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ESSENTIAL DRUG CONCEPT AND ROLE OF WHO IN THE PROMOTION OF RATIONAL DRUG USE

Jonathan D. Quick, MD, MPH, Director, Essential Drugs and Medicines Policy (EDM)

World Health Organization (WHO), Geneva

Essential drugs save lives and improve health. Yet, major challenges confront paediatric prescribing, especially for the 1.8 billion children living in developing countries. These challenges include inadequate access to life-saving essential drugs in many areas of the world; widespread non-adherence to prescribed treatment; underuse of simply effective treatments such as oral rehydration therapy; overuse of antibiotics for acute diarrhoea and viral respiratory infections; excessive and unsafe use of injections; and emergence of resistance to drugs for bacterial pneumonia, meningitis, malaria, and other common pathogens.

WHO’s aim is to support its 191 member countries in promoting therapeutically sound and cost-effective use of drugs by health professionals and consumers, in both the public and private sectors. This requires action by governments, professional associations, training institutions, public interest groups, and the private sector to implement national strategies for rational drug use, to encourage responsible drug promotion, to contain antimicrobial resistance, and to ensure injection safety.

To promote rational prescribing and dispensing, WHO provides treatment guidelines for most major health problems, a model list of essential drugs which is updated every two years, guidance on drugs and therapeutics committees, a programme for problem-based and skill-based therapeutics training, and has initiated an international course on rational drug use in the community.

WHO has recently adopted more rigorous procedures for developing evidence-based WHO treatment guidelines. It is now in the process of modernizing its approach to the essential drugs list to provide a closer link to WHO treatment guidelines, clearer documentation of the evidence base for decisions, a more straightforward handling of cost-effectiveness issues, and a model selection process as well as a model list. Finally, WHO ethical criteria for medicinal drug promotion provide a sound practical basis for responsible drug promotion. But considerable work is still needed to ensure that these guidelines are in fact followed.