The document discusses the concept of essential medicines and rational use of medicines. It defines essential medicines as those that satisfy the priority healthcare needs of the population based on criteria such as public health relevance, efficacy, safety and cost-effectiveness. Rational use requires patients receive appropriate medications for an adequate time at lowest cost. Irrational use can lead to ineffective and unsafe treatment, increased morbidity and mortality, and unnecessary costs. Strategies to promote rational use include education and training of healthcare providers, use of treatment guidelines, and ensuring availability of essential medicines.

1. ESSENTIAL
MEDICINE LIST
CONCEPT AND
RATIONAL USE OF
MEDICINE
Dr. Pravin Prasad
MBBS, MD Clinical Pharmacology
Assistant Professor, Department of Clincal
Pharmacology,
Maharajgunj Medical Campus, T.U.
13th December 2021 (27 Mangsir 2078),
Monday

2. List the criteria required for a medicine to be an Essential
Medicine
Define Rational use of Medicines
List examples of irrational use of medicines
Explain the strategies to minimise irrational use of medicines

3. “Those drugs that satisfy the priority of
healthcare needs of the population”
- World Health Organization

4. Medicines
Registered
Medicines Public
Health
Relevance
Efficacy
and
safety
Cost
effective
Essential
Medicines

5. ESSENTIAL MEDICINE CONCEPT
At all times
Should be available within the context of
functioning health systems
In adequate
amount
In appropriate
dosage forms

6. ESSENTIAL MEDICINE CONCEPT
Assured
Should be available within the context of
functioning health systems
Adequate
information
Affordable price to
individual

7. • Drug name
• Dosage forms
• Dosage
strength
• Indications*
Single vs Fixed
Dose
Combinations??
Main vs
Complementary
List

8. First Model List of Essential Drugs by WHO in 1977
AD
Current Edition –September 2021
Adult (WHO-EML): 22nd Edition
Paediatric (WHO-EMLc) – 8th Edition

9. National List of Essential Medicines
Nepal
Current Edition: 2021, Sixth
Approved on 21 April 2021
No separate list for paediatric
population
Modified for different level of health
facilities

10. RATIONAL USE
OF MEDICINES
Dr. Pravin Prasad
MBBS, MD Clinical Pharmacology
Assistant Professor, Department of Clincal
Pharmacology,
Maharajgunj Medical Campus, T.U.
27 December 2021 (12 Poush 2078),
Monday

11. The rational use of drugs requires that patients receive
medications appropriate to their clinical needs, in doses that
meet their own individual requirements for an adequate
period of time, and at the lowest cost to them and their
community.
WHO conference of experts Nairobi 1985
So, what would you understand by Irrational use of Medic

12. Irrational Use has various harms.
Ineffective & unsafe treatment
Increased morbidity (Adverse Drug Events,
prolonged illness) and mortality
Distress, harm and cost burden to patient and
community as a whole
Increased drug resistance

13. Lack of information
Role models – Teachers or seniors
Lack of diagnostic facilities/Uncertainty of diagnosis –
medicine for all possible causes
Demand from the patient

14. Patient load
Promotional activities of pharmaceutical industries
Drug promotion and exaggerated claim by companies
Defective drug supply system & ineffective drug regulation

16. Injudicious use of
antimicrobials
Unnecessary combinations
Use of drugs not related to
diagnosis
Incorrect route
Incorrect dosing – under or
overdose
Incorrect duration – prolong
or short term use
Unnecessary use of
expensive medicines
Unsafe use of
corticosteroids
Polypharmacy

18. Training for Providers
Undergraduate education
Continuing in-service
medical education (seminars,
workshops)
Face-to-face persuasive
outreach e.g. academic
detailing
Clinical supervision or
consultation
Printed Materials
Clinical literature and
newsletters
Formularies or therapeutics
manuals
Persuasive print materials
Media-Based Approaches
Posters
Audio tapes, plays
Radio, television

19. Changes in selection, procurement, distribution to ensure
availability of essential drugs
Essential Drug Lists, morbidity-based quantification, kit
systems
Strategies aimed at prescribers
targeted face-to-face supervision with audit, peer group
monitoring, structured order forms, evidence-based
standard treatment guidelines
Dispensing strategies
course of treatment packaging, labelling, generic

20. Avoid perverse financial incentives
prescribers’ salaries from drug sales
insurance policies that reimburse non-essential drugs or
incorrect doses
flat prescription fees that encourage polypharmacy by
charging the same amount irrespective of number of drug
items or quantity of each item

21. Drug registration
Banning unsafe drugs - but beware unexpected results
Substitution of a second inappropriate drug after banning a
first inappropriate or unsafe drug
Regulating the use of different drugs to different levels of the
health sector e.g.
Licensing prescribers and drug outlets
Scheduling drugs into prescription-only & over-the-counter
Regulating pharmaceutical promotional activities

22. Any Queries?
Thank you!