Access to appropriate medicines is vital to achieving global health goals1. More than eight million children under the age of five still die every year from causes such as pneumonia, diarrhoea and malaria. An estimated 1 000 women die every day due to complications during pregnancy and childbirth. Almost all of these deaths occur in developing countries and the vast majority can be prevented when the right medicines are available in the right formulations and are prescribed and used correctly.
Compiling the list
The top 30 priority list was compiled by experts in maternal and child health and medicines who analysed the WHO Model List of Essential Medicines2 and the latest WHO treatment guidelines to establish which medicines would save the most lives.
Haemorrhage, or severe bleeding, is the leading cause of maternal death. It can kill a healthy woman within two hours of giving birth. An injection of oxytocin immediately after delivery can stop the bleeding and can make the difference between life and death.
Other medicines on the list for mothers include medicines to treat infection, high blood pressure and sexually transmitted infections as well as drugs to prevent preterm birth.
Every year, pneumonia kills an estimated 1.6 million children under the age of five years, yet research has shown that treatment with simple antibiotics could avert as many as 600 000 deaths.
Improving access to Oral Rehydration Salts (ORS) and zinc tablets would save many of the 1.3 million children who are dying annually from diarrhoea.
Appropriate doses of the right combinations of antimalarials and antiretrovirals are critical to reducing child deaths and suffering from malaria and AIDS-related illness.
Most priority medicines are not available where needed
Surveys3 conducted in 14 African countries show that children’s medicines are available in only 35% to 50% of public and private centre pharmacies and drug stores.
The availability of medicines in developing countries for maternal and child health is compromised by poor supply and distribution systems, insufficient health facilities and staff, low investment in health and the high cost of medicines.
“We know that basic, cheap oral rehydration salts and zinc stop children from dying from diarrhoea, and we recommend that all countries make them accessible. But our surveys show that, at present, ORS is available in less than half of pharmacies and kiosks in African countries and zinc is not available at all in many places. This list is designed to help countries prioritize, so that they focus on getting the most critical things available and save the most lives,” said Dr Elizabeth Mason, Director of WHO’s Department of Maternal, Newborn, Child and Adolescent Health.
Medicines appropriate for children are often not available, partly because of a lack of awareness that children need different medicines from adults. As a result, health workers are forced to adapt medicines intended for adults. Tablets are crushed into imprecise portions and dissolved into unpalatable drinks that are difficult for children to swallow and are potentially ineffective, toxic or harmful.
WHO recommends that, wherever possible, medicines for children should be provided in doses that are easy to measure and easy for children to take. A newly developed artemesinin combination tablet for malaria is dissolved in liquid and is sweet tasting, making it easier for children to swallow and ensuring that they receive correct and effective doses.
“Medicines produced in liquid form are more expensive than tablets or powders and are also more difficult to store, package, and transport, due to their bulk, weight and need for refrigeration. The list we have drawn up tells manufacturers exactly what they should be producing to meet countries needs,” said Dr Hans V. Hogerzeil, Director of WHO’s Department for Essential Medicines and Pharmaceutical Policies.
Other life-saving medicines for children need research and development
The top 30 priorities list also features five urgently needed medicines that do not currently exist for the prevention and treatment of tuberculosis, particularly in HIV-infected children, and for newborn care.
Treatment guidelines for tuberculosis in children have been developed recently by WHO, but the recommended dosage requires a child to swallow many tablets a day over a long period of time. Combining the essential ingredients into one tablet results in a pill around the size of a one-euro coin — too large for a child to swallow.
WHO is therefore calling for more research to develop appropriate, palatable formulations for children.
Notes for the editors
Ghana hosts the 18th Expert Committee on the Selection and Use of Essential Medicines
The drugs on the priority medicines list for mothers and children are all included in the current version of the WHO Model List of Essential Medicines which is reviewed every two years by the Expert Committee on the Selection and Use of Essential Medicines.
This year the Committee is reviewing and considering 16 applications for the addition of a new medicine to the model list; 7 applications for the addition of a new formulation; and 9 applications for the deletion of a medicine from the list.
In addition, the Committee will discuss and provide advice on a number of policy items. These include the role of clinical pharmacologists in relation to improving use of medicines; new strategies and directions for improving the rational use of medicines; a draft document on how to develop a national essential medicines list and a proposal on missing essential medicines for the treatment of HIV in adults and children.
The 18th Expert Committee on the Selection and Use of Essential Medicines is taking place in Accra, Ghana on 21-25 March.
Ghana adopted the WHO Essential Medicines concept in 1998 for guiding the development of the pharmaceutical sector and improving access to medicines for the population. Since then, the Ghana National Drugs Programme has led the development and revisions of a National Drug Policy, treatment guidelines, and a national Essential Medicines List.
For more information, or to arrange interviews with experts, contact:
WHO Medicines Access and Rational Use
Telephone: +41 22 791 4560
WHO Maternal, Newborn, Child and Adolescent Health
Telephone: +41 22 791 1209
Mobile: +41 79 475 5545
1 Millennium Development Goals 4, 5 & 6:
- reduce child mortality;
- improve maternal health;
- combat HIV/AIDS, malaria and other diseases.
2 The WHO Model List of Essential Medicines is a guide for the development of national and institutional essential medicine lists that can be used as the basis for procurement and supply of medicines, schemes that reimburse medicine costs, medicine donations and to guide local medicine production.
3 Jane Robertson, Gilles Forte, Jean-Marie Trapsida & Suzanne Hill. What essential medicines for children are on the shelf? Bulletin of the World Health Organization 2009;87:231-237. doi: 10.2471/BLT.08.053645