Thirty years of essential medicines in primary health care.

The development of the first Model List of Essential Drugs2 [1] and the Declaration of Alma Ata [2], which advocated the adoption of primary health care (PHC), were both important milestones in the history of public health. Some elements of both were already in practice in some countries before the late 1970s when the World Health Organization (WHO) adopted and promoted them. They are dependent on each other for their success and they continue to bolster each other. Thirty years of the Alma Ata Declaration is also a history of essential medicines – the concept and its application. It is time to celebrate, reflect and revisit these time-tested concepts in order to face the future challenges for the organization and provision of effective health care services and health systems. This article first presents the conceptual need for and rationale of essential medicines, from its beginnings until now. Essential medicines, as an integral component of the PHC philosophy and system, are explained and developments in the essential medicines approach over the past 30 years are traced. The situation with regard to essential medicines in the East Mediterranean Region of the World Health Organization is briefly presented. Finally the existing and future challenges to PHC and essential medicines are defined and their relevance in the changing times and contexts of the 21st century is established.