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Twenty-Five Years Of Essential Drugs: Reflections
http://www.100md.com 2001年9月6日 中国医学论坛表
     Since the concept of "essential drugs" was first introduced to the world in 1975, much has been achieved. By the end of 1999, 156 countries had an essential drugs list (127, or 80%, of which had been recently updated), 135 countries had developed national treatment guidelines (83% of which had been recently updated), 88 countries had introduced the essential drugs concept into curricula for medicine and pharmacy students, and the WHO Guide to Good Prescribing had been translated into 18 languages and adopted by teaching institutions in numerous countries. Most importantly, the number of people estimated to have regular access to essential drugs rose from 2.1 billion in 1977 to nearly 4 billion in 1997.

    Despite these achievements, it is estimated that one-third of the world's population - roughly two billion people - lacks regular access to essential drugs. Unsafe and wasteful drug use persists: 25 to 75% of antibiotic prescriptions in teaching hospitals studies from both developed and developing countries are inappropriate, 30 to 60% of patients in primary health care centres received antibiotics (perhaps twice what is clinically needed), high levels of unnecessary and unsafe injections continue in many countries, and 50% of patients worldwide fail to take medicines correctly. Finally, 10 to 20% of sampled drugs in a survey of developing countries failed quality control tests. And in one large dataset of reported counterfeit and substandard drugs, 60% had no active ingredient.

    Hence, challenges include securing universal access to essential drugs, promoting rational use of drugs by health professionals and the public, and ensuring the quality and safety of all medicines. These challenges are especially great for the nearly 80 countries in which average income is less than $2 per capita per year.

    Key actions include expanding access to essential drugs through improved drug selection, equitable and sustainable drug financing mechanisms, affordable drug prices, and reliable pharmaceutical supply systems. Countering continued irrational use of drugs requires educational, managerial, and regulatory action for health professional and consumers in both the public and private sectors. And improving drug quality and safety requires not only appropriate standards, but also effective drug regulation systems., 百拇医药