Essential medicines concept for quality assurance of health care facilities.

Sir,

Patients are not aware of the concept of essential medicines list (EML) and what are the advantages of it. EML is largely a deal of stake holders in health care. Mostly, charity or voluntary organizations are developing or maintaining EML. For the rest of the world, medicines are a mode of increasing the revenue. In fact, EML has other benefits for which it should be followed without hurting the budgetary interests.[1]

World Health Organisation (WHO) promoted the concept of essential drugs. The concept of essential drugs started in the year 1997 with publication of the first list. Since then, WHO revises the list every 2 years. Recently, WHO intimated to use EML instead of Essential Drug List. The medicines included in the WHO Model List of Essential Medicines are selected with regard to disease prevalence, evidence of safety and efficacy, and comparative cost-effectiveness. A visibly transparent and difficult process which is done by a team of experts who critically analyze the available evidence and give to the process their expertise and experience on evaluating published studies.[2]

Since the 1970s, many developing countries have started national programs for essential drugs to promote the availability, accessibility, affordability, quality, and rational use of medicines. 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 or institutional responsibility. An essential medicine has been suggested as a strong indicator of the effectiveness of health systems and there should be clear relationships between the national EML, standard treatment guidelines, and procurement practices within the country.[34]

Formularies/Essential drug lists can be useful tools in managing hospitals more rationally, providing impartial drug information, and promoting the appropriate use of safe, effective, and contrasted medicines.

The concepts of evidence-based selection of medicines and cost-effective treatment protocols need to be included in the training of doctors, pharmacists, nurses, and other health care professionals. Pharmacovigilance remains an important aspect of ensuring the safety of selected medicines and suggesting further modifications of the EML. Concept of essential medicines is relatively new to India and Tamil Nadu was the first state to develop an EML as early as in 1994. Afterwards, Government of Delhi had developed its own list too. Since then, other individual states have implemented their own EML. Unfortunately, the list is not regularly updated except for Tamil Nadu. It is surprising that the Government of India, Ministry of Health and Family Welfare has taken 8 years to update the first EML created in 2003.[4] Campaigning to improve rational use of medicines through EML would be important. Governments should pay extra attention to this approach as medicines are important in regulating the national budget and health of most of the public.[5]

It is not compulsory that all the medicines used in the hospital should be in the hospital EML. EML/Formulary is a continually revised compilation of pharmaceuticals (plus important ancillary information) that reflects the current clinical judgment of medical staff. Availability of brands or generics can vary from single to many based on purchase policy. The drugs to be avoided or used with caution in renal failure, hepatic failure and in pregnancy need to be categorized and included in the formulary as additional information. The benefits other than that of budget need to be communicated to the corporate hospitals for promoting use of EML in most of the healthcare settings in India.

Thus, we hope that hospitals in India will make best use of EML with or without affecting their budgetary interests. EML should be considered as a step in quality assurance of the hospitals. As more hospitals get accredited for their quality service, we could observe better utilizations of essential medicines concept and rational drug use.