What is Quality of Life?


Quality of life (QOL) is defined by the World Health Organisation (WHO) as “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns”.

Standard indicators of the quality of life include wealth, employment, the environment, physical and mental health, education, recreation and leisure time, social belonging, religious beliefs, safety, security and freedom. QOL has a wide range of contexts, including the fields of international development, healthcare, politics and employment. Health related QOL (HRQOL) is an evaluation of QOL and its relationship with health.

Refer to Physical Quality of Life Index.

Engaged Theory

One approach, called engaged theory, outlined in the journal of Applied Research in the Quality of Life, posits four domains in assessing quality of life:

  1. Ecology;
  2. Economics;
  3. Politics; and
  4. Culture.

In the domain of culture, for example, it includes the following subdomains of quality of life:

  • Beliefs and ideas
  • Creativity and recreation
  • Enquiry and learning
  • Gender and generations
  • Identity and engagement
  • Memory and projection
  • Well-being and health

Under this conception, other frequently related concepts include freedom, human rights, and happiness. However, since happiness is subjective and difficult to measure, other measures are generally given priority. It has also been shown that happiness, as much as it can be measured, does not necessarily increase correspondingly with the comfort that results from increasing income. As a result, standard of living should not be taken to be a measure of happiness. Also sometimes considered related is the concept of human security, though the latter may be considered at a more basic level and for all people.

Quantitative Measurement

Unlike per capita GDP or standard of living, both of which can be measured in financial terms, it is harder to make objective or long-term measurements of the quality of life experienced by nations or other groups of people. Researchers have begun in recent times to distinguish two aspects of personal well-being: Emotional well-being, in which respondents are asked about the quality of their everyday emotional experiences – the frequency and intensity of their experiences of, for example, joy, stress, sadness, anger and affection – and life evaluation, in which respondents are asked to think about their life in general and evaluate it against a scale. Such and other systems and scales of measurement have been in use for some time. Research has attempted to examine the relationship between quality of life and productivity. There are many different methods of measuring quality of life in terms of health care, wealth, and materialistic goods. However, it is much more difficult to measure meaningful expression of one’s desires. One way to do so is to evaluate the scope of how individuals have fulfilled their own ideals. Quality of life can simply mean happiness, the subjective state of mind. By using that mentality, citizens of a developing country appreciate more since they are content with the basic necessities of health care, education and child protection.

According to ecological economist Robert Costanza:

While Quality of Life (QOL) has long been an explicit or implicit policy goal, adequate definition and measurement have been elusive. Diverse “objective” and “subjective” indicators across a range of disciplines and scales, and recent work on subjective well-being (SWB) surveys and the psychology of happiness have spurred renewed interest.

Human Development Index

Perhaps the most commonly used international measure of development is the Human Development Index (HDI), which combines measures of life expectancy, education, and standard of living, in an attempt to quantify the options available to individuals within a given society. The HDI is used by the United Nations (UN) Development Programme in their Human Development Report. However, since year 2010, The Human Development Report introduced an Inequality-adjusted Human Development Index (IHDI). While the original HDI remains useful, it stated that:

“the IHDI is the actual level of human development (accounting for inequality), while the original HDI can be viewed as an index of ‘potential’ human development (or the maximum level of HDI) that could be achieved if there was no inequality.”

World Happiness Report

The World Happiness Report is a landmark survey on the state of global happiness. It ranks 156 countries by their happiness levels, reflecting growing global interest in using happiness and substantial well-being as an indicator of the quality of human development. Its growing purpose has allowed governments, communities and organisations to use appropriate data to record happiness in order to enable policies to provide better lives. The reports review the state of happiness in the world today and show how the science of happiness explains personal and national variations in happiness.

Developed again by the UN and published recently along with the HDI, this report combines both objective and subjective measures to rank countries by happiness, which is deemed as the ultimate outcome of a high quality of life. It uses surveys from Gallup, real GDP per capita, healthy life expectancy, having someone to count on, perceived freedom to make life choices, freedom from corruption, and generosity to derive the final score. Happiness is already recognised as an important concept in global public policy. The World Happiness Report indicates that some regions have in the past been experiencing progressive inequality of happiness.

Other Measures

The Physical Quality of Life Index (PQLI) is a measure developed by sociologist M.D. Morris in the 1970s, based on basic literacy, infant mortality, and life expectancy. Although not as complex as other measures, and now essentially replaced by the Human Development Index, the PQLI is notable for Morris’s attempt to show a “less fatalistic pessimistic picture” by focusing on three areas where global quality of life was generally improving at the time, while ignoring gross national product and other possible indicators that were not improving.

The Happy Planet Index, introduced in 2006, is unique among quality of life measures in that, in addition to standard determinants of well-being, it uses each country’s ecological footprint as an indicator. As a result, European and North American nations do not dominate this measure. The 2012 list is instead topped by Costa Rica, Vietnam and Colombia.

In 2010, Gallup researchers trying to find the world’s happiest countries found Denmark to be at the top of the list. For the period 2014-2016, Norway surpasses Denmark to be at the top of the list. uSwitch publishes an annual quality of life index for European countries. France topped the list from 2009 to 2011.

A 2010 study by two Princeton University professors looked at 1,000 randomly selected US residents over an extended period. It concludes that their life evaluations – that is, their considered evaluations of their life against a stated scale of one to ten – rise steadily with income. On the other hand, their reported quality of emotional daily experiences (their reported experiences of joy, affection, stress, sadness, or anger) levels off after a certain income level (approximately $75,000 per year in 2010); income above $75,000 does not lead to more experiences of happiness nor to further relief of unhappiness or stress. Below this income level, respondents reported decreasing happiness and increasing sadness and stress, implying the pain of life’s misfortunes, including disease, divorce, and being alone, is exacerbated by poverty.

Gross national happiness and other subjective measures of happiness are being used by the governments of Bhutan and the United Kingdom. The World Happiness report, issued by Columbia University is a meta-analysis of happiness globally and provides an overview of countries and grassroots activists using GNH. The OECD (Organisation for Economic Co-operation and Development) issued a guide for the use of subjective well-being metrics in 2013. In the US, cities and communities are using a GNH metric at a grassroots level.

The Social Progress Index measures the extent to which countries provide for the social and environmental needs of their citizens. Fifty-two indicators in the areas of basic human needs, foundations of wellbeing, and opportunity show the relative performance of nations. The index uses outcome measures when there is sufficient data available or the closest possible proxies.

Day-Reconstruction Method was another way of measuring happiness, in which researchers asked their subjects to recall various things they did on the previous day and describe their mood during each activity. Being simple and approachable, this method required memory and the experiments have confirmed that the answers that people give are similar to those who repeatedly recalled each subject. The method eventually declined as it called for more effort and thoughtful responses, which often included interpretations and outcomes that do not occur to people who are asked to record every action in their daily lives.


The term quality of life is also used by politicians and economists to measure the liveability of a given city or nation. Two widely known measures of liveability are the Economist Intelligence Unit’s Where-to-be-born Index and Mercer’s Quality of Living Reports. These two measures calculate the liveability of countries and cities around the world, respectively, through a combination of subjective life-satisfaction surveys and objective determinants of quality of life such as divorce rates, safety, and infrastructure. Such measures relate more broadly to the population of a city, state, or country, not to individual quality of life. Liveability has a long history and tradition in urban design, and neighbourhoods design standards such as LEED-ND are often used in an attempt to influence liveability.


Some crimes against property (e.g., graffiti and vandalism) and some “victimless crimes” have been referred to as “quality-of-life crimes.” American sociologist James Q. Wilson encapsulated this argument as the broken windows theory, which asserts that relatively minor problems left unattended (such as litter, graffiti, or public urination by homeless individuals) send a subliminal message that disorder, in general, is being tolerated, and as a result, more serious crimes will end up being committed (the analogy being that a broken window left broken shows an image of general dilapidation).

Wilson’s theories have been used to justify the implementation of zero tolerance policies by many prominent American mayors, most notably Oscar Goodman in Las Vegas, Richard Riordan in Los Angeles, Rudolph Giuliani in New York City and Gavin Newsom in San Francisco. Such policies refuse to tolerate even minor crimes; proponents argue that this will improve the quality of life of local residents. However, critics of zero tolerance policies believe that such policies neglect investigation on a case-by-case basis and may lead to unreasonably harsh penalties for crimes.

In Healthcare

Within the field of healthcare, quality of life is often regarded in terms of how a certain ailment affects a patient on an individual level. This may be a debilitating weakness that is not life-threatening; life-threatening illness that is not terminal; terminal illness; the predictable, natural decline in the health of an elder; an unforeseen mental/physical decline of a loved one; or chronic, end-stage disease processes. Researchers at the University of Toronto’s Quality of Life Research Unit define quality of life as “The degree to which a person enjoys the important possibilities of his or her life” (UofT). Their Quality of Life Model is based on the categories “being”, “belonging”, and “becoming”; respectively who one is, how one is connected to one’s environment, and whether one achieves one’s personal goals, hopes, and aspirations.

Experience sampling studies show substantial between-person variability in within-person associations between somatic symptoms and quality of life. Hecht and Shiel measure quality of life as “the patient’s ability to enjoy normal life activities” since life quality is strongly related to wellbeing without suffering from sickness and treatment. There are multiple assessments available that measure Health-Related Quality of Life, e.g. AQoL-8D, EQ5D – Euroqol, 15D, SF-36, SF-6D, HUI.

In International Development

Quality of life has been deemed an important concept in the field of international development because it allows development to be analysed on a measure that is generally accepted as more comprehensive than standard of living. Within development theory, however, there are varying ideas concerning what constitutes desirable change for a particular society. The different ways that quality of life is defined by institutions, therefore, shape how these organisations work for its improvement as a whole.

Organisations such as the World Bank, for example, declare a goal of “working for a world free of poverty”, with poverty defined as a lack of basic human needs, such as food, water, shelter, freedom, access to education, healthcare, or employment. In other words, poverty is defined as a low quality of life. Using this definition, the World Bank works towards improving quality of life through the stated goal of lowering poverty and helping people afford a better quality of life.

Other organisations, however, may also work towards improved global quality of life using a slightly different definition and substantially different methods. Many non-governmental organisations (NGOs) do not focus at all on reducing poverty on a national or international scale, but rather attempt to improve the quality of life for individuals or communities. One example would be sponsorship programmes that provide material aid for specific individuals. Although many organisations of this type may still talk about fighting poverty, the methods are significantly different.

Improving quality of life involves action not only by NGOs but also by governments. Global health has the potential to achieve greater political presence if governments were to incorporate aspects of human security into foreign policy. Stressing individuals’ basic rights to health, food, shelter, and freedom addresses prominent inter-sectoral problems negatively impacting today’s society and may lead to greater action and resources. Integration of global health concerns into foreign policy may be hampered by approaches that are shaped by the overarching roles of defence and diplomacy.

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What is the International Pharmacopoeia?


The International Pharmacopoeia (Pharmacopoeia Internationalis, Ph. Int.) is a pharmacopoeia issued by the World Health Organisation (WHO) as a recommendation, with the aim to provide international quality specifications for pharmaceutical substances (active ingredients and excipients) and dosage forms, together with supporting general methods of analysis, for global use. Its texts can be used or adapted by any WHO member state wishing to establish legal pharmaceutical requirements.

The Ph.Int. is based primarily on medicines included in the current WHO Model List of Essential Medicines (EML) and medicines included in the current invitations to manufacturers to submit an expression of interest (EOI) to the WHO Prequalification Team – Medicines (PQT) and those of interest to other UN organisations. In recent years, priority has been given to medicines of importance in low and middle income countries, which may not appear in any other pharmacopoeias, including child-friendly dosage forms.

The Ph.Int. is designed to serve all Member States, especially their national and regional regulatory authorities, organisations in the United Nations system, and regional and interregional harmonisation efforts, and they underpin important public health initiatives, including the prequalification and procurement of quality medicines through major international entities, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, and UNICEF.

The monographs published in the Ph.Int. are established in an independent manner via a consultative procedure and based on international experience. Monographs on radiopharmaceuticals developed with the International Atomic Energy Agency.

Refer to The International Pharmacopoeia, British Pharmacopoeia, European Pharmacopoeia, United States Pharmacopoeia, Indian Pharmacopoeia Commission, Japanese Pharmacopoeia, and Pharmacopoeia of the People’s Republic of China.

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What is the International Classification of Functioning, Disability and Health?


The International Classification of Functioning, Disability and Health (ICF) is a classification of the health components of functioning and disability.

The ICF received approval from all 191 World Health Organisation (WHO) member states on May 22, 2001, during the 54th World Health Assembly. Its approval followed nine years of international revision efforts coordinated by WHO. WHO’s initial classification for the effects of diseases, the International Classification of Impairments, Disabilities, and Handicaps (ICIDH), was created in 1980.

The ICF classification complements WHO’s International Classification of Diseases-10th Revision (ICD), which contains information on diagnosis and health condition, but not on functional status. The ICD and ICF constitute the core classifications in the WHO Family of International Classifications (WHO-FIC).


The ICF is structured around the following broad components:

  • Body functions and structure.
  • Activities (related to tasks and actions by an individual) and participation (involvement in a life situation).
  • Additional information on severity and environmental factors.

Functioning and disability are viewed as a complex interaction between the health condition of the individual and the contextual factors of the environment as well as personal factors. The picture produced by this combination of factors and dimensions is of “the person in his or her world”. The classification treats these dimensions as interactive and dynamic rather than linear or static. It allows for an assessment of the degree of disability, although it is not a measurement instrument. It is applicable to all people, whatever their health condition. The language of the ICF is neutral as to aetiology, placing the emphasis on function rather than condition or disease. It also is carefully designed to be relevant across cultures as well as age groups and genders, making it highly appropriate for heterogeneous populations.


There are benefits of using the ICF for both the patient and the health professional. A major advantage for the patient is the integration of the physical, mental, and social aspects of his or her health condition. All aspects of a person’s life (development, participation and environment) are incorporated into the ICF instead of solely focusing on his or her diagnosis. A diagnosis reveals little about one’s functional abilities. Diagnoses are important for defining the cause and prognosis, but identifying the limitations of function is often the information used to plan and implement interventions. Once a rehabilitation team is aware of the daily activities a client is required to participate in, the problem solving sequence set up by the ICF can be utilised. An occupational therapist, for example, would observe a patient performing his or her daily activities and note the patient’s functional abilities. This information would then be used to determine the extent to which the individual’s abilities can be improved through therapy and to what extent the environment can be changed to facilitate the individual’s performance. Intervention at one level (current abilities) has the potential to prevent or modify events at a succeeding level (participation). For example, teaching a deaf child manual signs will foster effective interaction and increase one’s participation with his or her family.

Rehabilitation therapists will be empowered with the ICF not only in their daily work with their patients, but also when working with other medical disciplines; hospitals and other health care administrations; health authorities and policy makers. All items are operationally defined with clear descriptions that can be applied to real life evaluations with clarity and ease. The language used in the ICF helps facilitate better communication between these groups of people.

Clinical Relevance

Knowing how a disease affects one’s functioning enables better planning of services, treatment, and rehabilitation for persons with long-term disabilities or chronic conditions. The current ICF creates a more integrative understanding of health forming a comprehensive profile of an individual instead of focusing on one’s disease, illness, or disability. The implications of using the ICF include an emphasis on the strengths of individuals, assisting individuals in participating more extensively in society by the use of interventions aimed at enhancing their abilities, and taking into consideration the environmental and personal factors that might hamper their participation.


The ICF qualifiers “may be best translated clinically as the levels of functioning seen in a standardised or clinic setting and in everyday environments”. Qualifiers support standardisation and the understanding of functioning in a multidisciplinary assessment. They enable all team members to quantify the extent of problems, even in areas of functioning where one is not a specialist. Without qualifiers codes have no inherent meaning. An impairment, limitation or restriction is qualified from:

  • 0 (No problem; 0-4%);
  • 1 (Mild problem: 5-24%);
  • 2 (Moderate problem: 25-49%);
  • 3 (Severe problem: 50-95%); to
  • 4 (Complete problem: 96-100%).

Environmental factors are quantified with a negative and positive scale denoting the extent to which the environment acts as a barrier or facilitator.

For insurance purposes, the qualifiers can describe the effectiveness of treatment. One can interpret the decreasing of a qualifier score to be an increase in the functional ability of a patient.

Core Sets

An ICF Core Set can serve as a reference framework and a practical tool to classify and describe patient functioning in a more time efficient way. ICF Core Sets can be used along the continuum of care and over the course of a health condition. The ICF classification includes more than 1,400 categories limiting its use in clinical practice. It is time-consuming for a clinician to utilize the main volume of the ICF with his or her patients. Only a fraction of the categories is needed. As a general rule, 20% of the codes will explain 80% of the variance observed in practice. ICF Core Sets contain as few as possible, but as many ICF categories as necessary, to describe a patient’s level of functioning. It is hypothesized that using an ICF Core Set will increase the inter-rater reliability when coding clinical cases as only the relevant categories for a particular patient will be utilised. Since all of the relevant categories are listed in an ICF Core Set, its use in multidisciplinary assessments protects health professionals from missing important aspects of functioning.

Paediatric Use

As clinicians and researchers used the ICF, they became more aware of its limitations. The ICF lacks the ability to classify the functional characteristics of a developing child. Different ICF codes are needed across the first years of a child’s life to capture the growth and development of a disability even when the child’s diagnosis does not change. The coding system can provide essential information about the severity of a health condition in terms of its impact on functioning. This can serve a significant role for providers caring for children with spectrum disorders such as autism or cerebral palsy. Children with these conditions may have the same diagnoses, but their abilities and levels of functioning widely vary across and within individuals over time. The first draft of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) was completed in year 2003 and published in 2007. The ICF-CY was developed to be structurally consistent with the ICF for adults. A major difference between the ICF-CY and ICF is that the generic qualifiers from the adult ICF now include developmental aspects for children and youth in the ICF-CY. Descriptions of codes in the ICF-CY were revised and expanded and new content was added to previously unused codes. Codes were added to document characteristics as adaptability, responsivity, predictability, persistence, and approachability. “Sensing” and “exploration of objects” codes were expanded as well as the “importance of learning”. Since a child’s main occupation is playing, it is also important to include more codes in this area. Different levels of play have separate codes in the ICF-CY (solitary, onlooker, parallel). This contrasts with the adult ICF as only one code existed in regards to leisure or recreation.

Changes in ICF-CY codes over time reflect developmental effects attributable to the child’s interaction with the environment. Environmental factors influence functioning and development and can be documented as barriers or facilitators using the ICF-CY. The key environments of children and adolescents include their homes, day care centres, schools and recreation settings of playground, parks, and ball fields. Children will transition between different environments many times as they grow. For example, a child will transition into elementary or high school or from one service setting or agency to another. Attention to these transitions of children with disabilities has been identified as an important role for health care providers. A transition requires preparation and planning to find an appropriate and accommodating setting for a child’s needs. With a coding system such as the ICF-CY, the transition will be smoother and interventions can start where the previous health provider left off.

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What is Defined Daily Dose?


The defined daily dose (DDD) is a statistical measure of drug consumption, defined by the World Health Organisation (WHO) Collaborating Centre for Drug Statistics Methodology (WHOCC).

It is defined in combination with the ATC Code drug classification system for grouping related drugs. The DDD enables comparison of drug usage between different drugs in the same group or between different health care environments, or to look at trends in drug utilisation over time. The DDD is not to be confused with the therapeutic dose or prescribed daily dose (PDD), or recorded daily dose (RDD), and will often be different to the dose actually prescribed by a physician for an individual person.

The WHO’s definition is: “The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults.” The Defined Daily Dose was first developed in the late 1970s.

Refer to Prescribed Daily Dose, Average Daily Quantity, and Maintenance Dose.


Before a DDD is assigned by the WHOCC, it must have an ATC Code and be approved for sale in at least one country. The DDD is calculated for a 70kg adult, except if this drug is only ever used in children. The dose is based on recommendations for treatment rather than prevention, except if prevention is the main indication. Generally there is only one DDD for all formulations of a drug, however exceptions are made if some formulations are typically used in significantly different strengths (e.g. antibiotic injection in a hospital vs tablets in the community). The DDD of combination tablets (containing more than one drug) is more complex, most taking into account a “unit dose”, though combination tablets used for high blood pressure take the number of doses per day into account.

The formula for determining the dose is:

  • If there is a single recommended maintenance dose in the literature, this is preferred.
  • :If there are a range of recommended maintenance doses then
    • If the literature recommends generally increasing from initial to maximum dose provided it is tolerated, pick the maximum dose.
    • If the literature recommends only increasing from an initial dose if not sufficiently effective, pick the minimum dose.
    • If there is no guidance then pick the mid point between the dose range extremes.

The DDD of a drug is reviewed after three years. Ad hoc requests for change may be made but are discouraged and generally not permitted unless the main indication for the drug has changed or the average dose used has changed by more than 50%.


The DDD is generally the same for all formulations of a drug, even if some (e.g. flavoured syrup) are designed with children in mind. Some types of drug are not assigned a DDD, for example: medicines applied to the skin, anaesthetics and vaccines. Because the DDD is a calculated value, it is sometimes a “dose” not actually ever prescribed (e.g. a midpoint of two prescribed tablet strengths may not be equal to or be a multiple of any available tablet). Different people may in practice be prescribed higher or lower doses than the DDD, for instance in children, people with liver or kidney impairment, patients with a combination therapy, or due to differences in drug metabolism between individuals or ethnicities (genetic polymorphism).

Although designed primarily for drug utilisation research, data using the DDD can only give a “rough estimate” compared with actually collecting statistics on drug use in practice. The DDD is often use for long term research and analysis of drug utilisation trends over time, so changes to the DDD are avoided if possible, whereas changes in the actual daily dose prescribed for a population may often occur. For example, the Recorded Daily Dose (RDD) of simvastatin in Canada in 1997 was only 8% different to the DDD, but by 2006 it was 67% different. In 2009, the DDD of several statins were updated, with simvastatin changing from 15mg to 30mg.

The DDD is based on the maintenance dose, but in practice patients in a population will be on a mix of initial and maintenance doses.

Use and Misuse

The DDD can be used as the basis for calculating various indicators of drug utilisation. The indicator DDD per 1000 inhabitants per day can suggest what portion of a population are regularly using a drug or class of drugs. The indicator DDD per 100 bed days estimates on average how many inpatients are given a drug every day in hospital. The indicator DDDs per inhabitant per year can be used for drugs normally prescribed for short treatment duration (e.g. antibiotics) to indicate the average number of days in a year a person may take that treatment. The extent to which estimates using DDD reflect actual clinical practice depends on how close the DDD is to the typical prescribed dose in that country or setting and at that point in history.

Because the primary purpose of the ATC/DDD system is drug consumption measurement, the WHO recommend caution when considering its use for cost analysis: “DDDs, if used with caution can be used to compare, for example, the costs of two formulations of the same drug.” So, the cost per DDD of an extended-release tablet taken once a day compared with a standard tablet taken twice a day, may indicate the extended-release tablet costs much more to treat the same condition.

In contrast, using DDD to compare the cost of different drugs or drug groups is “usually not valid” according to the WHO. They recommend that “DDDs are not suitable for comparing drugs for specific, detailed pricing, reimbursement and cost-containment decisions”. The DDD may not necessarily compare well with the actual PDD, and two drugs in the same ATC group may not be equally effective at their DDD.

For example, an analysis of statin use in the Ontario Drug Benefit Programme, 2006-2007. The average cost per DDD of rosuvastatin was 21% more expensive than atorvastatin ($1.14 compared to $0.94), which would suggest the shift at the time from prescribing atorvastatin to prescribing rosuvastatin would result in increased costs to the healthcare budget. Both had a DDD at that time of 10mg, but 10mg was not the only dose prescribed. For example, atorvastatin once daily at 10mg, 20mg, 40mg and 80mg was prescribed 45%, 36%, 16% and 3% of the time respectively. If one compared cost per unit (daily tablet) then rosuvastatin was instead 24% cheaper than atorvastatin ($1.44 vs $1.90), and if one compares cost per RDD (recorded daily dose) then rosuvastatin was 26% cheaper than atorvastatin ($1.43 vs $1.93). An erroneous conclusion of a healthcare budget cost increase arises in this case from using cost per DDD. At the time, the RDD of rosuvastatin was similar to its DDD (12.6 mg vs 10mg), but the RDD of atorvastatin was twice its DDD (20.6 mg vs 10mg). The DDD of atorvastatin was revised in 2009 to 20mg.

The Canadian Patented Medicine Prices Review Board analysed the use of DDD for drug utilisation and cost analysis and offered recommendations. They particularly concentrated on the problems that occur when the RDD observed in the population deviates more than minimally from the DDD. They conclude that the DDD methodology “should generally not be used to interpret Canadian drug utilisation; should generally not be applied in cost analyses; and should generally not be applied in policy decisions”. The Board recommend that provided the agreement between DDD and RDD is known and minimal, then a cost per DDD “can provide a rough idea of the treatment cost” but “caution should still be used, as misinterpretation of the results based on the DDD methodology may still occur”. If the agreement between DDD and RDD is unknown or a significant disagreement is known, then the DDD methodology “should not be used in cost analyses”. In all cases, the Board state “The DDD methodology should not be used in guiding policy decisions regarding reimbursement, therapeutic substitution and other pricing decisions”.


If the DDD for a certain drug is given, the number of DDDs used by an individual patient or (more commonly) by a collective of patients is as follows.

Drug usage (in DDDs) = (Items issued x Amount of drug per item) divided by DDD.

For example, the analgesic (pain reliever) paracetamol has a DDD of 3 g, which means that an average patient who takes paracetamol for its main indication, which is pain relief, uses 3 grams per day. This is equivalent to six standard tablets of 500 mg each. If a patient consumes 24 such tablets (12 g of paracetamol in total) over a certain span of time, this equals a consumption of four DDDs.

Drug usage in DDDs = (24 (items) x 500 (mg/item)) divided by 3000 mg = 4

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What is the Anatomical Therapeutic Chemical Classification System?


The Anatomical Therapeutic Chemical (ATC) Classification System is a drug classification system that classifies the active ingredients of drugs according to the organ or system on which they act and their therapeutic, pharmacological and chemical properties.

Its purpose is an aid to monitor drug use and for research to improve quality medication use. It does not imply drug recommendation or efficacy. It is controlled by the World Health Organisation Collaborating Centre for Drug Statistics Methodology (WHOCC), and was first published in 1976.

Brief History

The ATC system is based on the earlier Anatomical Classification System, which is intended as a tool for the pharmaceutical industry to classify pharmaceutical products (as opposed to their active ingredients). This system, confusingly also called ATC, was initiated in 1971 by the European Pharmaceutical Market Research Association (EphMRA) and is being maintained by the EphMRA and Intellus. Its codes are organised into four levels. The WHO’s system, having five levels, is an extension and modification of the EphMRA’s. It was first published in 1976.

Coding System

This pharmaceutical coding system divides drugs into different groups according to the organ or system on which they act, their therapeutic intent or nature, and the drug’s chemical characteristics. Different brands share the same code if they have the same active substance and indications. Each bottom-level ATC code stands for a pharmaceutically used substance, or a combination of substances, in a single indication (or use). This means that one drug can have more than one code, for example acetylsalicylic acid (aspirin) has A01AD05 (WHO) as a drug for local oral treatment, B01AC06 (WHO) as a platelet inhibitor, and N02BA01 (WHO) as an analgesic and antipyretic; as well as one code can represent more than one active ingredient, for example C09BB04 (WHO) is the combination of perindopril with amlodipine, two active ingredients that have their own codes (C09AA04 (WHO) and C08CA01 (WHO) respectively) when prescribed alone.

The ATC classification system is a strict hierarchy, meaning that each code necessarily has one and only one parent code, except for the 14 codes at the topmost level which have no parents. The codes are semantic identifiers, meaning they depict information by themselves beyond serving as identifiers (namely, the codes depict themselves the complete lineage of parenthood). As of 07 May 2020, there are 6,331 codes in ATC; the table below gives the count per level.

ATC LevelCodesDifferent Names/Pharmaceuticals


In this system, drugs are classified into groups at five different levels.

First Level

The first level of the code indicates the anatomical main group and consists of one letter. There are 14 main groups:

AAlimentary tract and metabolism
BBlood and blood forming organs
CCardiovascular system
GGenito-urinary system and sex hormones
HSystemic hormonal preparations, excluding se hormones and insulins
JAnti-infectives for systemic use
LAntineoplastic and immunomodulating agents
MMusculo-skeletal system
NNervous system
PAntiparasitic products, insecticides, and repellents
RRespiratory system
SSensory organs

Second Level

The second level of the code indicates the therapeutic subgroup and consists of two digits.

  • Example: C03 Diuretics.

Third Level

The third level of the code indicates the therapeutic/pharmacological subgroup and consists of one letter.

  • Example: C03C High-ceiling diuretics.

Fourth Level

The fourth level of the code indicates the chemical/therapeutic/pharmacological subgroup and consists of one letter.

  • Example: C03CA Sulfonamides.

Fifth Level

The fifth level of the code indicates the chemical substance and consists of two digits.

  • Example: C03CA01 furosemide.

Other ATC Classification Systems


The Anatomical Therapeutic Chemical Classification System for veterinary medicinal products (ATCvet) is used to classify veterinary drugs. ATCvet codes can be created by placing the letter Q in front of the ATC code of most human medications.

  • For example, furosemide for veterinary use has the code QC03CA01.

Some codes are used exclusively for veterinary drugs, such as QI Immunologicals, QJ51 Antibacterials for intramammary use or QN05AX90 amperozide.

Herbal ATC (HATC)

The Herbal ATC system (HATC) is an ATC classification of herbal substances; it differs from the regular ATC system by using 4 digits instead of 2 at the 5th level group.

The herbal classification is not adopted by WHO. The Uppsala Monitoring Centre is responsible for the Herbal ATC classification, and it is part of the WHODrug Global portfolio available by subscription.

Defined Daily Dose

The ATC system also includes defined daily doses (DDDs) for many drugs. This is a measurement of drug consumption based on the usual daily dose for a given drug. According to the definition, “[t]he DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults.”

Adaptations and Updates

National issues of the ATC classification, such as the German Anatomisch-therapeutisch-chemische Klassifikation mit Tagesdosen, may include additional codes and DDDs not present in the WHO version.

ATC follows guidelines in creating new codes for newly approved drugs. An application is submitted to WHO for ATC classification and DDD assignment. A preliminary or temporary code is assigned and published on the website and in the WHO Drug Information for comment or objection. New ATC/DDD codes are discussed at the semi-annual Working Group meeting. If accepted it becomes a final decision and published semi-annually on the website and WHO Drug Information and implemented in the annual print/on-line ACT/DDD Index on 01 January.

Changes to existing ATC/DDD follow a similar process to become temporary codes and if accepted become a final decision as ATC/DDD alterations. ATC and DDD alterations are only valid and implemented in the coming annual updates; the original codes must continue until the end of the year.

An updated version of the complete on-line/print ATC index with DDDs is published annually on 01 January.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Anatomical_Therapeutic_Chemical_Classification_System >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Pan American Health Organisation?


The Pan American Health Organisation (PAHO) is an international public health agency working to improve the health and living standards of the people of the Americas.

It is part of the United Nations system, serving as the Regional Office for the Americas of the World Health Organisation (WHO) and as the health organisation of the Inter-American System. It is known in Latin America as the OPS or OPAS (Spanish: Organización Panamericana de la Salud; Portuguese: Organização Pan-Americana da Saúde).

Brief History

The organisation was founded in December 1902. It was originally called the Pan-American Sanitary Bureau.  In 1949, PAHO and WHO signed an agreement making PAHO the American Regional Office (AMRO) of WHO. Today the usual phrasing is “Regional Office for the Americas”. The first hemisphere-wide effort to eradicate smallpox was made in 1950 by the PAHO. The campaign was successful in eliminating smallpox from all countries of the Americas except Argentina, Brazil, Colombia, and Ecuador.


PAHO has scientific and technical expertise at its headquarters, in its 27 country offices, and its three Pan American centres, all working with the countries of the Americas in dealing with priority health issues. The health authorities of PAHO’s Member States set PAHO’s technical and administrative policies through its Governing Bodies. The PAHO Member States include all 35 countries in the Americas; Puerto Rico is an Associate Member. France, the Kingdom of the Netherlands, and the United Kingdom of Great Britain and Northern Ireland are the Participating States, and Portugal and Spain are the Observer States.

The Organization’s essential mission is to strengthen national and local health systems and improve the health of the peoples of the Americas, in collaboration with Ministries of Health, other government and international agencies, non-governmental organisations (NGO), universities, social security agencies, community groups, and many others.

PAHO promotes universal health coverage and universal access to health and strengthening of health systems based on primary health care strategies. It assists countries in fighting infectious diseases such as malaria, cholera, dengue, HIV and tuberculosis as well as the region’s growing epidemic of noncommunicable diseases such as cardiovascular disease, cancer and diabetes. PAHO engages in technical cooperation with ministries of health and facilitates coordination with other sectors to promote health in all policies. PAHO also promotes the use of research evidence to inform health care decisions and policymaking through the implementation of knowledge translation strategies such as the Evidence-Informed Policy Network – EVIPNet Evipnet. Through the Elimination Initiative, it targets HIV/AIDS.

In its efforts to improve health, PAHO targets the most vulnerable groups including mothers and children, workers, the poor, the elderly, and refugees, and displaced persons. It focuses on issues related to equity for those who lack access to health, and on a Pan American approach, encouraging countries to work together on common issues and build lasting capacities.

Specific initiatives spearheaded by PAHO include the Expanded Programme on Immunisation, which played a major role in the elimination of smallpox and polio from the Americas; the Tobacco-free Americas initiative; the Regional Coalition for Water and Sanitation to Eliminate Cholera in Hispaniola; the Salt Smart Consortium; the Pan American Network for Drug Regulatory Harmonization; and a blood safety initiative that seeks to improve blood safety and efficiency by helping countries reach 100% blood supplies from unpaid voluntary donors.

A major priority for the Americas is cutting infant mortality, and PAHO is mobilising new political, institutional, and financial resources to prevent an additional 25,000 infant deaths every year through the application of the Integrated Management of Childhood Illness strategy, a simple and practical approach in which primary health care workers are taught a complete process to evaluate the health status of children brought to a health post or clinic. They learn to recognise signs of disease and evaluate and treat them. They learn to give parents information on how to prevent disease in the home. If they see danger signs indicating the infant could die, they are taught to treat the child immediately or take him or her to a hospital.

Improvement of drinking water supplies, adequate sanitation, and increased access to health care for the poor are still top priorities for PAHO, with a focus on equity. The Organisation is intensifying its efforts to have countries know the true state of health of their populations and where the inequalities lie. Programme efforts focus on correcting inequality, taking into account decentralisation and change of state functions, on showing that health has a role to play in the success of other sectors, and on how attention to health affects positively other aspects of human development. Advocacy in this area is also directed to reducing pernicious gender inequity, which reflects in some health problems of women.

The Pan American approach is a part of PAHO history and the spirit of Panamericanism continues to stimulate technical cooperation among countries in health. PAHO has helped countries work together toward common goals, and to initiate multi-country health ventures in Central America, the Caribbean, the Andean Region, and the Southern Cone. Experience has shown practical benefits such as the solidarity that helped Central America after hurricane Mitch, and there are numerous other examples. Health collaboration found expression at the highest political level when American heads of state in their Summit in Santiago accepted a health initiative called “Health Technology Linking the Americas.”

The countries of Latin America and the Caribbean joined together over 20 years ago to buy vaccines through a revolving fund, bringing them tangible benefits and helping advance PAHO’s efforts to eliminate or control vaccine-preventable diseases. These are among the Organisation’s most notable successes, starting with the eradication of smallpox from the Americas in 1973; a triumph followed five years later by global eradication of the dreaded disease.

A major effort committing the Americas to embark on polio eradication in 1985 succeeded in September 1994, when a distinguished International Commission declared the Americas officially polio-free. The last case of polio in the Americas was identified on August 23, 1991, in a young boy named Luis Fermín Tenorio Cortez, in Junín, Peru. Since then, despite intensive surveillance, no cases of polio have been detected anywhere in the Americas, and the WHO is now working toward the goal of eradicating polio globally. PAHO assists the countries in mobilising the necessary resources to provide immunisation and treatment services for all vaccine-preventable diseases. PAHO is close to accomplishing the goal of eliminating measles from this hemisphere and is pressing on with the introduction of new vaccines that are currently available, such as Haemophilus influenzae B. to reduce meningitis and respiratory infections. PAHO works to reduce the toll of death and illness from diarrheal diseases, including cholera, through case management and oral rehydration therapy to prevent deaths from dehydration, and to provide adequate diagnosis and treatment of acute respiratory infections, thus saving the lives of hundreds of thousands of children each year.

PAHO disseminates scientific and technical information through its publications program, its Internet site, and a network of academic libraries, documentation centres, and local health care libraries.

The Organisation provides technical collaboration in a variety of specialised public health fields and organises emergency preparedness and disaster relief coordination. It supports efforts to strengthen national health systems, develop national health research systems, control malaria, Chagas’ disease, urban rabies, leprosy, and other diseases that affect the people of the Americas. PAHO collaborates with governments, other agencies, and private groups to address major nutritional problems including protein-energy malnutrition, and is now working to eliminate iodine and vitamin A deficiencies.

It engages in and facilitates health promotion to help countries deal with health problems typical of development and urbanisation, especially non-communicable diseases (NCDs) such as cardiovascular diseases, cancer, accidents, smoking, addiction to drugs and alcohol, and injuries among others. Beyond health promotion, PAHO also addresses health systems and quality of care issues in support of national efforts to respond to the NCD pandemic.

The Organisation also executes projects for other United Nations agencies, for international organisations such as the World Bank and Inter-American Development Bank, for official development cooperation agencies of various governments, and for philanthropic foundations.

PAHO strengthens the health sector capacity in the countries to advance their priority programmes through intersectoral action, promoting an integrated approach to health problems. It also works to improve women’s health, promoting the greater integration of women in society, as well as awareness of their importance as both recipients and providers of health services.

PAHO trains health workers at all levels, through fellowships, courses and seminars, and the strengthening of national training institutions. It leads to the use of advanced communications technologies for information, health promotion, and education, working with journalists in many countries.

The Organisation recognises the role of the private sector in the delivery of services and fosters dialogue and partnerships with the Ministries of Health. In addition to its core budget financed by quota contributions from its Member Governments, PAHO also seeks outside funding to help implement special programmes and initiatives in response to vital health needs. Voluntary tax-deductible contributions for PAHO health and education projects in the Americas may be made to the PAHO Foundation.

Headquarters Building

In March 1960, President Eisenhower signed into law a bill passed by the US Congress authorising the US government to purchase and donate a lot for the PAHO headquarters in Washington, D.C. At the meeting of its Executive Committee in April 1960, the PAHO decided to accept the USG’s offer and set forth parameters for proceeding with the project of a new headquarters building. PAHO decided to use an international open competition as the means of selecting an architect for the project, following the recent successful model of other international organisations (most notably the United Nations New York headquarters inaugurated in 1952, and the UNESCO Paris headquarters in 1953 – both resulting in landmark designs of modernist architecture). PAHO framed the competition based on standards developed by the International Union of Architects and determined that the competition should be open to architects from all countries of the Americas. The vision was that “the new building should be a monument to international health cooperation.”

Following a review of 58 entries, the PAHO in October 1961 declared Uruguayan architect Román Fresnedo Siri the winner of its competition. At the ceremony announcing him as a winner, the organization’s Director Abraham Horwitz said “this beautiful building will become a monument to the ideal of better health for the peoples of the Americas.” He described the winning design as one of “both grace and utility,” and said, “it reflects the high ideals of the Pan-American spirit in an age when we must move ahead to build a better future for our peoples.”

The building was designed in a modernist style by Fresnedo Siri in part as a tribute to Le Corbusier, a key influence on Fresnedo Siri’s work. Constructed in 1965, the exterior features 29 round bronze seals of the founding nations of the Pan American Health Organisation set in black stone. Each medallion is 2.5 feet (0.76 m) in diameter and were designed by American sculptor Michael Lantz. They were originally meant to be carved in granite. The east side of the south façade (left to right) seals are for: France, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, the Netherlands, Nicaragua, Panama, Paraguay, Peru, Trinidad and Tobago, United Kingdom, United States, Uruguay, and Venezuela. The west side of the south façade seals are for: Argentina, Barbados, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, and El Salvador. In 1993 the seals were surveyed by the Smithsonian Institution’s Save Outdoor Sculpture! program and were described as needing conservation treatment.

The building is situated on a triangular lot of just over one acre nestled between Virginia Avenue, E Street, and 23rd Street, Northwest, in the Foggy Bottom neighbourhood of Washington. Constructed of reinforced concrete over a steel frame with an exterior of glass and marble, the building is one of Washington’s most recognised examples of mid-century modern architecture. The building is divided into two distinct volumes: a gracefully curved ten-story building that hosts the organization’s main offices, and an adjoining four-story cylindrical annex that serves as the congress hall for formal assemblies of the PAHO member state delegates, as well as other meetings and events. It is surrounded by George Washington University to the north and east, the Columbia Plaza office/residential complex to the west, and the State Department to the south across the E street expressway underpass.

The main building features soaring white vertical columnar ribs evenly separating dark vertical columns of glass. There are no horizontal lines to compete with the vertical symmetry; the building’s vertical ribs disappear along “blind gables” into an invisible roofline. In the formalism and attention to symmetry, Fresnedo Siri said he was trying to stay true to the “classic spirit of the city of Washington.” The interplay of light and dark is accentuated by the use of white American marble, black Mexican granite, and dark gray glass. The building’s slender, windowless west and east sides are clad in white marble, while the black granite frames all the ground floor elements, including the entry portico, the hidden downward ramp to an underground garage, and the reflecting pool and garden elements.

Fresnedo Siri placed the main building on 20 rounded pilotis (columns) that lift it a full story above ground level. He employed this signature element of mid-century modernist design to maximise the open pedestrian plaza space on the relatively small and unusually shaped lot while enhancing visual transparency and flow. He added reflecting pools with fountains at the base of each building – his vision was that the cylindrical congress hall, in particular, would appear to be “emerging from the water.” The thin vertical streams spurting up from the fountains would echo the symmetry of the columns and vertical ribbing of the main building. A row of 42 flag poles (representing each PAHO member state) reinforces still further the building’s dancing array of vertical symmetries, while also gracefully delineating the Northeastern edge of the property site. Unfortunately, the reflecting pools years later were eliminated, filled in and replaced by garden plots.

Fresnedo Siri purposefully placed the convex side of the curved main office building to the north, smoothly integrating it into the urban streetscape of similarly sized office, university and residential buildings. This allowed the concave side of the building to face the open side of the lot, gently cradling the congress hall annex while framing the contours of the small but appealing pedestrian plaza area that flows toward the site’s open southern side.

The cylindrical annex’s around the central congress hall are about 92 feet (28 m) in diameter and seat up to 300 people. The single open space soars upward, filling the top three levels of the building. Fresnedo Siri designed a dramatic spider web-like steel structure to support the building, allowing the entire interior space to be free of any supporting columns. The resulting internal space, naturally lit by windows throughout the cylinder’s full 360 degrees, achieves an impressive sense of openness and purity of design. The cylindrical building is encased on the outside by a lattice-like grill of diamond-shaped hexagons composed of white marble, quartz and Portland cement. The recessed ground floor space of the cylinder is encased in the same Mexican black granite used for all the site’s ground-level elements, creating a striking contrast with the white honeycomb grill of the upper levels it supports.

After studying the main diplomatic congress halls at the UN, State Department, the OAS and elsewhere, Fresnedo Siri devised a “floating seat” solution for the chairs in the PAHO’s hall. The seats are all anchored to the floor in the rear to curved latitudinal support elements running behind each row (and serving as hidden conduits for the simultaneous translation cabling), achieving what he described as “a great functional and aesthetic purity.” All of the furnishings for the main halls and meeting rooms were designed under his specifications by Knoll Associates, a leading New York-based producer of modernist furniture including landmark designs of the era like the Saarinen womb chair and Mies Van de Rohe’s Barcelona chair. Fresnedo Siri designed the magisterial backdrop to the presidium of the Congress hall, using vertical slats of six different kinds of wood including Honduran mahogany, Brazilian jacaranda, American walnut and oak, arranged in his words “to accentuate the dimension of the space and the importance of the function it served.” Fresnedo Siri also designed the central chandelier of the Congress hall, calling the piece “a sculpture in light.” Measuring 20 feet in diameter and weighing 16,000 pounds (7,300 kg), it consisted of 3000 long rectangular pieces of Lucite, the translucent acrylic resin invented by Dupont in the 1930s for industrial and military uses then enjoying an early-60’s boom as a “space age” material for vanguard furniture and art.

What is the World Health Organisation Collaborating Centre?


World Health Organisation collaborating centres are institutions that work with the World Health Organisation (WHO) in disciplines such as occupational health, food safety, and communicable disease prevention.


There are over 700 such centres across 80 countries. Collaborating centres may be research institutes, parts of universities, or academies. The participating institutions partner with WHO to perform research, provide training, or offer other services in furthering the WHO health agenda. These partners are designated by the WHO director-general as a part of a collaborative network. By using networks of established organisations, WHO is able to strengthen the scientific validity of its work and lower the costs of research.

Centres Worldwide

The WHO has established networks related to a variety of health topics. For example, WHO has put in place centres focused on organ transplants, hearing loss prevention, hepatitis, leprosy, medical ethics, and maternal health. To move the work forward, WHO has numerous designated centres in each inhabited continent. The network of centres for reference and research on influenza draws upon resources from Japan, the United States, the United Kingdom, and Australia. The network of WHO collaborating centres in occupational health is chaired by Dr. John Howard, director of the US National Institute for Occupational Safety and Health, and contains more than 60 designated organisations from across the globe.

The WHO Collaborating Centre on Global Governance of Antimicrobial Resistance has been working on the Coronavirus disease 2019 and is directed by Steven Hoffman.

What is the WHO Assessment Instrument for Mental Health Systems?


The World Health Organisation Assessment Instrument for Mental Health Systems (WHO-AIMS) is a new WHO tool for collecting essential information on the mental health system of a country or region.


The goal of collecting this information is to improve mental health systems and to provide a baseline for monitoring the change.

What is WHO-AIMS?

WHO-AIMS is a WHO tool for collecting essential information on the mental health system of a country or region. The goal of collecting this information is to improve mental health systems and to provide a baseline for monitoring the change.

For the purpose of WHO-AIMS, a mental health system is defined as all the activities whose primary purpose is to promote, restore or maintain mental health. WHO-AIMS is primarily intended for assessing mental health systems in low and middle income countries, but is also a valuable assessment tool for high resource countries.

Note: Great care has been taken to ensure the reliability of the data presented in the WHO-AIMS country reports. Data for WHO-AIMS are collected by a team led by a focal point within the country and are, in most cases, approved by the Ministry of Health. However, since WHO is not directly responsible for the data collection, WHO cannot independently verify the accuracy of any of the data presented in these reports.

WHO-AIMS Instrument, Version 2.2

You can find country reports, sub-regional reports, and other reports here (Pan American Health Organisation (PAHO) site).

What is the Mental Health Gap Action Programme (mhGAP)?


The World Health Organisation (WHO) Mental Health Gap Action Programme (mhGAP) aims at scaling up services for mental, neurological and substance use disorders for countries especially with low- and middle-income.


Mental, neurological, and substance use disorders are common in all regions of the world, affecting every community and age group across all income countries. While 14% of the global burden of disease is attributed to these disorders, most of the people affected – 75% in many low-income countries – do not have access to the treatment they need.

As such, the programme asserts that with proper care, psychosocial assistance and medication, tens of millions could be treated for depression, schizophrenia, and epilepsy, prevented from suicide and begin to lead normal lives – even where resources are scarce.

The following overview is from the WHO ‘mhGAP Mental Health Gap Programme: Scaling Up Care for Mental, Neurological, and Substance Use Disorders’ published on 01 January 2008:

Mental, neurological and substance use disorders are highly prevalent and burdensome globally. The gap between what is urgently needed and what is available to reduce the burden is still very wide.

WHO recognizes the need for action to reduce the burden, and to enhance the capacity of Member States to respond to this growing challenge. mhGAP is WHO’s action plan to scale up services for mental, neurological and substance use disorders for countries especially with low and lower middle incomes. The priority conditions addressed by mhGAP are: depression, schizophrenia and other psychotic disorders, suicide, epilepsy, dementia, disorders due to use of alcohol, disorders due to use of illicit drugs, and mental disorders in children. The mhGAP package consists of interventions for prevention and management for each of these priority conditions.

Successful scaling up is the joint responsibility of governments, health professionals, civil society, communities, and families, with support from the international community. The essence of mhGAP is building partnerships for collective action. A commitment is needed from all partners to respond to this urgent public health need and the time to act is now!

References/Further Reading

WHO mhGAP Mental Health Gap Action Programme: Scaling Up Care for Mental, Neurological, and Substance Use Disorders (WHO site; published 01 January 2008).

Outline of the Mental Health Gap Action Programme (mhGAP) (WHO site).

Clinical Review: WHO Mental Health Gap Action Programme (mhGAP) Intervention Guide: A Systematic Review of Evidence from Low and Middle-Income Countries (BMJ Journals: Evidence-Based Mental Health).

What is the WHO Model List of Essential Medicines?


The WHO Model List of Essential Medicines (aka Essential Medicines List or EML), published by the World Health Organisation (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health system.

The list is frequently used by countries to help develop their own local lists of essential medicines. As of 2016, more than 155 countries have created national lists of essential medicines based on the WHO’s model list. This includes countries in both the developed and developing world.

40 years of the WHO Model List of Essential Medicines was celebrated in 2017.

The list is divided into core items and complementary items. The core items are deemed to be the most cost-effective options for key health problems and are usable with little additional health care resources. The complementary items either require additional infrastructure such as specially trained health care providers or diagnostic equipment or have a lower cost–benefit ratio. About 25% of items are in the complementary list. Some medications are listed as both core and complementary. While most medications on the list are available as generic products, being under patent does not preclude inclusion.

The first list was published in 1977 and included 208 medications. The WHO updates the list every two years. The 14th list was published in 2005 and contained 306 medications. In 2015, the 19th edition of the list was published and contains around 410 medications. The 20th edition was published in 2017, and contains 433 medications. The 21st list was published in 2019 and contains 460 medications. The 22nd list was published in 2021 and contains 479 medications. Various national lists contain between 334 and 580 medications.

A separate list for children up to 12 years of age, known as the WHO Model List of Essential Medicines for Children (EMLc), was created in 2007 and is in its 8th edition. It was created to make sure that the needs of children were systematically considered such as availability of proper formulations. Everything in the children’s list is also included in the main list. The list and notes are based on the 19th to 22nd edition of the main list. An α indicates a medicine is only on the complementary list. Therapeutic alternatives with similar clinical performance are listed for some medicines and they may be considered for national essential medicines lists.

Anaesthetics, Preoperative Medicines and Medical Gases

  • General anaesthetics and oxygen:
    • Inhalational medicines.
      • Halothane.
      • Isoflurane.
      • Nitrous oxide.
      • Oxygen.
    • Injectable medicines.
      • Ketamine.
      • Propofol.
  • Local anaesthetics:
    • Bupivacaine.
    • Lidocaine.
    • Lidocaine/epinephrine (lidocaine + epinephrine).
    • Ephedrineα.
  • Preoperative medication and sedation for short-term procedures:
    • Atropine
    • Midazolam
    • Morphine
  • Medical gases:
    • Oxygen.

Medicines for Pain and Palliative Care

  • Non-opioids and non-steroidal anti-inflammatory medicines (NSAIMs):
    • Acetylsalicylic acid (aspirin).
    • Ibuprofen.
    • Paracetamol.
  • Opioid analgesics:
    • Codeine.
    • Fentanyl.
    • Morphine.
    • Methadoneα.
  • Medicines for other common symptoms in palliative care:
    • Amitriptyline.
    • Cyclizine.
    • Dexamethasone.
    • Diazepam.
    • Docusate sodium.
    • Fluoxetine.
    • Haloperidol.
    • Hyoscine butylbromide.
    • Hyoscine hydrobromide.
    • Lactulose.
    • Loperamide.
    • Metoclopramide.
    • Midazolam.
    • Ondansetron.
    • Senna.

Antiallergics and Medicines used in Anaphylaxis

  • Dexamethasone.
  • Epinephrine (adrenaline).
  • Hydrocortisone.
  • Loratadine.
  • Prednisolone.

Antidotes and Other Substances used in Poisonings

  • Non-specific:
    • Charcoal, activated.
  • Specific.
    • Acetylcysteine.
    • Atropine.
    • Calcium gluconate.
    • Methylthioninium chloride (methylene blue).
    • Naloxone.
    • Penicillamine.
    • Prussian blue.
    • Sodium nitrite.
    • Sodium thiosulfate.
    • Deferoxamineα.
    • Dimercaprolα.
    • Fomepizoleα.
    • Sodium calcium edetateα.
    • Succimerα.


Anti-Infective Medicines

  • Anthelminthics:
    • Intestinal anthelminthics.
      • Albendazole.
      • Ivermectin.
      • Levamisole.
      • Mebendazole.
      • Niclosamide.
      • Praziquantel.
      • Pyrantel.
    • Antifilarials.
      • Albendazole.
      • Diethylcarbamazine.
      • Ivermectin.
    • Antischistosomals and other antinematode medicines.
      • Praziquantel.
      • Triclabendazole.
      • Oxamniquineα.
    • Cysticidal medicines.
      • Albendazoleα.
      • Mebendazoleα.
      • Praziquantelα.
  • Antibacterials:
    • Access group antibiotics.
      • Amikacin
      • Amoxicillin.
      • Amoxicillin/clavulanic acid (amoxicillin + clavulanic acid).
      • Ampicillin.
      • Benzathine benzylpenicillin.
      • Benzylpenicillin.
      • Cefalexin.
      • Cefazolin.
      • Chloramphenicol.
      • Clindamycin.
      • Cloxacillin.
      • Doxycycline.
      • Gentamicin.
      • Metronidazole.
      • Nitrofurantoin.
      • Phenoxymethylpenicillin (penicillin V).
      • Procaine benzylpenicillin.
      • Spectinomycin.
      • Sulfamethoxazole/trimethoprim (sulfamethoxazole + trimethoprim).
      • Trimethoprim.
    • Watch group antibiotics.
      • Azithromycin.
      • Cefixime.
      • Cefotaxime.
      • Ceftriaxone.
      • Cefuroxime.
      • Ciprofloxacin.
      • Clarithromycin.
      • Piperacillin/tazobactam (piperacillin + tazobactam).
      • Vancomycin.
      • Ceftazidimeα.
      • Meropenemα.
      • Vancomycinα.
    • Reserve group antibiotics.
      • Cefiderocolα.
      • Ceftazidime/avibactam (ceftazidime + avibactam)α.
      • Colistinα.
      • Fosfomycinα.
      • Linezolidα.
      • Meropenem/vaborbactam (meropenem + vaborbactam)α.
      • Plazomicinα.
      • Polymyxin Bα.
    • Antileprosy medicines.
      • Clofazimine.
      • Dapsone.
      • Rifampicin.
    • Antituberculosis medicines.
      • Ethambutol.
      • Ethambutol/isoniazid/pyrazinamide/rifampicin (ethambutol + isoniazid + pyrazinamide + rifampicin).
      • Ethambutol/isoniazid/rifampicin (ethambutol + isoniazid + rifampicin).
      • Isoniazid.
      • Isoniazid/pyrazinamide/rifampicin (isoniazid + pyrazinamide + rifampicin).
      • Isoniazid/rifampicin (isoniazid + rifampicin).
      • Isoniazid/rifapentine (isoniazid + rifapentine).
      • Moxifloxacin.
      • Pyrazinamide.
      • Rifabutin.
      • Rifampicin.
      • Rifapentine.
      • Amikacinα.
      • Amoxicillin/clavulanic acid (amoxicillin + clavulanic acid)α.
      • Bedaquilineα.
      • Clofazimineα.
      • Cycloserineα.
      • Delamanidα.
      • Ethionamideα.
      • Levofloxacinα.
      • Linezolidα.
      • Meropenemα.
      • Moxifloxacinα.
      • P-aminosalicylic acidα.
      • Streptomycinα.
  • Antifungal medicines.
    • Amphotericin B.
    • Clotrimazole.
    • Fluconazole.
    • Flucytosine.
    • Griseofulvin.
    • Itraconazole.
    • Nystatin.
    • Voriconazole.
    • Micafunginα.
    • Potassium iodideα.
  • Antiviral medicines
    • Antiherpes medicines.
      • Aciclovir.
    • Antiretrovirals.
    • Nucleoside/nucleotide reverse transcriptase inhibitors.
      • Abacavir.
      • Lamivudine.
      • Tenofovir disoproxil fumarate.
      • Zidovudine.
    • Non-nucleoside reverse transcriptase inhibitors.
      • Efavirenz.
      • [[Nevirapine].
    • Protease inhibitors.
      • Atazanavir/ritonavir (atazanavir + ritonavir).
      • Darunavir.
      • Lopinavir/ritonavir (lopinavir + ritonavir).
      • Ritonavir.
    • Integrase inhibitors.
      • Dolutegravir.
      • Raltegravir.
    • Fixed-dose combinations of antiretroviral medicines.
      • Abacavir/lamivudine (abacavir + lamivudine).
      • Dolutegravir/lamivudine/tenofovir (dolutegravir + lamivudine + tenofovir.
      • Efavirenz/emtricitabine/tenofovir.
      • Efavirenz/lamivudine/tenofovir (efavirenz + lamivudine + tenofovir).
      • Emtricitabine/tenofovir (emtricitabine + tenofovir).
      • Lamivudine/zidovudine (lamivudine + zidovudine).
    • Medicines for prevention of HIV-related opportunistic infections.
      • Isoniazid/pyridoxine/sulfamethoxazole/trimethoprim (isoniazid + pyridoxine + sulfamethoxazole + trimethoprim).
    • Other antivirals.
      • Ribavirin.
      • Valganciclovir.
      • Oseltamivirα.
      • Valganciclovirα.
    • Antihepatitis medicines.
    • Medicines for hepatitis B.
    • Nucleoside/Nucleotide reverse transcriptase inhibitors.
      • Entecavir.
      • Tenofovir disoproxil fumarate.
    • Medicines for hepatitis C.
    • Pangenotypic direct-acting antiviral combinations
      • Daclatasvir.
      • Daclatasvir/sofosbuvir (daclatasvir + sofosbuvir).
      • Glecaprevir/pibrentasvir (glecaprevir + pibrentasvir).
      • Sofosbuvir.
      • Sofosbuvir/velpatasvir (sofosbuvir + velpatasvir).
    • Non-pangenotypic direct-acting antiviral combinations
      • Dasabuvir.
      • Ledipasvir/sofosbuvir (ledipasvir + sofosbuvir).
      • Ombitasvir/paritaprevir/ritonavir (ombitasvir + paritaprevir + ritonavir).
    • Other antivirals for hepatitis C.
      • Ribavirin.
      • Pegylated interferon-alpha-2a or pegylated interferon-alpha-2bα.
  • Antiprotozoal medicines:
    • Antiamoebic and antigiardiasis medicines
      • Diloxanide.
      • Metronidazole.
    • Antileishmaniasis medicines
      • Amphotericin B.
      • Miltefosine.
      • Paromomycin.
      • Sodium stibogluconate or meglumine antimoniate.
    • Antimalarial medicines.
    • For curative treatment.
      • Amodiaquine.
      • Artemether.
      • Artemether/lumefantrine (artemether + lumefantrine).
      • Artesunate.
      • Artesunate/amodiaquine (artesunate + amodiaquine).
      • Artesunate/mefloquine (artesunate + mefloquine).
      • Artesunate/pyronaridine tetraphosphate (artesunate + pyronaridine tetraphosphate).
      • Chloroquine.
      • Dihydroartemisinin/piperaquine phosphate (dihydroartemisinin + piperaquine phosphate).
      • Doxycycline.
      • Mefloquine.
      • Primaquine.
      • Quinine.
      • Sulfadoxine/pyrimethamine (sulfadoxine + pyrimethamine).
    • For chemoprevention.
      • Amodiaquine + sulfadoxine/pyrimethamine (Co-packaged).
      • Chloroquine.
      • Doxycycline.
      • Mefloquine.
      • Proguanil.
      • Sulfadoxine/pyrimethamine (sulfadoxine + pyrimethamine).
    • Antipneumocystosis and antitoxoplasmosis medicines.
      • Pyrimethamine.
      • Sulfadiazine.
      • Sulfamethoxazole/trimethoprim (sulfamethoxazole + trimethoprim).
      • Pentamidineα.
    • Antitrypanosomal medicines.
    • African trypanosomiasis.
      • Fexinidazole.
    • Medicines for the treatment of 1st stage African trypanosomiasis.
      • Pentamidine.
      • Suramin sodium.
    • Medicines for the treatment of 2nd stage African trypanosomiasis.
      • Eflornithine.
      • Melarsoprol.
      • Nifurtimox.
      • Melarsoprolα.
    • American trypanosomiasis.
      • Benznidazole.
      • Nifurtimox.
  • Medicines for ectoparasitic infections.
    • Ivermectin.

Antimigraine Medicines

  • For treatment of acute attack:
    • Acetylsalicylic acid (aspirin).
    • Ibuprofen.
    • Paracetamol (acetaminophen).
    • Sumatriptan.
  • For prophylaxis:
    • Propranolol.

Immunomodulators and Antineoplastics

  • Immunomodulators for non-malignant disease:
    • Adalimumabα.
    • Azathioprineα.
    • Ciclosporinα.
    • Tacrolimusα.
  • Antineoplastics and supportive medicines:
    • Cytotoxic medicines.
      • Arsenic trioxideα.
      • Asparaginaseα.
      • Bendamustineα.
      • Bleomycinα.
      • Calcium folinateα.
      • Capecitabineα.
      • Carboplatinα.
      • Chlorambucilα.
      • Cisplatinα.
      • Cyclophosphamideα.
      • Cytarabineα.
      • Dacarbazineα.
      • Dactinomycinα.
      • Daunorubicinα.
      • Docetaxelα.
      • Doxorubicinα.
      • Etoposideα.
      • Fludarabineα.
      • Fluorouracilα.
      • Gemcitabineα.
      • Hydroxycarbamideα.
      • Ifosfamideα.
      • Irinotecanα.
      • Melphalanα.
      • Mercaptopurineα.
      • Methotrexateα.
      • Oxaliplatinα.
      • Paclitaxelα.
      • Pegaspargaseα.
      • Procarbazineα.
      • Realgar Indigo naturalis formulationα.
      • Tioguanineα.
      • Vinblastineα.
      • Vincristineα.
      • Vinorelbineα.
    • Targeted therapies.
      • All-trans retinoic acid (tretinoin) (ATRA)α.
      • Bortezomibα.
      • Dasatinibα.
      • Erlotinibα.
      • Everolimusα.
      • Ibrutinibα.
      • Imatinibα.
      • Nilotinibα.
      • Rituximabα.
      • Trastuzumabα.
    • Immunomodulators.
      • Filgrastimα.
      • Lenalidomideα.
      • Nivolumabα.
      • Thalidomideα.
    • Hormones and antihormones.
      • Abirateroneα.
      • Anastrozoleα.
      • Bicalutamideα.
      • Dexamethasoneα.
      • Hydrocortisoneα.
      • Leuprorelinα.
      • Methylprednisoloneα.
      • Prednisoloneα.
      • Tamoxifenα.
    • Supportive medicines.
      • Allopurinolα.
      • Mesnaα.
      • Rasburicaseα.
      • Zoledronic acidα.

Antiparkinsonism Medicines

  • Biperiden.
  • Levodopa/carbidopa (levodopa + carbidopa).

Medicines Affecting the Blood

  • Antianaemia medicines:
    • Ferrous salt.
    • Ferrous salt/folic acid (ferrous salt + folic acid).
    • Folic acid.
    • Hydroxocobalamin.
    • Erythropoiesis-stimulating agentsα.
  • Medicines affecting coagulation:
    • Dabigatran.
    • Enoxaparin.
    • Heparin sodium.
    • Phytomenadione.
    • Protamine sulfate.
    • Tranexamic acid.
    • Warfarin.
    • Desmopressinα.
    • Heparin sodiumα.
    • Protamine sulfateα.
    • Warfarinα.
  • Other medicines for haemoglobinopathies:
    • Deferoxamineα.
    • Hydroxycarbamideα.

Blood Products of Human Origin and Plasma Substitutes

  • Blood and blood components:
    • Fresh frozen plasma.
    • Platelets.
    • Red blood cells.
    • Whole blood.
  • Plasma-derived medicines:
    • Human immunoglobulins.
      • Rho(D) immune globulin (anti-D immunoglobulin).
      • Anti-rabies immunoglobulin.
      • Anti-tetanus immunoglobulin.
      • Normal immunoglobulinα.
    • Blood coagulation factors.
      • Coagulation factor VIIIα.
      • Coagulation factor IXα.
    • Plasma substitutes.
      • Dextran 70.

Cardiovascular Medicines

  • Antianginal medicines:
    • Bisoprolol.
    • Glyceryl trinitrate.
    • Isosorbide dinitrate.
    • Verapamil.
  • Antiarrhythmic medicines:
    • Bisoprolol.
    • Digoxin.
    • Epinephrine (adrenaline).
    • Lidocaine.
    • Verapamil.
    • Amiodaroneα.
  • Antihypertensive medicines:
    • Amlodipine.
    • Bisoprolol.
    • Enalapril.
    • Hydralazine.
    • Hydrochlorothiazide.
    • Lisinopril/amlodipine (lisinopril + amlodipine).
    • Lisinopril/hydrochlorothiazide (lisinopril + hydrochlorothiazide).
    • Losartan.
    • Methyldopa.
    • Telmisartan/amlodipine (telmisartan + amlodipine).
    • Telmisartan/hydrochlorothiazide (telmisartan + hydrochlorothiazide).
    • Sodium nitroprussideα.
  • Medicines used in heart failure:
    • Bisoprolol.
    • Digoxin.
    • Enalapril.
    • Furosemide.
    • Hydrochlorothiazide.
    • Losartan.
    • Spironolactone.
    • Dopamineα.
  • Antithrombotic medicines:
    • Anti-platelet medicines.
      • Acetylsalicylic acid (aspirin).
      • Clopidogrel.
    • Thrombolytic medicines.
      • Alteplaseα.
      • Streptokinaseα.
    • Lipid-lowering agents.
      • Simvastatin.

Dermatological Medicines (Topical)

  • Antifungal medicines:
    • Miconazole.
    • Selenium sulfide.
    • Sodium thiosulfate.
    • Terbinafine.
  • Anti-infective medicines:
    • Mupirocin.
    • Potassium permanganate.
    • Silver sulfadiazine.
  • Anti-inflammatory and antipruritic medicines:
    • Betamethasone.
    • Calamine.
    • Hydrocortisone.
  • Medicines affecting skin differentiation and proliferation:
    • Benzoyl peroxide.
    • Calcipotriol.
    • Coal tar.
    • Fluorouracil.
    • Podophyllum resin.
    • Salicylic acid.
    • Urea.
  • Scabicides and pediculicides:
    • Benzyl benzoate.
    • Permethrin.

Diagnostic Agents

  • Ophthalmic medicines:
    • Fluorescein.
    • Tropicamide.
  • Radiocontrast media:
    • Amidotrizoate.
    • Barium sulfate.
    • Iohexol.
    • Barium sulfateα.
    • Meglumine iotroxateα.

Antiseptics and Disinfectants

  • Antiseptics:
    • Chlorhexidine.
    • Ethanol.
    • Povidone iodine.
  • Disinfectants:
    • Alcohol based hand rub.
    • Chlorine base compound.
    • Chloroxylenol.
    • Glutaral.


  • Amiloride.
  • Furosemide.
  • Hydrochlorothiazide.
  • Mannitol.
  • Spironolactone.
  • Hydrochlorothiazideα.
  • Mannitolα.
  • Spironolactoneα.

Gastrointestinal Medicines

  • Pancreatic enzymesα.
  • Antiulcer medicines:
    • Omeprazole.
    • Ranitidine.
  • Antiemetic medicines:
    • Dexamethasone.
    • Metoclopramide.
    • Ondansetron.
    • Aprepitantα.
  • Anti-inflammatory medicines:
    • Sulfasalazine.
    • Hydrocortisoneα.
    • Prednisoloneα.
  • Laxatives:
    • Senna.
  • Medicines used in diarrhoea:
    • Oral rehydration salts + zinc sulfate (Co-packaged).
    • Oral rehydration.
      • Oral rehydration salts.
    • Medicines for diarrhoea.
      • Zinc sulfate.

Medicines for Endocrine Disorders

  • Adrenal hormones and synthetic substitutes:
    • Fludrocortisone.
    • Hydrocortisone.
  • Androgens:
    • Testosteroneα.
  • Estrogens:
    • No listings in this section.
  • Progestogens:
    • Medroxyprogesterone acetate.
  • Medicines for diabetes:
    • Insulins.
      • Insulin injection (soluble).
      • Intermediate-acting insulin.
      • Long-acting insulin analogues.
    • Oral hypoglycaemic agents.
      • Empagliflozin.
      • Gliclazide.
      • Metformin.
      • Metforminα.
    • Medicines for hypoglycaemia.
      • Glucagon.
      • Diazoxideα.
  • Thyroid hormones and antithyroid medicines:
    • Levothyroxine.
    • Potassium iodide.
    • Methimazole.
    • Propylthiouracil.
    • Lugol’s solutionα.
    • Methimazoleα.
    • Potassium iodideα.
    • Propylthiouracilα.


  • Diagnostic agents:
    • Tuberculin, purified protein derivative (PPD).
  • Sera, immunoglobulins and monoclonal antibodies:
    • Anti-rabies virus monoclonal antibodies.
    • Antivenom immunoglobulin.
    • Diphtheria antitoxin.
    • Equine rabies immunoglobulin.
  • Vaccines:
    • Recommendations for all.
      • BCG vaccine.
      • Diphtheria vaccine.
      • Haemophilus influenzae type b vaccine.
      • Hepatitis B vaccine.
      • Human papilloma virus (HPV) vaccine.
      • Measles vaccine.
      • Pertussis vaccine.
      • Pneumococcal vaccine.
      • Poliomyelitis vaccine.
      • Rotavirus vaccine.
      • Rubella vaccine.
      • Tetanus vaccine.
    • Recommendations for certain regions.
      • Japanese encephalitis vaccine.
      • Tick-borne encephalitis vaccine.
      • Yellow fever vaccine.
      • Recommendations for some high-risk populations.
      • Cholera vaccine.
      • Dengue vaccine.
      • Hepatitis A vaccine.
      • Meningococcal meningitis vaccine.
      • Rabies vaccine.
      • Typhoid vaccine.
    • Recommendations for immunisation programmes with certain characteristics.
      • Influenza vaccine (seasonal).
      • Mumps vaccine.
      • Varicella vaccine.

Muscle Relaxants (Peripherally-Acting) and Cholinesterase Inhibitors

  • Atracurium.
  • Neostigmine.
  • Suxamethonium.
  • Vecuronium.
  • Pyridostigmineα.
  • Vecuroniumα.

Ophthalmological Preparations

  • Anti-infective agents:
    • Aciclovir.
    • Azithromycin.
    • Erythromycin.
    • Gentamicin.
    • Natamycin.
    • Ofloxacin.
    • Tetracycline.
  • Anti-inflammatory agents:
    • Prednisolone.
  • Local anaesthetics:
    • Tetracaine.
  • Miotics and antiglaucoma medicines:
    • Acetazolamide.
    • Latanoprost.
    • Pilocarpine.
    • Timolol.
  • Mydriatics:
    • Atropine.
    • Epinephrine (adrenaline)α.
  • Anti-vascular endothelial growth factor (VEGF):
    • Bevacizumabα.

Medicines for Reproductive Health and Perinatal Care

  • Contraceptives:
    • Oral hormonal contraceptives.
      • Ethinylestradiol/levonorgestrel (ethinylestradiol + levonorgestrel).
      • Ethinylestradiol/norethisterone (ethinylestradiol + norethisterone).
      • Levonorgestrel.
      • Ulipristal.
    • Injectable hormonal contraceptives.
      • Estradiol cypionate/medroxyprogesterone acetate (estradiol cypionate + medroxyprogesterone acetate).
      • Medroxyprogesterone acetate.
      • Norethisterone enantate.
    • Intrauterine devices.
      • IUD with copper.
      • IUD with progestogen.
    • Barrier methods.
      • Condoms.
      • Diaphragms.
    • Implantable contraceptives.
      • Etonogestrel-releasing implant.
      • Levonorgestrel-releasing implant.
    • Intravaginal contraceptives.
      • Ethinylestradiol/etonogestrel (ethinylestradiol + etonogestrel).
      • Progesterone vaginal ring.
  • Ovulation inducers:
    • Clomifeneα.
  • Uterotonics:
    • Carbetocin.
    • Ergometrine.
    • Mifepristone + misoprostol (Co-packaged).
    • Misoprostol.
    • Oxytocin.
  • Antioxytocics (tocolytics):
    • Nifedipine.
  • Medicines administered to the mother:
    • Dexamethasone.
    • Multiple micronutrient supplement.
    • Tranexamic acid.
  • Medicines administered to the neonate:
    • Caffeine citrate.
    • Chlorhexidine.
    • Ibuprofenα.
    • Prostaglandin E1α.
    • Surfactantα.

Peritoneal Dialysis Solution

  • Intraperitoneal dialysis solution (of appropriate composition)α.

Medicines for Mental and Behavioural Disorders

  • Medicines used in psychotic disorders:
  • Medicines used in mood disorders:
    • Medicines used in depressive disorders.
    • Medicines used in bipolar disorders.
      • Carbamazepine.
      • Lithium carbonate.
      • Valproic acid (sodium valproate).
  • Medicines for anxiety disorders:
  • Medicines used for obsessive compulsive disorders:
    • Clomipramine.
  • Medicines for disorders due to psychoactive substance use:
    • Bupropion.
    • Nicotine replacement therapy.
    • Varenicline.
    • Methadoneα.

Medicines Acting on the Respiratory Tract

  • Antiasthmatics and medicines for chronic obstructive pulmonary disease:
    • Budesonide.
    • Budesonide/formoterol (budesonide + formoterol).
    • Epinephrine (adrenaline).
    • Ipratropium bromide.
    • Salbutamol.
    • Tiotropium.

Solutions Correcting Water, Electrolyte and Acid-Base Disturbances

  • Oral:
    • Oral rehydration salts.
    • Potassium chloride.
  • Parenteral:
    • Glucose.
    • Glucose with sodium chloride.
    • Potassium chloride.
    • Sodium chloride.
    • Sodium hydrogen carbonate.
    • Sodium lactate, compound solution.
  • Miscellaneous:
    • Water for injection.

Vitamins and Minerals

  • Ascorbic acid.
  • Calcium.
  • Colecalciferol.
  • Ergocalciferol.
  • Iodine.
  • Multiple micronutrient powder.
  • Nicotinamide.
  • Pyridoxine.
  • Retinol.
  • Riboflavin.
  • Thiamine.
  • Calcium gluconateα.

Ear, Nose and Throat Medicines

  • Acetic acid.
  • Budesonide.
  • Ciprofloxacin.
  • Xylometazoline.

Medicines for Diseases of Joints

  • Medicines used to treat gout:
    • Allopurinol.
  • Disease-modifying agents used in rheumatoid disorders (DMARDs):
    • Chloroquine.
    • Azathioprineα.
    • Hydroxychloroquineα.
    • Methotrexateα.
    • Penicillamineα.
    • Sulfasalazineα.
  • Juvenile joint diseases:
    • Acetylsalicylic acid (aspirin).
  • Dental preparations:
    • Fluoride.
    • Glass ionomer cement.
    • Silver diamine fluoride.