Year : 2014 | Volume
: 5 | Issue : 1 | Page : 56--58
Essential medicine list 2011
Keshab Mukhopadhyay1, Ritesh Singh2,
1 Professor and Head, Department of Pharmacology, College of Medicine and JNM Hospital, WBUHS, Kalyani, West Bengal, India
2 Assistant Professor, Department of Community Medicine, College of Medicine and JNM Hospital, WBUHS, Kalyani, West Bengal, India
Department of Community Medicine, College of Medicine and JNM Hospital, Kalyani - 741 235, West Bengal
Medicines are as important as health care workers. In developing countries patients has to travel many miles before seeing a health care professional. Many times they cannot afford medicines prescribed by doctors. Thus, they feel that their interaction with the doctor was futile. Availability of medicines at the point of care is of utmost importance if the public health system of a country is to be strengthened. This increases the confidence of common people in public health system of the country. Due to monetary constraints all the required medicines cannot be given by the government free of cost to its people. There must be a priority list of medicine or otherwise called essential list of medicines. The government should ensure the availability of these medicines at each health post. These medicines are carefully chosen after much deliberation and assessing the health profile of the country. Government of India developed an essential list of medicine in 2011. The last such list was developed in 2003. This paper reviews the essential medical list 2011 of India.
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Mukhopadhyay K, Singh R. Essential medicine list 2011.Muller J Med Sci Res 2014;5:56-58
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Mukhopadhyay K, Singh R. Essential medicine list 2011. Muller J Med Sci Res [serial online] 2014 [cited 2021 Dec 2 ];5:56-58
Available from: https://www.mjmsr.net/text.asp?2014/5/1/56/128947
The Alma-Ata declaration during the International Conference on Primary Health Care in 1978 reaffirms that health is a fundamental human right and the attainment of the highest possible level of health is a most important world-wide social goal.  The Alma-Ata declaration has outlined the eight essential components of primary health care and provision of essential medicines is one of them. Medicines are integral parts of the health care and the modern health care is unthinkable without the availability of necessary medicines. They not only save lives and promote health, but prevent epidemics and diseases too.  The medicines are undoubtedly one of weapons of mankind to fight disease and illness. Accessibility to medicines is thus the fundamental right of every person.
The World Health Organization (WHO) defines essential medicines as "those that satisfy the priority health care needs of the population."  Only some medicines can be categorized as essential ones. The bases for selection of those medicines are the importance of the disease they treat, their efficacy and safety and in developing countries their cost-effectiveness.
Concepts of "Essential Medicine"
According to WHO "drug is any substance or product which is used or intended to be used to modify or explore physiological system and pathological state for the benefit of the recipient." The WHO introduced the concept of essential medicines in 1977.  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 the 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. Experience has shown that careful selection of a limited range of essential medicines results in a higher quality of care, better management of medicines (including improved quality of prescribed medicines) and a more cost-effective use of available health resources. The WHO has developed the first essential medicines list in 1977 and since then the list has been revised every 2 years. The current versions are the 17 th WHO Essential Medicines List and the 3 rd WHO Essential Medicines List for Children updated in March 2011. The essential medicine list contains limited cost-effective and safe medicines, whereas the open pharmaceutical market is flooded with a large number of medicines many of which are of doubtful value. The model list of WHO serves as a guide for the development of national and institutional essential medicine list. The concept of essential medicines has been world-wide accepted as a powerful tool to promote health equity and its impact is remarkable as the essential medicines are proved to be one of the most cost-effective elements in health care.
Criteria for Selecting Essential Medicines
Which treatment is recommended and which medicines are selected depend on many factors, such as the pattern of prevalent diseases, treatment facilities, the training and experience of available personnel, financial resources and genetic, demographic and environmental factors. The following criteria are used by the WHO Expert Committee on the Selection and Use of Essential Medicines:
Only medicines for which sound and adequate evidence of efficacy and safety in a variety of settings is available should be selected.Relative cost-effectiveness is a major consideration for choosing medicines within the same therapeutic category. In comparisons between medicines, the total cost of the treatment - not only the unit cost of medicine - must be considered and be compared with its efficacy.In some cases, the choice may also be influenced by other factors such as pharmacokinetic properties or by local considerations such as the availability of facilities for manufacture or storage.Each medicine selected must be available in a form in which adequate quality, including bioavailability, can be ensured; its stability under the anticipated conditions of storage and use must be determined.Most essential medicines should be formulated as single compounds. Fixed dose combination products are selected only when the combination has a proven advantage in therapeutic effect, safety, adherence or in decreasing the emergence of drug resistance in malaria, tuberculosis and human immunodeficiency virus/acquired immunodeficiency syndrome.
Usage of Essential Medicine List
The concept of essential medicines has also been adopted by many international organizations, including the United Nations Children's Fund and the Office of the United Nations High Commissioner for Refugees, as well as by non-governmental organizations and international non-profit supply agencies. Many of these organizations base their medicine supply system on the model list. Lists of essential medicines also guide the procurement and supply of medicines in the public sector, schemes that reimburse medicine costs, medicine donations and local medicine production and furthermore, are widely used as information and education tools by health professionals. Health insurance schemes too are increasingly using national lists of essential medicines (NLEMs) for reference purposes. The model list serves as a baseline for further modification (addition and deletion of new medicines), correct dosage strength and form depending upon the national priority and available evidence.
Essential Medicine List of India
This concept of essential medicines is relatively new to India and Tamil Nadu is the first state to develop the essential medicine list as early as in 1994. Then Government of Delhi too had developed its own list. The Government of India and many other individual states have their own essential medicines list and the current national list was compiled during 2011. The list has been updated after 8 years.
Salient Features of NLEM 2011
The medicines have been categorized according to therapeutic area. Therefore medicine with more than one indication appears in more than one category. The strength of medicine dose is mentioned. For essentiality of requirement the medicines have been categorized as follows:
P, S and T denote essentiality at Primary, Secondary and Tertiary levels respectively while P, S and T (U in NLEM 2003) indicates essentiality at all levels.
A total of 348 medicines are present in NLEM 2011. In the NLEM 2011, 181 medicines fall under the category of P, S and T, 106 medicines fall under the category of S, T while 61 medicines are categorized as T only. In comparison to NLEM 2003, 47 medicines have been deleted and 43 new medicines have been added. Benzylpenicillin, cefuroxime, chloramphenicol, furazolidone, gamma benzene hexachloride, ketoconazole, mebendazole, norfloxacin, pethidine hydrochloride, pyrantel pamoate, tetracycline and tinidazole are some of the important medicines which are not considered as essential medicines according to the new list. Combination drug amoxicillin and clavulinic acid, allopurinol, atorvastatin, cetirizine, cefixime, diazepam, lorazepam, mefloquine, pantoprazole, permethrin, tramadol and zinc sulfate are new drugs made available in the NLEM 2011 due to their wide usage.
Some Issues with NLEM 2011
Some glaring mistakes which catch the eye while reading the NLEM 2011 are:
NLEM includes three antiallergic drugs which does not differ in efficacy but has minor pharmacokinetic differences: Pheniramine maleate, chlorpheniramine maleate and dexchlorpheniramine maleate.  Antibiotics from the same class are included in the NLEM like erythromycin and azithromycin.Though atenolol has the best evidence among many β-blockers, yet it is not included as an antianginal.Oral formulations of ampicillin causes diarrhea hence it need to be deleted from National Essential Medical List (NEML).It is strange that iron and folic acid is not mentioned as an essential medicine in NLEM 2011.Many common and important drugs like paracetamol do not have either the dose or dosage form appropriate for children.Due to pharmacokinetic properties of phenytoin, its strength of 25 mg is important. It is missing in the NLEM 2011.No fixed dose combination of antitubercular drugs and second-line antitubercular agent (except ofloxacin) is mentioned in the NLEM 2011.No drug other than mefloquine is included for prophylaxis of malaria.
The NLEM 2011 is significantly better than the NEML 2003. It has some mistakes and omissions which hopefully can be corrected in the next revision. Although preparing such essential list needs of local people should be of the paramount importance. The government should revise the list quite frequently.
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