What is the role of essential medicines in primary health care?

Role of Essential Medicines in Primary Health Care

Essential medicines are fundamental to primary health care by ensuring that treatments for priority health conditions are available, accessible, and affordable to meet the health needs of populations, with correct access potentially saving up to 10.5 million lives per year. 1

Core Functions of Essential Medicines in Primary Care

Essential medicines serve as the backbone of effective primary health care delivery by addressing several critical functions:

Meeting Identified Population Health Needs

• Essential medicines enable primary care to provide evidence-based treatment for conditions causing substantial mortality and morbidity when health workers deliver care based on identified health needs of the population 1, 2
• The World Health Organization's Essential Medicines List (EML) includes medicines selected based on disease prevalence, public health relevance, clinical efficacy, safety, and cost-effectiveness 3
• Primary care implementation succeeds when it provides comprehensive, person-centered care using essential medicines tailored to identified community needs 2

Enabling Treatment of Priority Conditions

• Essential medicines in primary care address both acute and chronic conditions across the lifespan, including cardiovascular disease risk factors (hypertension, diabetes, dyslipidemia), infectious diseases, and mental health conditions 1
• Team-based primary care models that include pharmacists, nurses, and other health professionals can effectively screen, diagnose, prescribe essential medicines, and monitor treatment for conditions like hypertension and diabetes 1
• The median availability of key antibiotics like ciprofloxacin (96% of countries), amoxicillin, ceftriaxone, and cotrimoxazole (89% of countries) demonstrates the global recognition of essential medicines for common infections 1

Impact on Morbidity and Mortality

Cardiovascular Disease Prevention and Management

• Primary care using essential medicines for cardiovascular risk factor management (blood pressure medications, lipid-lowering agents, glucose control medications) is associated with reduced illness and mortality rates and lower total cost of care 1
• Better access to primary care with essential medicines improves blood pressure awareness and control regardless of socioeconomic status 1
• Team-based care led by nurses or pharmacists using essential medicines effectively improves blood pressure, glucose control, and dyslipidemia management 1

Addressing Global Health Burden

• Nearly 2 billion people globally lack access to essential medicines, meaning these treatments are unavailable, unaffordable, inaccessible, or of low quality for more than a quarter of the world's population 4
• Correct access to essential medicines would potentially save up to 10.5 million lives annually, making this a critical mortality reduction strategy 1
• Essential medicines are central to achieving Universal Health Coverage and the Sustainable Development Goals 4

Critical Barriers in Low- and Middle-Income Countries

Availability and Accessibility Challenges

• Generic essential medicines are poorly available in public sector facilities in low-income countries (36.1%) compared to private sector (76.3%), creating access disparities 1
• Only three of 14 surveyed central African countries had >50% of key pediatric medicines available from central medical stores at the time of assessment 1
• Up to 90% of populations in low- and middle-income countries purchase medicines through out-of-pocket payments, making medicines the largest family expenditure after food 1

Pricing and Affordability Issues

• African countries pay 34-44% more than international reference prices for essential medicines on average 1
• Pediatric formulations are typically more expensive than adult equivalents, leading to inappropriate or unsafe use of adult dosage forms in children 1
• Financial pressures cause patients to purchase medicines daily rather than complete courses, or to store expired antibiotics for later self-medication 1

Common Pitfalls and How to Avoid Them

Over-the-Counter Antibiotic Sales

• Two-thirds of antibiotics are sold over the counter without prescriptions, allowing purchase for self-diagnosed problems without medical consultation 1
• This practice, combined with incomplete treatment courses and storage of expired medications, fosters antimicrobial resistance 1
• Primary care systems must implement prescription requirements and patient education to prevent inappropriate antibiotic use and resistance development 1

Pricing Paradoxes

• Reducing prices too aggressively can paradoxically decrease availability by creating disincentives to stock low-priced generics in favor of higher-priced branded products 1
• Policy makers must balance affordability with sustainable supply chain economics 1

Incomplete Implementation

• While 156 countries accept the principle of essential medicines availability, implementation remains variable 5
• Most countries list priority non-communicable disease interventions on national essential medicines lists (median 88% of 43 WHO-recommended interventions), but listing does not guarantee actual availability or access 6

Integration with Modern Primary Care Models

Team-Based Care Delivery

• Effective primary care models include clinicians, nurses, pharmacists, nutritionists, health psychologists, and social workers working together to prescribe, monitor, and adjust essential medicines 1
• Veterans Health Administration Patient Aligned Care Teams demonstrate that sites with greater team-based implementation achieve higher performance on quality measures including hypertension and diabetes control using essential medicines 1

Addressing Social Determinants

• Primary care must link patients with essential medicines to community resources, social services, and disease management programs to ensure medication adherence and effectiveness 1
• Lack of health insurance is associated with lower use of primary care services and inferior control of conditions requiring essential medicines (hypertension, elevated cholesterol, diabetes) 1

Technology and Systems Support

• Electronic health record tracking tools, population health management systems, and self-monitoring programs enhance essential medicine prescribing, adherence monitoring, and treatment titration in primary care 1