Essential medicines: the first generation Monday 30 May 2011, Chateau de Penthes, Geneva Margaretha Helling Borda (former Director WHO Action Programme on Essential Drugs)

In the 1970’s - serious problems and acute situations… Letter to WHO in 1974 : -- « our latest indent is 105 % more expensive than last year’s. I need hardly say that this makes complete nonsense of our financial estimates, and my Government cannot, in the near future, double the money allocated to medicines » -- « our latest indent is 105 % more expensive than last year’s. I need hardly say that this makes complete nonsense of our financial estimates, and my Government cannot, in the near future, double the money allocated to medicines » Ebrahim Samba, Chief Medical Offcier MOH, Gambia – later Regional Director, AFRO

M. Helling Borda October years anniversary 3 Birth of Essential Drugs Concept (EDC) Complaints in the early seventies: Complaints in the early seventies: No links between drugs and health needs No links between drugs and health needs No access to most essential drugs No access to most essential drugs Rising costs of pharmaceuticals Rising costs of pharmaceuticals Uneven rural-urban distribution Uneven rural-urban distribution Protests against industry marketing practice Protests against industry marketing practice No comprehensive NDP to support PHC etc. No comprehensive NDP to support PHC etc. Against this background birth of EDC Against this background birth of EDC

Major events in the 1970’s 1974 DPM unit established 1974 DPM unit established th World Health Assembly, - DG’s Report on drugs followed by Resolution WHA28.66 requesting advise on selection, procurement, at reasonable cost, of essential drugs of established quality corresponding to national needs WHO entered the era of essential medicines 1976 First consultation on the Selection of essential drugs 1976 First consultation on the Selection of essential drugs

WHO Model List of Essential Drugs 1976: two WHO consultants, clinical pharmacologists, prepared working document (including a preliminary draft list). Document circulated for comments 1977: WHO Expert Committee on the Selection of Essential Drugs: WHO, Geneva, 17 – 21 Oct.1977 incl. model list and outline for a programme TRS 615 (36 pages) became an instant WHO best seller --and a vital tool for public health

After publication of first EDL- what ? 1977: Situation analyses in Asia six countries- six-weeks 1977: Situation analyses in Asia six countries- six-weeks 1978: WHO meetings in SEARO and WPRO 1978: WHO meetings in SEARO and WPRO 1978: 31st WHA – Technical discussions on: Drug Policies with its technical and administrative components 1978: 31st WHA – Technical discussions on: Drug Policies with its technical and administrative components 1978: Res. WHA urging countries to establish ED programme; raises the issue of a WHO marketing code; and proposes establishment of an Action Programme on Essential Drugs 1978: Res. WHA urging countries to establish ED programme; raises the issue of a WHO marketing code; and proposes establishment of an Action Programme on Essential Drugs 1978: WHO/Unicef meeting on PHC in Alma Ata 1978: WHO/Unicef meeting on PHC in Alma Ata

The time around the start of the Action Programme on Essential Drugs … 1979: The Selection of Essential Drugs revised – 2 nd Expert Committee (dosage forms included) 1979: The Selection of Essential Drugs revised – 2 nd Expert Committee (dosage forms included) 1979: 32nd WHA calls for the establishment of an administrative structure for the Action Programme on Essential Drugs 1979: 32nd WHA calls for the establishment of an administrative structure for the Action Programme on Essential Drugs 1981: Establishment of an Administrative Unit for Action Programme on Essential Drugs with the acronym DAP (staff of 4) 1981: Establishment of an Administrative Unit for Action Programme on Essential Drugs with the acronym DAP (staff of 4)

On the way to action…and consolidation 1981: WHA-34 adopts Global Strategy on Health for All by the year 2000 – availability of essential drugs is one of eight major elements in HFA 1981: IFPMA voluntary marketing code 1981: Health Action International (HAI) founded 1982: Third Expert Cttee emphasis on «The use of EDs» 1982: WHA-35 adopts a plan of action for APED 1983: DAP placed in office of Director-General 1984: WHA-37 calls for meeting on rational use of drugs 1985: Nairobi Conference on Rational Use of Drugs broadens the scope of essential drugs policies 1986: WHA-39 accepts Revised Drug Strategy