7. Applications of the essential drugs concept

The concept of essential drugs has been endorsed unanimously by the World Health Assembly. It is intended to be flexible and adaptable to many different situations; exactly which drugs are regarded as essential remains a national responsibility.

The concept of essential drugs has been disseminated and promoted extensively at the country level by WHO’S Action Programme on Essential Drugs, as well as by disease control programmes in WHO, international and nongovernmental organizations throughout the world and bilateral agencies. The wide applicability of the concept is now evident from experience gained in many countries. National lists of essential drugs may need to be stratified to reflect skills and requirements at different levels within the health care infrastructure. The model list now contains many medications which require a high degree of expertise to ensure safe and effective use. Adequate specialist skills and complementary resources are needed before the introduction of some classes of drugs. Examples of situations where specialist control of drug use is necessary are:

· The use of reserve antimicrobials for multiresistant bacteria.
· Establishing adequate regimens for treatment of tuberculosis and leprosy.
· The use of antineoplastic and immunosuppressive drugs.
· The use of antiretroviral drugs.
· The use of antimicrobial, antifungal and antiviral agents for the treatment of opportunistic infections in immunocompromised patients.

Typically, a very short list has been compiled for community health workers while the most comprehensive lists have been reserved for large urban and regional hospitals. Many countries have also successfully applied the concept to teaching hospitals and facilities providing specialized care. The concept has also been applied in the development of national formularies (section 13).

The model list has been adopted by numerous international and bilateral agencies that now include drug supply and the rationalization of drug use in their health care programmes. Adoption of the list has resulted in greater international coordination in health care development, and it is also being used to evaluate whether drug donations are appropriate in a given situation.

A shorter, adapted list has proved to be of particular value in emergency situations. It is contained in an emergency health kit (33), designed to cover the basic needs of a population of 10000 for a period of about 3 months, which has been developed and updated by WHO, the Office of the United Nations High Commissioner for Refugees, UNICEF, Médecins sans frontières, the International Federation of Red Cross and Red Crescent Societies, the Christian Medical Commission and several other nongovernmental organizations. Many non-profit suppliers maintain a stock of kits containing most of the drugs on the list, which allows a rapid response to demand. In addition, the same interagency group has drawn up a slightly longer list of essential drugs for use in emergency situations, which has been included in a United Nations catalogue of items for emergency relief (34).

The concept of essential drugs has also been applied to the integrated management of childhood illness (35), which the Committee considered an important aspect of WHO’S work.