Essential Medicines for Children

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The first WHO Model List of Essential Medicines (EML) was published 40 years ago in 1977, and the WHO Action Programme on Essential Drugs established in 1982. This year the 20th EML will come out. The program has been described previously in this journal.2 Recently, a document by The Lancet Commission titled “Essential medicines for universal health coverage” was published looking at past, present, and the future of essential medicines.3
Essential medicines included on the EML are selected by the WHO Expert Committee on the Selection and Use of Essential Medicines meeting every 2 years. Disease prevalence and public health relevance, evidence of clinical efficacy and safety, and comparative costs and cost‐effectiveness are considered before inclusion. Essential medicines are intended to be available within the context of functioning health systems always in adequate amounts, in the appropriate dosage forms, with assured quality, and at an affordable price the individual and the community can afford.1 The WHO Model List is the beginning of a long process that optimally leads to this outcome. The Model List is a guide for the development of national and institutional essential medicine lists. Most countries have national lists and some have provincial or state lists as well. National lists of essential medicines usually relate closely to national guidelines for clinical healthcare practice, which are used for the training and supervision of health workers. While the WHO Essential Medicines Program provides tools, guidance, and assistance for the work that is needed in the countries, the responsibility for access of the population to essential medicines lies with the national governments.
Like so many of the WHO programs, excluding specific pediatric programs, the Essential Medicines Program considered children's needs late and only to a limited extent.4 After adoption of Resolution WHA 60.20 by the World Health Assembly (WHA) in May 2007, the first Model List of Essential Medicines for Children (EMLc) was adopted in October 2007, on the day of the 30th anniversary of the 1st EML,4 and the current EMLc is only the 5th (Table1). The EMLc considers children up to the age of 12 years; those older than that are supposed to be covered by the “adult” EML. All the medicines listed on the EMLc are automatically included on the EML. This is important, as 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, particularly in low‐ and middle‐income countries (LMIC). Many international organizations, including UNICEF, UNHCR, and UNFPA, as well as nongovernmental organizations and international nonprofit supply agencies, base their medicine supply system mainly on the Model List.1 When children's medicines are not properly considered in the EML, they are not procured. For example, the availability of key essential medicines for children in 14 central African countries was poor in 2007, before the first EMLc became available.4
Today, 10 years and five EMLc later it is difficult to say if children's access to essential medicines has improved and to what extent. Certainly, there was a period of activity at the WHO 2008–2012 during the WHO Better Medicines for Children initiative. Other efforts were also launched to promote access to medicines and health technologies for maternal and child health, including the UN Commission on Life Saving Commodities for Women and Children. Programs on procurement and supply management (PSM) of pharmaceuticals have produced numerous tools and web‐based information resources to support national governments to progress on PSM aspects to improve availability of medicines for children.
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