who medicines strategy - libdoc.who.int - World Health Organization

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WHO MEDICINES STRATEGY 2004-2007 | 116EO 7.2Essential medicines list, clinicalguidelines, and formulary processdeveloped and promotedRationaleThe selection of a list of medicines, based on anumber of criteria including disease pattern andrecommended treatments, is the foundation of theessential medicines concept 58 . Clinical guidelinesindicate the most cost-effective therapeuticapproach, on the basis of valid clinical evidence.Their impact is greatest if the end-users,prescribers and, to a certain extent, patients areclosely involved in developing the guidelines.Formularies are commonly publications thatcombine the list of medicines with conciseguidance on their safe and rational use. Evidencefrom practice and research has demonstrated thatthe most cost-effective use of medicines may vary— depending on factors such as local marketprices, availability, and distribution costs — andthere is a need to support countries in developingor updating their rational use publications.ProgressThe WHO Model List of Essential Medicineshas been regularly revised and proved tobe a valuable tool over the past 25 years,complemented and enhanced by the publicationin 2002 of the WHO Model Formulary 59 .Collaboration within WHO has resulted in aformulary that incorporates updates in treatmentprotocols from the disease-specific departments inWHO. Access is available via the WHO EssentialMedicines Library on the WHO website 60 .The Library links essential medicines to WHOtreatment guidelines, the Model Formulary, priceinformation, pharmacopoeal monographs, andother WHO sites including information on adversedrug reactions and the ATC/DDD classification(Figure 24). There are now 135 countries withnational standard treatment guidelines and 156countries with national essential medicines lists,of which about 75% have been updated withinthe last five years.Figure 26: The WHO Essential Medicines Library (http://mednet3.who.int/eml/)Clinical guidelineSummary of Clinical GuidelineEvidence:Reasons for inclusionSystematic reviewsKey referencesWHOMODELLISTWHO Model FormularyCost:per unitper treatmentper monthper case preventedQuality information:Basic quality testsInternational PharmacopoeiaReference standards
COMPONENTS OF THE STRATEGY | 117Figure 27: Relation between treatment guidelinesand a list of essential medicinesList of common diseases and complaintsChallenges remainingThere is a continuing need within WHO forsystematic evidence-based approaches to theproduction of authoritative treatment guidelinesto assist countries and to form the basis of theModel List (Figure: 27). National formularies,lists of medicines that are reimbursable (“positivelists”), and treatment guidelines exist but are onlyoccasionally evidence-based, rarely updated,and often ignored. The challenge is to providetechnical assistance to countries to improve theirtechniques of selection and to develop or updatetheir rational use materials.Treatment choiceTreatment guidelinesTreatment TrainingSupervisionMeeting the challenges 2004-2007Over the next four years WHO will:List of essential drugsNational formularySupply of drugs> provide technical support to countries torevise their national formulary and positivelist development, using an evidence-basedapproach.> strengthen the process of developingevidence-based clinical guidelines withinWHO for use by WHO and other UNagencies (UNICEF, UNFPA, UNHCR).OUTCOME INDICATORS1999 2003 2007No. of countries with national list of essential medicinesupdated within the last 5 yearsNo. of countries with treatment guidelines updated withinthe last 5 years#REPORTING % TARGET#REPORTING % TARGET129/175 74% 75% 82/114 72% 75%60/90 67% 70% 47/76 62% 65%
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