Essential medicines: Essential medicines: the first generationthe first generation

Monday 30 May 2011, Chateau de Penthes, GenevaMonday 30 May 2011, Chateau de Penthes, Geneva

Margaretha Helling BordaMargaretha Helling Borda

(former Director WHO Action Programme on (former Director WHO Action Programme on Essential Drugs) Essential Drugs)

In the 1970’s - serious problems and In the 1970’s - serious problems and acute situations…acute situations…

Letter to WHO in Letter to WHO in 1974 1974 :: -- -- « our latest indent is 105 % more expensive « our latest indent is 105 % more expensive

than last year’s. I need hardly say that this makes than last year’s. I need hardly say that this makes complete nonsense of our financial estimates , complete nonsense of our financial estimates , and my Government cannot, in the near future, and my Government cannot, in the near future, double the money allocated to medicines »double the money allocated to medicines »

Ebrahim Samba, Chief Medical Offcier MOH, Gambia Ebrahim Samba, Chief Medical Offcier MOH, Gambia – – later Regional Director, AFRO later Regional Director, AFRO

M. Helling Borda October 2002 - 25 years M. Helling Borda October 2002 - 25 years anniversary anniversary

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Birth of Essential Drugs Concept (EDC) Birth of Essential Drugs Concept (EDC)

Complaints in the Complaints in the early seventiesearly seventies:: No links between drugs and health needsNo links between drugs and health needs No access to most essential drugsNo access to most essential drugs Rising costs of pharmaceuticalsRising costs of pharmaceuticals Uneven rural-urban distributionUneven rural-urban distribution Protests against industry marketing practiceProtests against industry marketing practice No comprehensive NDP to support PHC etc.No comprehensive NDP to support PHC etc.

Against this background birth of EDC Against this background birth of EDC

Major events in the 1970’sMajor events in the 1970’s

19741974 DPM unit established DPM unit established

19751975 2 28th World Health Assembly, - DG’s Report on drugs followed by Resolution WHA28.66

requesting advise on selection, procurement, at reasonable cost, of essential drugs of established quality corresponding to national needs

WHO entered the era of essential medicines

1976 First consultation on the Selection of essential 1976 First consultation on the Selection of essential

drugsdrugs

WHO Model List of Essential DrugsWHO Model List of Essential Drugs 1976: two WHO consultants, clinical

pharmacologists, prepared working document (including a preliminary draft list). Document circulated for comments

1977: WHO Expert Committee on the Selection of Essential Drugs: WHO, Geneva,

17 – 21 Oct.1977 incl. model list and outline for a programme

TRS 615 (36 pages) became an instant WHO best seller --and a vital tool for public health

After publication of first EDL- what ?After publication of first EDL- what ?

19771977: Situation analyses in Asia six countries- : Situation analyses in Asia six countries- six-weeks six-weeks

19781978:: WHO meetings in SEARO and WPRO WHO meetings in SEARO and WPRO 19781978: 31st WHA – Technical discussions on: : 31st WHA – Technical discussions on:

Drug Policies with its technical and Drug Policies with its technical and administrative components administrative components

19781978:: Res. Res. WHA 31.32WHA 31.32 urging countries urging countries to establish ED programme; raises the issue of to establish ED programme; raises the issue of

a WHO marketing code; and proposes a WHO marketing code; and proposes establishment of an Action Programme onestablishment of an Action Programme onEssential DrugsEssential Drugs

19781978: WHO/Unicef meeting on PHC in Alma Ata: WHO/Unicef meeting on PHC in Alma Ata

The time around the start of the Action The time around the start of the Action Programme on Essential Drugs …Programme on Essential Drugs …

19791979: The Selection of Essential Drugs revised – : The Selection of Essential Drugs revised – 2 2ndnd Expert Committee Expert Committee (dosage forms included)(dosage forms included)

19791979: 32nd WHA calls for the establishment: 32nd WHA calls for the establishment of of an administrative structure for the an administrative structure for the Action Programme on Essential DrugsAction Programme on Essential Drugs

19811981: Establishment of an Administrative Unit : Establishment of an Administrative Unit for Action Programme on Essential for Action Programme on Essential Drugs with the acronym Drugs with the acronym DAP DAP (staff of (staff of

4)4)

On the way to action…and consolidation On the way to action…and consolidation

19811981: WHA-34 adopts Global Strategy on Health for All by : WHA-34 adopts Global Strategy on Health for All by the year 2000 – availability of essential drugs is one of the year 2000 – availability of essential drugs is one of eight major elements in HFAeight major elements in HFA

19811981: IFPMA voluntary marketing code: IFPMA voluntary marketing code

19811981: Health Action International (HAI) founded: Health Action International (HAI) founded

1982:1982: Third Expert Cttee emphasis on «The Third Expert Cttee emphasis on «The useuse of EDs» of EDs»

19821982: WHA-35 adopts a plan of action for APED: WHA-35 adopts a plan of action for APED

19831983: DAP placed in office of Director-General: DAP placed in office of Director-General

19841984: WHA-37 calls for meeting on rational use of drugs : WHA-37 calls for meeting on rational use of drugs

19851985: Nairobi Conference on Rational Use of Drugs broadens : Nairobi Conference on Rational Use of Drugs broadens the scope of essential drugs policiesthe scope of essential drugs policies

19861986: WHA-39 accepts Revised Drug Strategy: WHA-39 accepts Revised Drug Strategy