !!!!
The Thalidomide
Tragedy

7. By 1960, Thalidomide was
marketed in 46 countries,
with sales nearly matching
those of aspirin.

12. The drug was withdrawn
from sale

13. According to the World
Health Report (WHO, 2008)
‘nearly 30 000 children die
every day from diseases that
could easily have been
treated if they had had
access to essential
medicines’.

14. The birth
of the essential medicine concept

15. Begin as Idea In the Twenty-eighth WorId
Health Assembly.
in 1975 the Director-General reviewed:
• The main drug problems facing the
developing countries.
• Outlined possible new drug policies.
• Referred to the experience gained in some
countries where schemes of basic or
essential drugs implemented.

18. Identified the primary health
care as the key to reach the goal
of Health for All

19. The concept of essential
medicine was mentioned in one
of the ten points of the
1978 Alma Ata declaration.

20. VII
Primary health care:

21. 3. includes at least:

22. …. promotion of food supply and proper
nutrition; an adequate supply of safe
water and basic sanitation; maternal
and child health care, including family
planning; immunization against the
major infectious diseases; prevention
and control of locally endemic diseases;
appropriate treatment of common
diseases and injuries; and provision of
essential drugs.

23. 1981……WHO established the Action
Programme on Essential drugs to
implement national drug policy.
1998…..WHO created the department
of essential drugs and other medicines
(EDM).

24. Definition Of Essential
Medicine

25. Essential medicines, as defined by
the (WHO) are "those drugs 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 appropriate dosage forms, at a price
the community can afford."

26. Criteria For The Selection
Of Essential Drugs

27. The choice of selection depends on:
1- pattern of prevalent diseases.
2- Priority of health problems.
2-the treatment facilities.
3-the training and experience of the available personnel.
4-the financial resources.
Each selected drug must be available in a form in which
adequate quality, including bioavailability, can be
assured; its stability under the anticipated conditions of
storage and use must be established.

28. If two or more drugs appear to be approximately
similar →→ the choice between them should be
made on the basis of
In cost comparisons between drugs, the cost of the
total treatment, and not only the unit cost of the
drug, must be considered.

29. Essential Medicine And Primary
Health Care

30. 1-The pattern of endemic disease: The prevalence of
major endemic infections and parasitic diseases may vary
from region to region within a country. Careful planning
and epidemiological surveys are required to ensure that
the most effective drugs are provided.
2- Existing systems of medicine: The establishment of
primary health care services in developing countries
should not result in abrupt disruption of prevailing
cultural patterns in rural communities.
3- The national health infrastructure.
the proximity and nature of the first referral facilities.

31. 4-Training and supplies: The numbers of trained
personnel. Workers with one or more years'
training can do more than personnel reliant upon
an intensive course of practical instruction lasting
only a few weeks.

32. Components Of A National Drug Policy
(1) Identifying therapeutic needs in the
community.
(2) Selecting essential drugs for the different
levels of the health care system.
(3) Estimating quantities needed for the various
drugs.
(4) Improving drug supply and management,
including procurement, storage, distribution, and
the related training of personnel.

33. (5) Ensuring the proper use of essential drugs
through the provision of appropriate
information and training.
(6) Providing education for health workers and
the general public for the proper use of drugs;
(7) Developing financing mechanisms to ensure
the availability
And equality in the health care system;
(8) Strengthening local production of certain
(9) Ensuring quality control

34. (10) Introducing proper legislation covering such
matters as drug registration; proprietary and
generic names; quality Assurance
(11) Ensuring coordinated multi-sectoral action by
all other sectors involved, such as education,
planning, finance, industry, trade.
(13) An evaluation process to assess the progress of
the national drug policy implementation.

35. WHO LIST
Classified by their therapeutic action

36. WHO list

38. Drug information sheet
-Generic name of each active substance.
-Clinical information: (a) Indications (b) Dosage
pharmacokinetic data:
-average and range for adults and children:-special
situations, e.g., renal, hepatic, cardiac.
-Contraindications.
-Precautions and warnings -Adverse effects - Drug
interactions - Over dosage:
-Pharmaceutical information:
-Dosage forms.
-Storage conditions and shelf-life (expiry date).
-Pack sizes.
- Legal category (narcotic or other controlled drug.
-Name and address of manufacturer.

39. The 1st WHO Model List of Essential Medicines
for Children was developed by a sub-committee
in July 2007.

40. Is Vaccine Considered Essential Drugs?
WHO's creation of the Expanded Program on
Immunization (EPI) in the 1970s established a
policy for selection and use of vaccines that the
vast majority of developing countries adopted.
Only three vaccines: HepB, yellow fever (YF), and
Haemophilus influenzae type B (Hib) have been
added since then, and the overall program
directions remain largely intact.

41. WHO national vaccine policy
• Every eligible child must have equal access to
nationally adopted vaccines regardless of
religion, caste, or economic status.
• Countries should strive toward financial
Support for the national immunization
program

42. Prescription and Rational Use of Drugs
the correct drug being given to the correct patient,
for the correct indication, in the correct dosage, by
the correct route of administration, for the correct
duration of treatment.
Any error at any stage of this complex
process can prevent the drug from being
effective.

43. Drug Quality
• Storage:
Temperature
Air, light
• Deterioration:
Color, Odour, Solubility.
• Expiration:

44. • Limiting the use of injection: more cost
• Limiting the use of syrup: incorrect dose
• Shortest and least divided doses

45. The Essential Medicine Not
Only Essential Drugs !!
But also essential equipment
and supplies
A lot of information is available
about essential drugs, and WHO
have produced model lists of
essential drugs. Until recently, less
information was available about
medical supplies and equipment,
despite the fact that there is a
much wider range of different
brands

46. Medical supplies and equipment
■ Supplies : Items that need to be replaced on a
routine basis, including: disposable syringes and
needles, items that are used within a short time,
e.g. cotton wool, laboratory stains and tape;
reusable items, e.g. catheters.
■ Equipment :Durable items that last for several
years, e.g. beds, examination tables, sterilizers,
microscopes.

49. Choosing equipment is often given little
attention.
Items can be inappropriate
because they are technically
unsuitable or incompatible
with existing equipment,
accessories or spare parts
are not available, or because
staff have not been trained
to use them.
This can result in procurement of
inappropriate equipment.

51. Definition:
Planned and systematic actions that can be
demonstrated to provide confidence that a
product or services will fulfill the requirements
for quality.

52. Importance
1-Ensure the ongoing quality, safety and
effectiveness of medical devices
2- Avoid medical device failures during critical
medical procedures
3-Improve clinical effectiveness and device
availability
4- Reduce patient and staff risk and improve
patient confidence

53. Maintenance
Medical equipment should be maintained at a
higher safety level than other types of equipment.
Maintenance not only has a positive impact on the
safety and effectiveness of healthcare technology,
but also has two important economic benefits:
1- It increases the lifetime of equipment and thus
helps to save costs.
2- It enhances the demand for health services.

54. Healthcare Equipment That Is Out Of Order
Quickly Leads To A Decline In Demand,
Which Will In Turn Reduce The Income And
Quality Of Services Of The Health Facilities.
The Hospital Will Lose Clients

56. CASE 1:
a female aged 42, married with four children
started taking T.B therapy in 2015 Though
Anti T.B has improved her life, she still face
huge difficulties adhering to the TTT.
She has to travel 50 kilometers from her
village to the nearest clinic every month.
Mona starts her journey in the morning either
on foot or if she is lucky, she finds a van which
she pays an equivalent of 8USD to and fro.

57. Upon arrival at the clinic she usually waits for
5 to 6 hours and occasionally finds some
food to eat which costs her nearly 0.5 USD.
She finally see the doctor, who takes less
than ten minutes to do routine check ups.
Usually she gets no chance to ask questions,
and too often the doctor is already
overworked and moody.
Furthermore, she may need to have liver
tests and others investigations done, which
cost a lot of money”.

58. Access means not only the availability of drugs at
the health care institution, but also the ability of
the patient to physically get them. Transport,
meals, diagnostic tests and other related costs,
act as barriers to access for many in the
community. Furthermore adequate human
resources to ensure patients receive adequate
attention is a major factor in the success of
treatment. Therefore though delivery of drugs
and supply to the community is a major issue for
the success of PHC, this must be accompanied by
other supportive services.

59. Mr X a male aged 36, married with two children,
diagnosed as urinary bladder carcinoma with bone
metastasis this caused him severe pain that he
could hardly
sleep.
He went to a public hospital where the doctor
prescribed him a strong pain killer and advised him
to visit a private clinic. He visited the clinic and he
was in shock to find that the clinic belonged to the
doctor who prescribed him the medicines in the
public hospital.

60. “I was re-examined with some simple test and
the doctor told me that I have to take the very
pain killer he earlier prescribed.” He says. The
price of the medicines was about 200$. He was
forced to use the money he had reserved for rent
since he was desperate.
“After learning more about essential medicines, I
discovered that the pain killer I was given at the
private clinic was on the essential medicine drug
list.” He says.

61. Drugs use Indicators
Core drug use indicators :
• Average number of drugs per patiant
• Percentage of drugs prescribed by generic
name
• Percentage of patients with antibiotic
prescribed
• Percentage of patients with injection
prescribed
• Percentage of drugs prescribed from essential
drug list

62. Patient care indicators:
• Average consultation time
• Patient knowledge of correct dosage
• Percentage of drugs actually
dispensed
• Average dispensing time.

63. The medicine situation
Accessibility : distance, quantity, quality,
financial ((affordable )).
Multiple source of supply :Governomental,NGO
Corruption affect the selection
Good prescription writing
Self medication : challenge
Affordable price

64. A non-functioning health care system can lead
to unscrupulous practices.
In addition a lack of understanding of what
drugs are essential and therefore should be
available at all times can be costly to the
patients.

65. A primary health care system without
medicines like
a river without water. (J. Escobal,2007)