WHO’s definition of essential medicines is that “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 efficacy and safety, and comparative cost-effectiveness.” In India there are uncountable numbers of medicine formulations available; many of these are similar in therapeutic action, however some may be more expensive albeit many inexpensive medicines are highly effective. Apart from, medicines which are known to be therapeutically ineffective, irrational or even may be harmful are commercially available. An estimated 20000 pharmaceutical companies in India produce over 50000 formulations that are freely available in the market. Over 100 brands of paracetamol, omeprazole and Amoxicillin either alone or in combination with another medicine exist in Indian medicine retail market. Hence there is a need to select essential medicines from the innumerable medicines available in the market. It is a paradox that many non-essential and, even adulterated medicines are available yet there is a shortage of essential medicines particularly in the developing countries including India .The WHO essential medicine concept that focus on people in the developing countries is that a limited range of carefully selected essential medicines leads to better health care, better medicine management and lower cost.
In October 1977, WHO published the first model essential drugs list (EDL) of 186 individual drugs, in the wake of 1975 World Health Assembly’s call on focusing attention on essential medicines of good quality at reasonable cost. The EDL, advocated by WHO, was a guideline and was based on the principle that some medicines were more essential than others on the contrary many medicines in developing countries were not useful. In the past 35 years, 17 times revisions in the list have been carried out (on an average every two years). The name of the list, 2003 onwards, has also changed, from essential drugs list (EDL) to essential medicines list (EML). The current version, the 17th WHO EML, was published in 2011 that contained about 350 individual medicines. There is also a “WHO Model List of Essential Medicines for Children”, whose third edition was also published in 2011.
The WHO EML represents the most compelling international compilation of essential medicines for public health. Each country is encouraged by WHO to prepare their own national lists taking into consideration local priorities. Over 150 WHO member countries have adopted a national list of essential medicines. Major international agencies (UNICEF, UNHCR) prepare their medicines catalogue on the basis of the WHO model list. The WHO model EML forms basis for WHO model formulary, International Pharmacopoeia, basic quality tests and development for reference drug standards.
National List of Essential Medicines of India (NLEM): The first national essential drugs list, prepared by the Ministry of Health and Family Welfare, Government of India in 1996, contained 279 medicines. The list was modelled on the WHO EDL pattern, and followed the general principles enunciated by WHO in the preparation of the list. The second revision was carried out in 2003, contained 354 medicines. The current revision has been published recently in 2011. It has 348 individual medicines. The national list of essential medicines implies that the medicines included in it are adequate to meet the common contemporary health needs of the general population of India.