The availability of medicines in developing countries is undermined by several factors: poor medicine supply and distribution systems; insufficient health facilities and staff; and low investment in health and the high cost of medicines.
The Essential Medicines List can help countries rationalize the purchasing and distribution of medicines, thereby reducing costs to the health system.
Pharmaceuticals account for 15% to 30% of health spending in transitional economies and 25% to 66% in developing countries. In some developing countries, medicines are the largest health expense for poor households.
A 2006 WHO study in China of 41 surveyed medicines – 19 of which were essential – showed only 10% were available in private pharmacies as branded products and 15% as generics.
A 2004 survey in Uganda showed that among 28 nationally listed essential medicines, only 55% could be found in free health facilities. “Out-of-pocket’ prices were 13.6 times higher for branded products and 2.6 higher for generics than the international pricing reference.
Only about a dozen countries had an essential medicines list or programme in 1977. Today, four out of five countries have adopted national lists. To be selected, medicines must be available through health systems, in suitable amounts and dosage forms. The list is a cornerstone of national medicine policies and the entire pharmaceutical system.
By 2015, over 10 million deaths per year could be avoided by scaling up certain health interventions, the majority of which depend on essential medicines. The Declaration of Alma-Ata in 1978 – a milestone in international public health – was the first official document to underline the importance of primary care and the role of essential medicines at a global level.
Thirty years ago, the concept of a national medicine policy was unknown in most countries. Today, over 100 countries have policies in place or under development. They can act as frameworks to advance pharmaceutical sector reform. Early pioneers in essential medicines include Mozambique, Peru and Sri Lanka.
Objective information on rational use of medicines was extremely limited, especially in developing countries. Today at least 135 countries have their own therapeutic manuals and formularies with current, accurate and unbiased information.
Growing from an international effort started in 1977, a global network of 83 countries now monitors for adverse medicine reactions and potential safety problems.
Thirty years ago, there was virtually no publicly available price information for medicines and few countries actively encouraged generic substitution. Today, 33 countries collect and make pricing information public. The use of generic medicines has brought down prices through increased demand and competition.