14. Selection and updating of lists of essential drugs

An essential drug list must be flexible enough to accommodate, as necessary, new drugs, new information on established drugs and changes in the status of internationally controlled substances. Experience with the original model list and the subsequent revisions, as well as with regional and national lists of essential drugs, has confirmed the need for regular review and updating. Revision is necessary not only because of advances in drug therapy but also in order to meet the needs of practice in the light of experience. Frequent and extensive changes are clearly undesirable since they result in disruption of channels of procurement and distribution and may have implications for the training of health personnel. For this reason a number of drugs have been retained on the model list that have been largely superseded in countries where there is a more extensive range of new medicaments but that are still used widely and successfully elsewhere. In revising and updating the model list, the Committee was guided in its deliberations by the following statements which appeared in the first report:

1. The extent to which countries implement schemes or establish lists of essential drugs is a national policy decision of each country.

2. As far as health services in developing countries are concerned, the organized procurement and use of essential drugs have many advantages in terms of economy and effectiveness. However, the concept of “essential drug lists” must accommodate a variety of local situations if the lists are ever to meet the real health needs of the majority of the population.

3. There are convincing justifications for WHO to propose “model” or “guiding” lists of essential drugs as a contribution to solving the problems of Member States whose health needs far exceed their resources and who may find it difficult to initiate such an endeavour on their own.

4. Such “model” or “guiding” lists should be understood as a tentative identification of a “common core” of basic needs which has universal relevance and applicability. In certain situations, there is a need to make available additional drugs essential for rare diseases. The further local needs move away from the core, the more the health authorities or specific sectors of the health services will have to adjust the lists. However, any list proposed by WHO should set out to indicate priorities in drug needs, with the full understanding that exclusion does not imply rejection. A list of essential drugs does not imply that no other drugs are useful, but simply that in a given situation these drugs are the most needed for the health care of the majority of the population and, therefore, should be available at all times in adequate amounts and in the proper dosage forms.

5. The selection of essential drugs is a continuing process, which should take into account changing priorities for public health action and epidemiological conditions, as well as progress in pharmacological and pharmaceutical knowledge. It should be accompanied by a concomitant effort to supply information and give education and training to health personnel in the proper use of the drugs.

Applications for the addition of drugs to the model list will always receive full consideration by WHO. An application form can be found in Annex 1.