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. A third strategy is to focus on mechanisms that maintain effective supplies. International loans from the World Bank and aid agencies have supported the procurement of essential drugs. A fourth strategy is to improve the rational use of essential drugs by health workers and consumers, especially in the private sector, because market purchases represent a major source of access to pharmaceuticals in developing countries. Despite past controversies, a broad consensus has emerged on strategies to improve access to essential drugs in poor countries, and substantial progress has been achieved.