Essential Drugs

Definition – drugs that satisfy the health care needs of the majority of the population

Therefore, they need to be available at all times, in adequate amount, in appropriate dosage forms and at all levels of health care delivery

It is a major component of PHC

Public confidence in health services depend on the maintenance of reliable and affordable supply of drugs

What makes a drug merit designation as Essential drug?

• Meet common health needs of the people
• Have significant therapeutic effect
• Adequately safe
• Cost-effective – satisfactory value for money

In 1981, WHO Action Program on essential drugs was established

Provide operational support to countries in development of national policies that will help in rational use of drugs

13th Dec 1989 Nigeria promulgated decree 43

States that no one shall deal with any drug by way of importation, display for sale, advertise or manufacture in Nigeria any drug which is not contained in the list without the expressed permission of the Minister of Health

To use a drug not on the list there must be evidence of:

• Drug required to treat uncommon disease
• Disease require specialized skills for diagnosis and treatment
• Evidence of intolerance or lack of response to the drug on the list

Only drugs on the list can be prescribed

Prescribed drug must be in generic name

Drug labels must contain the generic name of the drug

Administratively limits and guides prescribers of drugs

Serve as a medium for producing and maintaining a selection of essential drugs for a health system

List varies depending on level of health care delivery

List reviewed periodically

Limiting number of drugs promotes rational use

Effective spending on health care since large proportion goes into drugs

Prevent unnecessary, ineffective and often dangerous drugs and irrational selection and use

Health need of the majority of the people

Efficacy

Safety

Quality

Stability

Ease of storage

Price

Availability

Factors affecting choice

• Prevalent diseases
• Treatment facilities
• Training and experience of personnel
• Financial resources
• Demographic and environmental factors

Select only drugs with sound and adequate data on efficacy

Drugs selected should in a form in which adequate quality and bioavailability can be assured

Score the drugs based on the criteria set when there are more that the number to include on the list

Also consider cost of the drugs – for total treatment, not only unit cost

To make drugs available to the entire population

To promote rational use of drugs

Increase attendance and credibility of health facilities

To ensure safety and efficacy of drugs

Rational selection of essential drugs

Rational procurement of drugs

Rational distribution of drugs

Rational use of drugs

Administration

Information System

Personnel

Facilities

Equipment

Finance

Means patients receive drugs appropriate to their clinical needs, in doses that meet their own individual requirement for an adequate period of time and at the lowest cost to them and the community

Need to assess the patient and balance the benefit against risk and cost

Drugs need to be available when needed

Using drugs when unnecessary

Some ailments are self-limiting

About half of prescribed drugs are of real benefit to patients

False perception that there is a drug for every illness

Practice of polypharmacy by prescribers and drug sellers (Akape)

Some patients have access to drugs more than they need and others do not have what they need

Patient compliance to prescribed drugs (20 – 50%)

Poor communication is a factor in poor compliance

Prescribers do not make reliable diagnosis

Symptomatic treatment of patients

Unqualified people prescribe

Practice of self-medication

Poor quality of training on drug quality

Resistance to change by die-hards

Unregistered pharmacy shops

Sale of fake drugs – too many illegal manufacturers

Free sale of drugs without demanding for prescription for prescription

Fraudulent diversion and sale of government supplied essential drugs

Slow pace of supply of drugs in the face of rapid demand

Poor distribution system of drugs particularly to the rural areas

Smuggling of drugs not on the list into the country

Encourages utilization of drugs within limited resources

Ensures adequate and regular supply of drugs to rural areas at affordable cost

Essential for effective and uniform costing of health insurance scheme

Checks polypharmacy

Research is concentrated in areas of essential drugs

Enables formulation and standardization of treatment pattern

Reduces wastage from drugs – expired drugs that are not in demand

Drugs available at health facilities to the benefit of the populace

ED list ensure that first line drugs are readily available

Help with the problem of health funding

Drugs take a major component of health care financing

Increasing burden on the part of government because of increasing population, increasing burden of disease and complexity/high technology in treatment of diseases

Government can no longer cope with free drug policies for all diseases

Drug availability in health facilities a major concern in developing countries

Lot of inefficiency in procurement, distribution, storage and prescription of drugs

African Ministers of Health launched the Bamako initiative in 1987 as a solution to the poor primary health structures and functionality

Strong advocacy in favor of use of essential drugs in order to ensure access to quality drugs at affordable cost

Promote better drug prescribing and use

Use of generic names

Community participation in drug management

Cost recovery in drugs sales – sales with lowest possible profit to maintain supply

Drug revolving scheme – involves provision of drug revolving fund Initial seed money (capital) used to procure drugs.

Drugs are sold to consumers with little profit to sustain availability of drugs and maintain other vital aspects of health services

Monies from sold drugs used to further procure drugs

Initial seed money may be provided by Government, Agencies, Donors, Community.

Provision should be made for increasing the capital to take care of inflation and increasing drug needs

Fund management is a major problem in developing countries