Bitter Pills:Medicines & The Third World Poor | Page 22
ESSENTIAL DRUGS FOR PRIMARY HEALTH CARE
Over the past five years governments of all complexions have been expressing
their commitment to extending health services to cover their entire population.
The new emphasis on the universal right to health care dates back to the joint
World Health Organisation (WHO) and United Nations Children's Fund|
(UNICEF) international conference on Primary Health Care held in
Alma-Ata in 1978. This set the ambitious target of "the attainment by
all peoples of the world by the year 2000 of a level of health that will permit them
to lead a socially and economically productive life". <571 Of course, the rhetoric
obscures the reality in developing countries, but aims for politically neutral ground
to galvanise governments into action.
The Alma-Ata Declaration defines primary health care as "essential health care
.... made universally accessible to individuals and families in the community ....
through their full participation and at a cost that the community and country can
afford ...." (581 It is within the framework of these primary health care services
that medicines could be used most effectively as part of a wider preventive strategy.
In the words of WHO, "While medicinal products alone are not sufficient to
provide adequate health care, they do play an important role in protecting,
maintaining and restoring the health of the people". '""(WHO'S emphasis)
The crucial issue for poor countries is that, whereas a limited number of drugs
are vital to health needs, not all drugs are essential, let alone useful. Of the
thousands of different drugs sold, WHO has identified a selection of approximately
200 which experts consider "essential", in other words "basic, indispensable and
necessary to any nation's health needs". 'm The drugs included in the WHO
Selection of essential drugs (Appendix i) have mostly been in use for many years
and are known to be relatively safe and cost- effective. WHO also urges individual
countries to make a much more limited selection of drugs for their priority needs
in primary health care. |6I) Whilst different experts hold different views on exactly
which drugs should be considered 'essential' for primary health care, many agree
that as few as a dozen or so vital drugs are sufficient to cater for the most pressing
needs of poor communities. (62'
In this chapter we have fOcussed on the relatively limited role of medicines in terms
of the Third World's overall health strategy. But modern drugs are nonetheless,
in the words of one United Nations (UN) report, "a marginal albeit essential
technology".