The global drug gap between rich and poor countries arises from multiple market and government failures as well as from huge income differences. Consequently, multiple policies are required to address this inequity. WHO has promoted the concept of essential drugs to advance health equity through expanded access to basic medicines for poor people in poor countries. Nearly 150 countries have adopted a national essential drugs list. Some controversy remains about whether a country's list of essential drugs should represent the maximum number of available drugs as a ceiling, or the minimum number of available drugs as a floor.
Debate also persists about which products to define as essential and by whom.
But enough consensus has emerged that even the International Federation of Pharmaceutical Manufacturers Associations, which initially opposed the idea, now accepts the principle of efficient provision of essential drugs in primary health care as a priority when resources are limited. Eleventh Model List of Essential Drugs includes 302 active ingredients. Typical examples are ibuprofen, morphine, mebendazole, and ampicillin. Several mechanisms are available to promote access to essential drugs. A second strategy is improving the state's capacity to manage the national pharmaceutical system.