Community Medicine Cheat Sheet
Essential Medicines Are a System Promise
Essential medicines and NLEM 2022: 384 medicines, P-S-T levels, WHO Model List, selection criteria and rational drug use for NEET-PG community medicine.
MedNext Academy | 3 min read
Essential Medicines Are a System Promise
Essential medicines and NLEM 2022: 384 medicines, P-S-T levels, WHO Model List, selection criteria and rational drug use for NEET-PG community medicine.
Essential medicines satisfy the priority health-care needs of a population and are selected by balancing disease burden, efficacy, safety, cost-effectiveness and health-system level, forming the basis of rational prescribing in India's NLEM.
High-yield lines
- Essential medicines are those that satisfy the priority health-care needs of the population and should be available at all times in adequate amounts and at affordable cost.
- WHO introduced the concept in 1977 with a first Model List containing 208 medicines.
- The WHO Model List of Essential Medicines is updated every two years by an Expert Committee.
- India's first National List of Essential Medicines was published in 1996 with around 279 medicines.
- NLEM 2022 is the current edition and contains 384 medicines across 27 therapeutic sections.
- NLEM classifies each medicine by level of care as P for primary, S for secondary and T for tertiary.
- A medicine listed at P level must be available at the Primary Health Centre.
- NLEM 2022 added agents including bedaquiline and delamanid for drug-resistant tuberculosis and dolutegravir-based antiretroviral regimens.
- Selection balances public-health relevance, evidence of efficacy and safety, and comparative cost-effectiveness.
- The Government of India banned 344 irrational fixed-dose combinations in 2016 under Section 26A of the Drugs and Cosmetics Act 1940.
- Affordability is judged by total treatment cost, not merely the unit price of a tablet.
- The essential medicines concept was a response to scarce budgets being spent on redundant brand-name products while basic drugs were unavailable.
- Rational drug use means prescribing the right drug at the right dose for the right duration at the lowest cost to patient and community.
- NLEM tiering prevents a Primary Health Centre from stocking drugs it cannot manage safely and a tertiary hospital from treating availability as optional.
Mapped competency codes
- CM19.1
- CM19.2
- CM19.3
Continue into the full chapter
This summary maps to CM19-essential-medicine.
Frequently Asked Questions
How many medicines are in NLEM 2022?
384 medicines across 27 therapeutic sections, a net increase from the 376 in NLEM 2015.
What do the P, S and T levels in NLEM mean?
P denotes primary care such as the PHC, S denotes secondary care such as the district hospital, and T denotes tertiary care such as a medical college.
When and with how many medicines did WHO start the essential medicines concept?
In 1977, with a first Model List of Essential Medicines containing 208 medicines.
How is affordability assessed for essential medicines?
By total treatment cost including monitoring and adverse events, not just the unit cost of a single tablet.
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