Essential medicines

Many people believe that modern medicine is continuing to significantly improve global health. Polio has been nearly eradicated, smallpox eliminated, and it will only be a matter of time before cures for all other diseases are found. However, this confidence is misplaced and based more on history than reality. Today, one- third of the world’s population lacks access to essential medicines; in the poorest parts of Africa and Asia this figure rises to one-half.

Aims to support countries in developing national drug policies, to work towards the rational use of drugs.

Health Minister Manto Tshabalala-Msimang has called on the continent's health industry to improve access to affordable medicine. Access to healthcare is a constitutional right for all citizens of this continent.

Though the fight over medicine prices has gone to the highest court in the land, scant attention has focused on how much tax South Africans pay for their medicines. At 14% VAT, which earns government R1,4bn/year on prescription drugs alone, tax on medicines in a developing country such as SA could be reduced.

In keeping with the objectives of the National Drug Policy, the third edition of the Standard Treatment Guidelines and Essential Drugs List for Primary Health Care has been developed.

Geneva - The World Health Organisation (WHO) on Tuesday issued guidelines for ensuring the safety and efficacy of the multibillion-dollar herbal medicines market amid reports that some products are tainted with toxic substances. The guidelines, intended for national regulatory bodies, lay out the best techniques for growing and harvesting medicinal plants used for various ailments or weight loss, as well as the clear labelling of the contents of any product. Herbal medicines represent an estimated $60-billion (about R413-billion) a year global market, about 20 percent of the overall drug market, according to the United Nations agency. Yet only China, Japan and the European Union have regulations for medicinal plants. It is not a binding guideline for any country, but it is a model or sort of checklist which they can use to make their own national regulations, Hans Hogerzeil, acting director of WHO's essential drugs and medicines department, told a news briefing. In Africa, up to 80 percent of the population depends on traditional medicine for primary health care. In China, herbal preparations account for up to 50 percent of total consumption.(Source: Reuters, February 10 2004 on www.iol.co.za)

In a decisive move to strengthen action against AIDS in developing countries, the World Health Organization (WHO) has today announced the first treatment guidelines for HIV/AIDS in poor settings. Parallel to that, WHO has endorsed the inclusion of AIDS medicines in its Essential Medicines List. The action is a breakthrough in a comprehensive prevention through care package that could contribute to dramatically wider access to treatment over the coming years. WHO estimates that nearly six million people living with HIV/AIDS need access to care and support including antiretrovirals (ARVs). Currently, fewer than five per cent of those who require treatment in developing countries can access these medicines. WHO believes that at least three million people needing care should be able to get medicines by 2005 - a more than ten-fold increase. WHO sees wider access to safe and practical treatment as an important element of an overall strategy to fight HIV/AIDS. It combines prevention, improved diagnostics and effective care so that these elements mutually reinforce each other. The new treatment guidelines and the designation of ARVs as essential are vital steps in the battle against the AIDS pandemic. They should encourage both industrialized and developing country governments to make HIV treatment more widely available, says Gro Harlem Brundtland, Director-General of WHO. The new guidelines propose a practical, standardized and simplified combination of ARV therapy. They provide guidance on more rational use of ARV treatments resulting in fewer side effects, less resistance and better tolerance of the medicines. They ensure that AIDS patients obtain appropriate combinations of medicines that will make their lives longer and more productive. The guidelines will also make it easier to train health workers and make ARVs simpler to use. A vital component of the WHO strategy to scale up access to care and treatment in poor countries is the inclusion of ARVs on the WHO Essential Medicines List. They include nevirapine and zidovudine - previously listed for prevention of mother-to-child transmission but now also recommended for treatment of HIV in adults and children. The new medicines in the List are abacavir, didanosine, efavirenz, indinavir, lamivudine, lopinavir, nelfinavir, ritonavir (low-dose), saquinavir, and stavudine. When used effectively in the recommended combinations, antiretrovirals improve life expectancy and quality of life for people living with HIV. The decision to add these ARVs follows a strong recommendation by the Expert Committee on the Use of Essential Medicines, a panel of independent experts convened by WHO. It is based on a careful analysis of current evidence of ARV efficacy in developing countries, which shows that these medicines can be used effectively and safely in poor settings. The Committee’s selections allow for several multi-drug combinations, many of which are becoming increasingly affordable in developing countries.The identification of ARVs as essential medicines and the treatment protocol should help national governments and health care institutions to select appropriate treatment for people with AIDS. explains Professor Juan-Ramon Laporte, Chair of the Expert Committee. It will also help to train health professionals, to inform patients, to monitor treatment outcomes, and to assist reimbursement of such medicines by health insurance schemes. The first Model List of Essential Medicines was released by WHO in 1977 and has since been updated every two years. It aims to provide an example for countries to develop their own essential medicines lists, according to their priority health needs. By the end of 1999, 156 WHO Member States had official medicines lists, of which 127 had been updated in the previous five years.  The antiretroviral treatment guidelines developed by WHO will greatly assist governments and national AIDS programmes in providing people living with HIV/AIDS with greater access to these life-saving medicines, said Dr Peter Piot, UNAIDS Executive Director. The long-sought inclusion of antiretrovirals in WHO’s Essential Medicines List will encourage governments in hard-hit countries to further expand the distribution of these vital drugs to those who need them.Since AIDS was reported over twenty years ago, over 20 million people have died as a result of HIV infection. Current estimates suggest that 40 million people worldwide are infected with HIV and more than 90% of infected persons live in the developing world. In 2001, 5 million people worldwide became infected with HIV, and 3 million others died from HIV/AIDS-related causes.  Left untreated, HIV infection results in a period of 3 to 10 years or more during which the infected person remains relatively healthy. Once symptomatic disease or AIDS develops, without access to antiretroviraltreatment, death results within an average of two years. In high-income countries, an estimated 1.5 million people live with HIV, many of them productively, due to pervasive antiretroviral therapy. In the USA, the introduction of triple combination antiretroviral therapy in 1996 led to a decline of 70% in deaths attributable to HIV/AIDS. The Guidelines for Scaling Up Antiretroviral Therapy and the 2002 WHO Model List of Essential Drugs are available on WHO web site: http://www.who.int/ Source: WHO

The new book How to develop and implement a national drug policy is now available as an official WHO publication. This replaces the Guidelines for developing national drug policies of 1988. The timing of this book may be quite significant for South Africa, since Dr Humphrey Zokufa indicated that the process of revising the South African National Drug Policy must start this year, at his address to the annual conference of the SA Association of Hospital and Instutional Pharmacists (1 Mar 2002). A national drug policy provides an invaluable strategic framework to identify national goals and commitments. This publication guides the reader through the development process of a national drug policy, and discusses key policy components like the selection of essential drugs, affordability, finance and supply, regulation and quality assurance, rational use, research, human resources, monitoring and evaluation. Each chapter presents useful practical advice and lists many references to other sources of more detailed technical information. ISBN 92 4 154547 X 83 pages price $23.40 ; 30% reduction for developing countries Copies can be ordered from the WHO Department of Marketing and Dissemination, e-mail bookorders@who.int Single copies of the book are available free of charge to experts from developing countries, from the Documentation Centre of the WHO Department of Essential Drugs and Medicines Policy, e-mail edmdoccentre@who.int The book is also posted on the EDM web site http://www.who.int/medicines. [Sources: E-drug, SAAHIP Conference www.saahip.org.za] The existing NDP is available from the DoH web site http://www.doh.gov.za/docs/policy/drugsjan1996.pdf or in HTML from http://www.sadap.org.za/ndp/

The rapid escalation of drug costs is a world wide problem. But by all accounts, drug prices in South Africa's private sector are among the highest in the world. The South African government has responded to this problem by way of developing a national drug policy . An important element of this is an essential drugs programme which has, in the first instance, been developed for the public sector primary health care facilities.

The concept of an essential drugs list is a cornerstone of the National Drug Policy and an essential step in the transformation of the health care delivery system in South Africa. The process of compiling treatment guidelines and essential drugs lists is ongoing, and frequent updates will be necessary, involving, inter alia, indigenous research groups and the regulatory authoritys advice, certified good manufacturing practice and quality assurance. The document presented is thus the beginning of a continuous process.