World Health Organization Model List of Essential Medicines

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The World Health Organization (WHO) Model List of Essential Medicines is a guideline for national governments that want to ensure they have an inventory of the medicines needed by every health system.

The list is important because:

  • it forms the basis of national drugs policy in many countries, both developed and developing (e.g. South Africa, Eritrea).
  • governments refer to WHO recommendations when making decisions on health spending.

Essential medicines: theory and practice

The original 1977 WHO definition of “essential medicines” was that they were ‘of utmost importance, basic, indispensable, and necessary for the healthcare needs of the population’.[1] The concept was mentioned in one of the ten points of the 1978 Alma Ata Declaration on primary health care.

The difficulty of putting this into practice is reflected in the rather longer and more categorical 2002 definition:

‘Essential medicines are those that satisfy the priority health care needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness. Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford. The implementation of the concept of essential medicines is intended to be flexible and adaptable to many different situations; exactly which medicines are regarded as essential remains a national responsibility.’[2]

The WHO Model List of Essential Medicines has been updated every two years since 1977. The current version, the 15th list, dates from March 2007.

Sections

The constituents of the list remain controversial. The list is divided into two sections:

  • Core medicines that are efficacious, safe, and cost effective medicines for priority conditions.
  • Medicines that are efficacious, safe and cost effective, but that are not necessarily affordable, or for which specialized healthcare services are required.

Cost-to-benefit ratio

Cost effectiveness is difficult to define and is the subject of fierce debate between producers (pharmaceutical companies) and purchasers of drugs (national health services).

Number of drugs

The number of drugs has nearly doubled, from 186 in 1977 to 320 in 2002. The range has increased substantially over the years and now includes antimigraine drugs, antidotes, and antineoplastic drugs.

List

A † indicates the medicine is a complementary item.

1. Anesthetics

1.1 General anesthetics and oxygen

1.2 Local anesthetics

1.3 Preoperative medication and sedation for short-term procedures

2. Analogesics, antipyretics, non-steroidal anti-inflammatory medicines, medicines used to treat gout and disease modifying agents in rheumatoid disorders

2.1 Non-opioids and non-steroidal anti-inflammatory medicines (NSAIMs)

2.2 Opioid analgesics

2.3 Medicines to treat gout

2.4 Disease modifying agents used in rheumatoid disorders (DMARDs)

3. Antiallergics and medicines used in anaphylaxis

4. Antidotes and other substances used in poisonings

4.1 Non-specific

4.2 Specific

5. Anticonvulsants/antiepileptics

6. Anti-infective medicines

6.1 Anthelminthics

6.1.1 Intestinal anthelminthics
6.1.2 Antifilarials
6.1.3 Antischistosomals and antitrematode medicine

6.2 Antibacterials

6.2.1 Beta Lactam medicines
6.2.2 Other antibacterials
6.2.3 Antileprosy medicines
6.2.4 Antituberculosis medicines

6.3 Antifungal medicines

6.4 Antiviral medicines

6.4.1 Antiherpes medicines
6.4.2 Antiretrovirals
6.4.2.1 Nucleoside/nucleotide reverse transcriptase inhibitors
6.4.2.2 Non-nucleoside reverse transcriptase inhibitors=
6.4.2.3 Protease inhibitors=
6.4.3 Other antivirals

6.5 Antiprotozoal medicines

6.5.1 Antiamoebic and antigiardiasis medicines
6.5.2 Antileishmaniasis medicines
6.5.3 Antimalarial medicines
6.5.3.1 For curative treatment
6.5.3.2 For prophylaxis
6.5.4 Antipneumocytosis and antioxoplasmosis medicines
6.5.5 Antitrypanosomal medicines
6.5.5.1 African trypanosomiasis
6.5.5.2 American trypanosomiasis=

7. Antimigraine medicines

7.1 For treatment of acute attack

7.2 for prophylaxis

8. Antineoplastic, immunosuppressives and medicines used in palliative care

8.1 Immunosuppressive medicines

8.2 Cytotoxic medicines

8.3 Hormones and antihormones

8.4 Medicines used in palliative care

None

9. Antiparkinsonism medicines

10. Medicines affecting the blood

10.1 Antianaemia medicines

10.2 Medicines affecting coagulation

11. Blood products and plasma substitutes

11.1 Plasma substitutes

11.2 Plasma fractions for specific use

12. Cardiovascular medicines

12.1 Antianginal medicines

12.2 Antiarrhythmic medicines

12.3 Antihypertensive medicines

12.4 Medicines user in heart failure

12.5 Antithrombotic medicines

12.6 Lipid-lowering agents

13. Dermatological medicines (topical)

13.1 Antifungal medicines

13.2 Anti-infective medicines

13.3 Anti-inflammatory and antipruritic medicines

13.4 Astringent medicines

13.5 Medicines affecting skin differentiation and proliferation

13.6 Scabicides and pediculicides

14. Diagnostic agents

14.1 Ophthalmic medicines

14.2 Radiocontrast media

15. Disinfectants and antiseptics

15.1 Antiseptics

15.2 Disinfectants

16. Diuretics

17. Gastrointestinal medicines

17.1 Antacids and other antiulcer medicines

17.2 Antiemetic medicines

17.3 Anti-inflammatory medicines

17.4 Laxatives

17.5 Medicines used in diarrhea

17.5.1 Oral rehydration
  • Oral rehydration salts
17.5.2 Medicines for diarrhea in children
17.5.3 Antidiarrheal (symptomatic) medicines in adults

18. Hormones, other endocrine medicines and contraceptives

18.1 Adrenal hormones and synthetic substitutes

See 3.

18.2 Androgens

18.3 Contraceptives

18.3.1 oral hormonal contraceptives
18.3.2 Injectable hormonal contraceptives
18.3.3 Intrauterine devices
18.3.4 Barrier methods
18.3.5 Implantable contraceptives

18.4 Estrogens

18.5 Insulins and other antidiabetic agents

18.6 Ovulation inducers

18.7 Progesterones

18.8 Thyroid hormones and antithyroid medicines

19. Immunologicals

19.1 Diagnostic agents

19.2 Sera and immunoglobulins

  • Anti-D immunoglobulin
  • Antitetanus immunoglobulin
  • Antivenom immunoglobulin
  • Diphtheria antitoxin
  • Rabies immunoglobulin

19.3 Vaccines

20. Muscle relaxants (peripherally-acting) and cholinesterase inhibitors

21. Ophthalmological preparations

21.1 Anti-infective agents

21.2 Anti-inflammatory agents

21.3 Local anesthetics

21.4 Miotics and antiglaucoma medicines

21.5 Mydriatics

22. Oxytocics and antioxytocics

22.1 Oxytocics

22.2 Antioxytocics

23. Peritoneal dialysis solution

24. Psychotherapeutic medicines

24.1 Medicines used in psychotic disorders

24.2 Medicines used in mood disorders

24.2.1 Medicines used in depressive disorders
24.2.2 Medicines used in bipolar disorders

24.3 Medicines used in generalized anxiety and sleep disorders

24.4 Medicines used for obsessive compulsive disorders and panic attacks

24.5 Medicines used in substance dependence programs

25. Medicines acting on the respiratory tract

25.1 Antiasthmatic and medicines for chronic obstructive pulmonary disease

25.2 Other medicines acting on the respiratory tract

26. Solutions correcting water, electrolyte and acid-base disturbances

26.1 Oral

26.2 Parenteral

26.3 Miscellaneous

27. Vitamins and minerals

See also

External links

References

  1. ^ WHO | Health topics | Essential Medicines <http://www.who.int/topics/essential_medicines/en/>.
  2. ^ WHO | Health topics | Essential Medicines <http://www.who.int/topics/essential_medicines/en/>.
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