In response to the vast range of drugs that had become available, the World Health Organization formulated a model core list of drugs essential and relevant to health care needs. This Essential Drug Concept was formalised with the publication of the first WHO Model Essential Drug List in 1977. Kenya was one of the first countries to recognise the importance of the concept and made its own list in 1981 based on the WHO model list. The Kenya Essential Drugs List was for all levels of health care but was initially used for the rural health institutions and also formed the basis of the drug kits. In addition, Kenya hosted the WHO sponsored International Conference on Rational Drug Use in 1985 which gave rise to the much acclaimed ‘Spirit of Nairobi’.
In the late 80s the Ministry of Health promoted the list at the secondary and tertiary health care facilities. In 1992 the Ministry decided to revise the list and to rigorously implement the revised KEDL as the basis for managing drug supply in the public health sector. A workshop with participation of senior personnel that included clinicians, pharmacists, academicians and health educators was organised in July 2002 to revise the KEDL. This publication is a result of this workshop.
The concept and the criteria for selection of Essential Drugs is clearly outlined in the WHO Technical Report 825 - The Use of Essential Drugs (Seventh List), Fifth Report of the WHO Expert Committee, 1992.
Essential Drugs are those that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and appropriate dosage forms.
The choice of such drugs depend on many factors, such as the pattern of prevalent diseases; the treatment facilities; the training and experience of the available personnel; the financial resources; and genetic, demographic and environmental factors.
Drugs selected should be only those for which sound and adequate data on efficacy and safety are available from clinical studies and for which evidence of performance in general use in a variety of medical settings has been obtained.
Each selected drug must be available in a form in which adequate quality, including bioavailability, can be assured; its stability under the anticipated conditions of storage and use must be established.
Where two or more drugs appear to be similar in the above respects, the choice between them should be made on the basis of careful evaluation of their relative efficacy, safety, quality, price and availability.
In cost comparisons between drugs, the cost of the total treatment, and not only the unit cost of the drug, must be considered. The cost/benefit ratio is a major consideration in the choice of some drugs for the lists. In some cases the choice may be influenced by other factors such as comparative pharmacokinetic properties, or by local considerations such as availability of facilities for manufacture or storage.
Most essential drugs should be formulated as single compounds. Fixed-ratio combination products are acceptable only when the dosage of each ingredient meets the requirements of a defined population group and when the combination has a proven advantage over single compounds administered separately in therapeutic effect, safety or compliance.
Practically what this means is that only one drug from a therapeutic category will be available and between equivalent drugs the choice will be made on cost. Familiarity with a single drug will make the prescribers more confident in using it, encourage its better use and also reduce the cost through bulk purchase. Since the list is for the majority of the population it will not provide “All the drugs for all the patients” but the instances where a prescriber has to go outside the list should be few and far between.
The KEDL was last revised in 1993. This revision has been done along with and in close collaboration with the Clinical Guidelines of the Ministry of Health. This joint effort is central to the efforts of the Ministry of Health in harmonising activities in the drug sector. The development of the Clinical Guidelines will encourage the rational use of the carefully selected drugs in the KEDL.
The third edition of the KEDL takes into consideration the changing trends in the provision of health care especially in areas of Malaria, TB and HIV/AIDs.
In addition, the KEDL, which also has pharmaceutical specifications, will serve as a guide for procuring these drugs for the Ministry of Health and also encourage the local manufacturers to adapt their production for the health care needs of the country. It will also serve as a pointer to donor agencies on the pharmaceutical requirements of Kenya.
The KEDL will also serve as a reference document for legislation, staff development and management improvement aimed at ensuring the regular supply of safe and effective drugs that are affordable and of acceptable quality to all sectors of health care. It is also expected that the KEDL will play a central part in the implementation of the Kenya National Drug Policy, which is on going.
The KEDL is comprehensive and virtually all the drugs that are taught in medical and paramedical training courses are included. Hence the KEDL is a sound basis for formulating the curriculum on drug and therapeutics in training Institutions.
Dr. K.C. Koskei, OGW,
Chief Pharmacist,
Ministry of Health,
Afya House,
P.O. Box 30016,
Nairobi.
