Access to Essential Medicines - Definitions

To begin with, we need to consider the phrase “access to essential medicines” itself.  The phrase is often used to get across the fact that many people in poor countries cannot access a number of medicines which are seen as ‘essential’.  The WHO has a “model list” of medicines, which can be tailored to individual countries to tackle their priority diseases, i.e. those which are most relevant to public health.2  This list includes a “core” list – medicines that are needed for a “basic” healthcare system, and a “complementary” list – describing medicines for which more specialised facilities/training is needed. 

Do ‘essential medicines’ mean only drugs though?  Should things such as condoms – very much needed to prevent a range of sexually transmitted infections – or mosquito nets – a very effective way of preventing malaria and many other mosquito-borne infections – be excluded from the term ‘essential medicines’?

When considering the message “access to essential medicines”, we believe it is necessary to think in terms of not just access to drugs, but also access to health care.  Each part of the term can be dissected – access requires available health care which is not discriminated on in any way – e.g. women or other populations being unable to access health services; ‘essential’ means that medicines are for ‘priority’ conditions – “selected on the basis of current and future public health relevance, and potential for safe and cost-effective treatment”;³ and finally ‘medicines’ as a group of items that can be used to achieve the “highest attainable standard of health”.⁴

Essentially, the four basic elements to the WHO’s framework for access to essential medicines -  (1) rational selection and use; (2) affordable prices; (3) sustainable financing; and (4) reliable supply systems4 - apply just as much to high-income countries to those in low-income ones, particularly for countries which don’t have a free healthcare system.

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