M. Helling Borda October years anniversary 1 WHO Model List of Essential Drugs/Programme – start and evolution Global Perspective and Reflections Margaretha Helling Borda 21 October 2002, Cambodia

M. Helling Borda October years anniversary 2 Overview of the presentation Introduction and background History and major events up to 1977 After first EDL-what? (78-82) Action and evolution (83-88) Increased country impl.of EDC and NDP (89-96) Expansion-new challenges (96-present) Achievements today Conclusion

M. Helling Borda October years anniversary 3 Birth of Essential Drugs Concept (EDC) Complaints in the early seventies: No links between drugs and health needs No access to most essential drugs Rising costs of pharmaceuticals Uneven rural-urban distribution Protests against industry marketing practice No comprehensive NDP to support PHC etc. Against this background birth of EDC

M. Helling Borda October years anniversary 4 Early years up to first WHO model EDL 1975 –1976: WHO era of essential drugs with WHA res Informal WHO consultation on selection 1976 Comments from countries and elsewhere stressing:  Any final list should be a local responsibility  Importance and need for well-established criiteria to guide in selection  Education of physicians and public through information system must accompany any essential drugs list

M. Helling Borda October years anniversary – WHO first model EDL Comments from 1976 working paper and three other major working papers was background for the WHO first Expert Committee on Selection of Essential Drugs WHO Expert Committee on the Selection of Essential Drugs held 17 –21 October 1977 A little blue booklet of about 35 pages –TRS 615 became an instant WHO bestseller

M. Helling Borda October years anniversary 6 The WHO first Expert Commite report TRS 615, the Selection of Essential Drugs a model list of around 250 main and complementary drugs with criteria and guidelines for establishing the list WHO had produced a vital tool for public health According to Médecins sans Frontières (2000) « The first list was a major breakthrough in the history of medicine, pharmacy and public health ».

M. Helling Borda October years anniversary 7 Not all « smooth sailing » in 1977 and after but… Some complaints and objections But… TRS 615 started an evolution - became a central tool in the aim and process to assure regular access to essential drugs the text in the first expert committee report has stood its test of time Still is very much quoted and was used as basis for implementation of the essential drugs concept worldwide

M. Helling Borda October years anniversary 8 After publication of first EDL – what? EDL became the technical tool and HFA/Primary Health Care the policy context  Provision of essential drugs one of the 8 key elements in the aims to attain Health For All by the year 2000 Finding a way in a constrained, complex and confrontational atmosphere  Funds and human resources constraints  Searching for strategies  Lobbying for/against aWHO marketing code for pharm. On the way to action –EDL must be part of NDP

M. Helling Borda October years anniversary 9 Action and consolidation period 1983 –1988: Milestones : 1983: New DAP head -direct reporting to DG 1984: WHA calls for meeting on RUD 1985: Nairobi Conference of Experts on RUD 1986: WHA adopts WHO Revised Drug Strategy 1988: WHO publishes: Ethical Criteria for Medicinal Drug Promotion; Estimating Drug Requirements; World Drug situation; Guidelines for Developing National Drug Policies; and fifth WHO Model EDL « The Use of Essential Drugs « (title changed in third report 1982 to stress use)

M. Helling Borda October years anniversary 10 Reflections on a very exciting action period Countries started implementing ED programmes and NDPs Close country and WHO collaboration– funds started coming « Spirited marketing of the concept of essential drugs »: national and global advocacy Nairobi conference – a mile stone for general acceptance of the EDC  Sharing of responsibilities outlined  Conference set the tone for years to come and reinforced WHO mandate as lead agency on pharmaceutical matters Many lessons learnt from operationalizing the EDC concept

M. Helling Borda October years anniversary 11 Increased country implementation of EDC and NDP: EDC more widely known, accepted and implemented in developing countreis Break up USSR created alarming shortage of essential medicines: adoption of EDL and NDP in the newly independant states (NIS) WHO produced more « how to » methodologies and gudelines: e.g. NDP indicators; how to investigate drug use, good prescribing and teaching guides, regulatory and QA guides, donation guidelines etc., – all reported in the EDMonitor First NDP Expert Commitee in 1995 to update 1988 guidelins

M. Helling Borda October years anniversary 12 Expansion – new complex issues: 1996 – present Catastrophic increases in HIV/AIDS, Malaria, TB New expensive essential drugs – but advocacy, corporate responsiveness and competition have reduced antiretroviral prices 95% in 3 years New partnerships Much expanded mandates for WHO and department of Essential Drugs and Medicines Policy (EDM) Comprehensive WHO/EDM documentation on websites and in publications (NDP, EDL, TRIP, Prices, QA, pharmaco-economics, WHO Formulary)

M. Helling Borda October years anniversary 13 Summary of Achievements in 25 years Use of the WHO Model List of Essential Drugs 156 countries have a national list of essential drugs, of which 81% have been updated in the last 5 years and one third within two years Major international agencies (UNICEF, UNHCR, IDA) base their catalogue on the WHO Model List Sub-sets: UN list of recommended essential drugs for emergency relief (85 drugs); interagency New Emergency Health Kit (55 drugs for 10,000 consultations ) Normative tools: WHO Model Formulary, International Pharmacopoea, Basic Quality Tests, and development of reference standards follow the WHO Model List Source: WHO Department Essential Drugs and Medicines Policy 2002

M. Helling Borda October years anniversary 14 Achievements: Number of countries with a National Drug Policies In 1999 one hundred and one (101) countries had a National Drug Policy  Among these about half (54) were low-income countries, 43 were middle – income countries and 4 were high- income countries In 1995 there were fourty seven (47) countries with a NDP In 1990 ten (10) countries had a NDP In 1985 only five (five) countries had adopted a national drug policy Source: WHO Department Essential Drugsand Medicines Policy 2002

M. Helling Borda October years anniversary 15 Achievements: Number of people with access to essential drugs: In 20 years from 1977 to 1997, when world pop. went from around 4 to close to 6 billion people regular access to essential drugs nearly doubled; from around two to just under four billion people In spite of this, as much as one-third of the world’s six billion people in 1997 lacked access and still lacks regular access Worst situation in Africa where 320 million people have less than 50% access to essential medicines Financing, delivery and other constraints limit access to essential drugs and these problems worsen with economic pressures and poverty Source: WHO Department Essential Drugs and Medicines Policy 2002

M. Helling Borda October years anniversary 16 Conclusion The content in TRS 615 of 1977 with the model essential drug list triggered of an evolution- a revolution- to increase access to essential drugs The WHO Model list of Essential Medicines remains a powerful public health tool Drug selection is a start – a core element in a succesful EDP and NDP implementation The concept of essential medicines has global relevance for today’s challenges

M. Helling Borda October years anniversary 17 Today – 25 th Anniversary of the first WHO Model list Essential Drug List- Is a Tribute to the achievements of all countries with EDL, NDP and improvements in access to essential medicines Thank you