Essential Drug Policy and the Essential Medicines List

What are essential medicines?

Essential medicines are those that satisfy the priority health care needs of the population. They are selected because of their importance to public health, the evidence that they work and are safe, and their value for money.

The idea behind them is that essential medicines should be available at all times, in enough quantity, in the right dosage forms, of assured quality, and at a price that individuals and communities can afford.

Examples that appear on the WHO list include paracetamol, amoxicillin, oral rehydration salts, zinc sulfate for diarrhoea, and artemether-lumefantrine for malaria.

What is a national drug policy?

A national drug policy is a government's written commitment and plan for making sure that medicines are available, safe, effective, of good quality, affordable and used properly. It sets goals and guides the actions of many people: government, regulators, hospitals, pharmacists, pharmacy technicians, manufacturers and the public.

Nigeria has a National Drug Policy and a National Essential Medicines List (NEML). They are reviewed from time to time, so always use the current edition in your practice.

Aims of a drug policy

• Make sure essential medicines are available and accessible to everyone who needs them.
• Make sure all medicines are safe, effective and of good quality.
• Make medicines affordable to patients and to the health system.
• Promote the rational use of medicines by prescribers, dispensers and patients.
• Support local production of medicines where it is possible.
• Guide regulation, training and research.

Parts of a national drug policy

A national drug policy usually covers:

1. Selection of essential medicines
2. Affordability and financing
3. Supply systems, including buying, storing and distributing
4. Regulation and quality assurance
5. Rational use of medicines
6. Research
7. Human resources and training
8. Monitoring and evaluation

The essential medicines list

An essential medicines list is a list of the medicines a country has chosen as priorities for its health system. It is based on the most common diseases in the population. Many national lists show which level of health care each medicine is meant for: primary, secondary or tertiary.

Criteria for selecting essential medicines

A medicine is chosen when it:

• is relevant to the diseases that affect the most people;
• has proven efficacy and safety, supported by good evidence;
• is good value for money compared with other treatments for the same condition;
• is of assured quality, with reliable absorption and stability;
• is available as a single active ingredient. Fixed-dose combinations are included only when they have clear advantages;
• is suitable for local conditions, including storage, ease of use and availability;
• is listed by its generic (international non-proprietary) name.

Benefits of an essential medicines list

• Better availability. Supply is focused on the medicines that matter most.
• Lower cost. Buying a smaller number of medicines in large quantities usually brings better prices.
• Better quality. It is easier to check the quality of fewer products.
• Easier training and prescribing. Health workers can learn a smaller list well, using standard treatment guidelines.
• Easier stock control. Fewer products mean simpler ordering, storage and record keeping.
• Less waste from expiry and from stocking products that are rarely needed.
• Supports rational use of medicines.

Rational use of medicines

The WHO describes rational use as patients receiving medicines appropriate to their clinical needs, in doses that meet their own requirements, for an adequate period of time, and at the lowest cost to them and their community.

Irrational use includes:

• using too many medicines for one patient;
• using antibiotics for conditions they do not treat, such as colds;
• giving the wrong dose, or stopping a course too early;
• giving injections when oral medicines would work as well.

Irrational use wastes money, can harm patients, and helps drug-resistant germs develop.

The pharmacy technician's role

A pharmacy technician helps apply the policy every day by:

• knowing the essential medicines list and stocking from it;
• using generic names when ordering, labelling and talking to patients;
• keeping good stock records and applying FEFO, so stock does not expire;
• helping make sure patients know how to use their medicines properly;
• encouraging patients to complete the course of antibiotics and not to share medicines;
• reporting shortages, expired stock, side effects and suspected poor-quality or fake medicines to the pharmacist.

Generic and brand names: the generic name is the medicine's official name, such as paracetamol. A brand name is the name chosen by a company. Different brands of the same generic medicine contain the same active ingredient.