‘Rational use is as crucial as drug mktg’
Dr Kathleen Holloway, medical officer, essential drugs and medicines policy, WHO, was in India recently to conduct the Drug Therapeutics Committee (DTC) course for clinical pharmacologists and says that a lot of work still needs to be done to promote essential medicines. She emphasises the point that essential drugs list should be followed by all nations. In a conversation with Soumya Viswanathan, she delves on the importance of implementing essential drugs list (EDL). Excerpts:
India has a national essential drug list that was framed six years ago, but it was not really modelled on the then WHO recommendations. How can WHO make sure that member nations adapt the right list?
WHO has formulated model list of drugs and guidelines for treatment. But the work on both these lists are done by different committees. One speciality frames the guidelines and another makes the model list which has resulted in certain inconsistencies between the two. We are trying to rectify that. Therefore, it is necessary that even though WHO has a model list of essential drugs, member country must adapt this model after studying prevailing conditions in their nation. It is the responsibility of member states to use it correctly.
Can you tell us the importance of having essential drugs list?
WHO defines essential medicines as those that satisfy the priority healthcare needs of the population. When WHO formulated the essential medicines concept 25 years ago, it was out of the need to rationalise use of drugs. Official adoption of the essential medicines concept involves government in the pharmaceutical sector. It also identifies the optimum medicine supply for the public sector. By having a list of essential medicines, the public sector can concentrate on use of fewer drugs and thereby minimise chances of side effects. And minimising side effects will help in rational use of drugs.
Where does India stand as far as essential drugs is concerned? How important is it for the private sector to have an EDL?
In India, a lot of work has to be done in drug selection for a healthcare organisation’s formulary. Documented efficacy, safety, quality and cost of all drugs requested for the formulary have to be reviewed before selecting a drug. Here, most hospitals don’t even have an EDL.
And if 80 per cent people in India go to private sector, it becomes all the important for private sector hospitals to have EDL. WHO is keen to see a change in India.
What is the key point in drafting an EDL?
The most significant point here is that a hospital’s DTC is instrumental in implementing the ED concept. Every hospital must therefore have a DTC and should make choice of essential medicines based on scientific results. List should be based on diseases treated by the particular centre and morbidity. The hospital can be then assured of good quality and cost-effective drugs. The same applies for drafting EDL on a state and a national level.
Through our course on DTC, we have been training representatives from the countries across the world on setting up effective DTCs to promote rational drug use, follow improved drug procurement, manage drug expenditures and select high quality and cost effective drugs for the formulary.
What are the hurdles in implementing EDL in a healthcare system?
If you implement EDL in a participatory way and involve stakeholders, you are more likely to meet compliance. If the policy were thrust on the users, it would not work.
Another problem is that the govt does not invest in promoting rational use of drugs. We would benefit if there were as much investment in rational use as much as a pharma company invests in promoting a product.
Also, standard treatment guidelines (STG) that are framed while developing EDL must be followed. STG tells how a particular condition should be treated. STG and EDL therefore should be consistent. It does not make sense if you have an EDL but do not follow STG.