EDL

1. CONCEPT OF
ESSENTIAL DRUGS
Azhar Hussain
Associate Professor & Director
Hamdard Institute of Pharmaceutical Sciences
Hamdard University, Islamabad.

2. The Access to Medicines
Crisis
Communicable diseases = leading causes of
death in developing countries, accounting for
over 25% of all deaths globally
14 million die each year, 97% in developing
countries
- HIV/AIDS: 3 million per year
- Tuberculosis: 2 million per year
- Malaria: 1-2 million per year
1/3 of world lacks access to essential quality
drugs, diagnostics, vaccines

3. CONCEPT EMERGENCE
• Essential Drugs concept has global relevance &
potential to meet global needs
• Originated in 1975
• World Health assembly introduced two concepts
aimed at Public Health “Essential Drugs” &
“National Drug Policy”
• Materialized in 1977 when WHO announced its
first Model List of Essential Drugs List (EDL)
• Declaration of Alma Ata identified “provision of
essential drugs” as one of the eight elements of
primary health care

4. CONCEPT EMERGENCE
• EDL helped to establish the principle that
some medicines were more useful than
others and that essential medicines were
often inaccessible to many populations

5. The WHO Model List of
Essential Medicines
• 1977 - 1st
Model List
– 208 active substances
• 2002 - 12th
Model List
– 325 active substances
– 13th
Model List
– 14th
Model List

6. National Essential Medicines List
< 5 years (127)
> 5 years (29)
No NEDL (19)
Unknown (16)
156 countries with
EDLS
1/3 within 2 years
3/4 within 5 years
Countries with an official selective list for training, supply, reimbursement or related health
objectives. Some countries have selective state/provincial lists instead of or in addition to
national lists.
20022002 - at least 156 countries with national / provincial lists for
procurement, reimbursement, training, other uses
Essential medicines listsEssential medicines lists
19771977 - perhaps a dozen countries with national lists

7. EDL PAKISTAN
• 1st
EDL 1988 Drug Formulary
• 2nd
EDL 1994
• 3rd
EDL 1996 477 medicines
• 4th
EDL 2002 464 medicines
• 5th
EDL 2005 400 medicines

8. DEFINING
ESSENTAIL MEDICINES
• Defining an essential medicine has moved from
an experience to an evidence-based process,
including criteria such as public-health
relevance, efficacy, safety, and cost-
effectiveness.
• Differences exist between the WHO model EDL
and national EDLs since countries face varying
challenges relating to costs, drug effectiveness,
morbidity patterns, and rationality of prescribing

9. DEFINING …….
Essential drugs are those that meets
priority health care needs, strong
evidence of efficacy and safety exists
and they represents good value for
money, they should also be of
assured quality, and sold at a price
that individual and community can
afford. (WHO)

10. Pooled
procurement
Quality
assurance
STGs
Formulary
Essential Medicines List
Research
Monitoring
Unbiased
Info
Rational
prescribing

11. ED list a useful tool for …..
• Policy making
• Management
• Selection
• Procurement
• Distribution
• Inventory management
• Quality assurance
• Financing

12. ED list a useful tool for …..
• Promoting rational use
• Training of health Professionals
• For providing medicines information
and education
• Cost effective therapy

13. FACTORS EFFECTING PRICES
Prices of essential medicines
in developing countries
Generic
competition
Monopolies
Local
production
Differential
pricing
TRIPS
safeguards
High
volume
Low volume, low
demand

14. Number of drugs from the national essential drug
list prescribed, out of total number of drugs
prescribed.
Geographical Region Public
%
Private %
Federal Area 75.37 49.1
Punjab 81.40 50.11
N.W.F.P 66.24 45.08
Sind 81.07 47.55
Collective 76.02 47.96

15. Number of drugs from NEDL sold out of total
number of drugs sold.
Geographical Region Number of Drugs
Sold
Federal Area 50.66 %
Punjab 55.66 %
N.W.F.P 48.33 %
Sind 55.33
Collective 52.48 %

16. Average stock-out duration for a basket of
drugs
Geographical Region Average Stock-out
Duration
Federal Area 171.3 days
Punjab 147.9 days
N.W.F.P 278.95 days
Sind 197.00 days
Collective 198.78 days = 6.62
months

17. Number of prescribers having direct access
to NEDL
Geographical Region Prescribers having
NEDL
Federal Area 10 %
Punjab 0 %
N.W.F.P 0 %
Sind 0 %
Collective 2.5 %