The widespread availability of effective medicines has contributed to an increase in the average global life expectancy during the past century. But over-use and under-use of medicines is a global public health problem with serious consequences, including antibiotic resistance, avoidable adverse drug events, and untreated or undertreated illnesses leading to hospitalization and death.
Since 1977, the World Health Organization (WHO) has advocated the concept of “essential medicines” — effective low cost drugs used to treat serious infectious diseases and an increasing range of chronic non-infectious diseases—and developed a range of policies to promote quality use of these medicines. There is evidence that implementing these policies does improve medicine use in high-income countries; but their role in quality of medicine use in developing or transitional countries has not been clear.
In the current issue of PLOS Medicine, Kathleen Holloway from WHO and David Henry from the Institute for Clinical Evaluative Sciences (ICES) evaluated data on reported adherence to the WHO essential medicines practices and measures of quality use of medicines from 56 low and middle income countries for 2002-2008. They compared the countries’ government-reported implementation of 36 essential medicines policies with independent survey results for 10 validated indicators of quality use of medicines. The authors say the results provide the strongest evidence to date that WHO essential medicines policies are associated with improved medicines use.
In particular, the authors identified four policies that were associated with a 10 per cent or greater improvement in medicines use:
- Free essential medicines at point of care to all patients
- Better undergraduate training of doctors in standard treatment guidelines
- Better undergraduate training of nurses in standard treatment guidelines
- A dedicated unit promoting rational use of medicines in the country’s ministry of health
“There was a positive correlation between the number of medicines policies that countries reported implementing and the quality of their medicines use. This correlation was strongest and statistically significant in countries with national per capita wealth levels below the median of the study countries (US$2,333), underscoring the importance of essential medicines policies in low-income countries,” said Dr. David Henry, co-author of the study and a senior scientist at ICES.
The authors added that international support for the WHO, increasingly, is being channelled to disease programmes (e.g., addressing AIDS, tuberculosis, and malaria) and away from programmes designed to support development and maintenance of health policies and standards. The medicines policies and data discussed here were developed and collected as part of the WHO core functions, which are now under threat. It is important that the critical role of the WHO is recognized and that these efforts are sustained and enhanced.
“WHO essential medicines policies and use in developing and transitional countries: an analysis of reported policy implementation and medicines use surveys,” appears today in PLOS Medicine.
ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario
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