Making the List: The Role of Essential Medicines Lists In Reproductive Health

Abstract

After immunization for common childhood illnesses, appropriate use of essential medicines is one of the most cost-effective components of modern health care. (1) Many interventions for communicable and noncommunicable diseases and conditions that threaten maternal and child health rely on the use of these high-quality medicines. (2) In 1977, the World Health Organization (WHO) developed its first model list of essential medicines to provide governments with a guide for selecting the drugs and medical devices that best address public health needs. (2) National essential medicines lists give priority status to the medicines necessary to treat a country's most pressing public health problems. By focusing public sector medicine procurement and treatment on this limited set of essential medicines, resources will be maximized. The lists are, in short, a vital tool for improving and maintaining health. As a result, for more than three decades, WHO has devoted substantial effort to an essential medicines program that seeks to improve access to the most needed drugs and devices. This comment examines the development of essential medicines lists--both the WHO model list and those compiled by individual countries. We discuss the place devices and medicines for reproductive health occupy on national lists and the importance of their inclusion in reducing the burden of disease attributable to reproductive health problems. We also review the process of establishing essential medicines lists, give examples of their use at the country level, and provide insight into their potential for ensuring access to medicines and devices for reproductive health. Our assessment draws on multiple sources of information, including WHO guidelines on essential medicines, data collected by individual countries, and work completed by WHO, the United Nations Population Fund (UNFPA) and PATH as part of our joint development of a guide to the essential medicines list selection process at the country level. Determining the WHO Model List The idea behind the lists was, and remains, that the use of a limited number of proven, essential medicines leads to better health care, improved supply, lower costs, and broader and more equitable access to products. (1) Some 30 years later, national essential medicines lists are in place in most WHO member states. (2) They provide support for national policies regarding the use and availability of medicines and promote primary health care by providing a rationale for the selection and use of medicines and their cost. Every two years, WHO convenes a committee on the selection and use of essential medicines with experts from around the world in such fields as medicine, pharmacology, medicines policy and medicines regulation, as well as other health organizations. The expert committee updates the model list to reflect changes in global health concerns, pharmaceutical developments and patterns of drug resistance. Applications for inclusions, changes or deletions to the model list can be prepared by outside institutions, but must be sponsored or submitted by someone within a WHO program. These applications are intended to be evidence-driven and must explain why a specific drug meets the model list's criteria for acceptance. The criteria take into account disease prevalence, evidence of efficacy and safety, and comparative cost-effectiveness. Applications include the names of the submitting or supporting WHO representative and of organizations consulted in preparing and supporting the application. (3) The 18th Expert Committee on the Selection and Use of Essential Medicines will be held March 21-25, 2011. The most recent WHO model list (http://www.who.int/selection_medicines/committees/expert/17/sixteenth_adult_list_en.pdf) was revised in March 2009 and identifies 340 medicines that address conditions that include malaria, HIV/AIDS, diabetes and cancer. (2) Organized by category of medication (for example, oxytocics is a category, as is antioxytocics), the model list identifies specific drugs by generic names, such as misoprostol and nifedipine. …