Drug Shortages in Kenya
DDBA 8560 - Seminar in Healthcare Managerial Decision Making
Drug Shortages in Kenya
The drug supply situation in Kenya is acute. In one facility, it was alleged that the government
had not procured enough reagents for CD4 or viral load tests used in HIV/AIDS testing and
treatment, and it was impossible for hospitals or clinics to buy supplies directly, even though
they had funds in hand from patients’ user fees. Pharmaceuticals, they said, were centrally
supplied but were often of very poor quality;4 for instance syrups turning black, tablets
crumbling, weak sutures, because contracts were awarded to the lowest generic bidder and their
quality was not properly checked (Kangwana et al, 2009).
It is evident that an acute shortage of medicines and other essential supplies in public hospitals is
creating a trail of misery for patients across Kenya. The drugs missing include: malaria drugs,
rehydration salts, ARVs and antibiotics (Amoxicillin and treatments for STDs). Many patients
are unable to afford the extra charges demanded by hospital staff to source for drugs elsewhere.
The patients accuse nurses and other medical personnel of hoarding the drugs and secretly
supplying them to private pharmacies (Kangwana et al, 2009), a practice they cited as a key
contributor to the shortage of drugs. The only drugs available are pain killers (aspirin, panadol,
brufen) and de-wormers. Clients report being given the appropriate prescription on consultation
but having to purchase the drugs from chemists within the facility at inflated prices. Therefore, it
is highly likely that these chemists either work with the medical staff or are actually owned by
them. Likewise, in case the doctor recommends an injection, patients are forced to buy needles,
syringes and gloves from the private chemists or clinics around public facilities. .
4Patients consistently mention that health providers deny them some drugs in facilities, but sell
the same to other patients from their bags at higher prices or refer them to nearby private
4It is not clear how they access the drugs; whether they buy for re-sale or in collaboration with
the pharmacist or facility in-charge. Some clients narrate an incident where a mother took her
sick daughter to hospital for treatment at night in January 2010. She arrived at the facility at 11
p.m. and after being attended to by the clinician, there were no drugs and all the pharmacies were
closed. Upon pleading for assistance for about 30 minutes, the mother was asked by a nurse
whether she had Kshs 1, 500 to purchase the necessary drugs from a friend’s pharmacy. The
nurse returned a few minutes later with the drugs and asked for more money for needles and
syringes for administering the drugs (Kangwana et al, 2009).
The process of drawing health facility budgets is conducted by the health facility boards which
are integrated into one comprehensive budget for each health facility. The budget is then
approved and dispensed in quarters to the medical facility, and the money that is utilized in a
particular quarter is drawn from funds collected from the previous quarter. However, from all
these collections and utilities, most health facilities run at a deficit of more than 60%, pushing
some of the health facilities into heavy debt. .
4This situation leads to suppliers refusing to provide the health facility with commodities due to
fear of delayed payments. 4Despite the huge collections, facility managers are limited in
ploughing back the income to meet the cost of supplies and other items thus compromising the
effective functioning of the health facility (TI Kenya, 2011).
At the Moi Teaching and Referral Hospital in Eldoret, one of two referral hospitals in the
country, suppliers had threatened to stop the delivery of drugs and other supplies due to unpaid
debts amounting to Kshs 75 million. Funds from treasury are not adequate to meet the needs of
the facility. Some suppliers had stopped deliveries due to non-payment, a move that does not
augur well for a referral hospital. The hospital’s director made a special appeal to the government
to salvage the situation; a plea that was echoed in all the sampled institutions. The experience at
the Moi Teaching and Referral Hospital was attributed to the lack of alignment between
budgetary allocations and service provision. The hospital being a referral unit provides highly
technical services which are costly and it serves a large volume of clients. In terms of drugs and
medical supplies, the institution was fairly resourced (TI Kenya, 2011).
High levels of corruption at various levels in the health sector especially in the procurement of
drugs and medical supplies are hindering many donors from working with the government or
MoH directly. The Kenya Medical Supplies Agency (KEMSA) lacks the institutional capacity,
autonomy, financial and human resources capacity to perform this critical function efficiently
and effectively since it works under the influence of the MoH ministers, politicians or senior
MoH staff. In the 2009 financial year, due to inefficiency and high corruption levels at KEMSA,
the MoH decided to procure drugs and medical supplies directly. The donor group decided to
improve governance and efficiency at KEMSA by awarding a two-year contract to the GF Kenya
Consortium to strengthen procurement and supply chain management in Kenya funded by the
Ministry of Finance (Kenya’s Global Fund “Principal Recipient”). The work of the consortium
focused on building the capacity of KEMSA staff in both procurement and supply chain
management, establishing national procurement strategies for GF-financed commodities, and
strengthening Kenya’s health logistics systems (TI Kenya, 2011).
As part of the strategy, the Consortium attached experts to build procurement management and
logistics, management capacity, conduct a capacity building training programme, and design and
implement a procurement management database for KEMSA (John Snow Inc. 2010). This
culminated into several accusations and conflict among MoH ministers and senior staff that had
an interest in KEMSA operations. The team was frustrated and left; as a result the already
established systems were run down to create loopholes for corruption. This is one of the reasons
why efforts to make KEMSA autonomous have been frustrated by intense vested interests (TI
Procurement practices in the health facilities strictly adhere to the guidelines provided by the
Public Procurement Oversight Authority (PPOA). They have access to PPOA manuals. They use
three systems of procurement: open national tenders: pre- qualified, low value purchases, in case
of emergencies; and quotations, for small items. 4The public health facilities sampled in this
study have a tendering committee comprising 12 members who meet after every three months or
when need arises. The community is not adequately involved in the procurement processes and
cases of malpractices based on available evidence are rare. In an evaluation of facilities of the
same class by the Public Procurement Oversight Authority (PPOA), the New Nyanza Provincial
General Hospital performed well. However, there were rampant complaints relating to the debts
owed to suppliers mainly due to limited funds to the hospital (TI Kenya, 2011).
The way forward is to reform the financial management and logistics of public health facilities.
Kangwana et al (2009) observed that facilities in Coast Province, namely Ganze, 4Kilifi and
Coast General Hospital have improved, institutionalized funds’ collection and 4developed
effective accountability systems with the assistance of development partners. 4.
All financial transactions have been computerized. Improved systems have had a significant
impact on the amount of funds collected for example in one hospital facility visited 4at the coast,
the cost sharing revenue increased from Kshs 500, 000 to seven million 4shillings per month. The
cash collected is banked daily as a strategy to reduce the potential risks of loss. Once the money
is banked, health facility officials are not required to withdraw the money. The withdrawals are
authorized by provincial health officials who will only authorize by confirming the budget drawn
by the health facility to cover the year on a quarterly basis. This could be used to supplement
health facilities’ drug supply, but this can only be done upon the authorization of policy. .
4The slow procurement process by KEMSA and MoH, lengthy ministerial consultations, inflated
tenders, and budget limitations were some of the challenges raised and recommended for reform.
According to the information obtained from respondents in the study by Kangwana et al (2009),
funds allocated for procurement are not sufficient to meet the needs of the facilities.
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