2nd February 2022
By Bevin Likuyani, Pharmacist, MBA, CSCP
American senator Bernie Sanders once said that healthcare must be recognized as a right and not a privilege, I couldn’t agree more. Accessibility to quality healthcare is the right of every individual and the responsibility of every Government to ensure that this is provided. Unfortunately, in developing countries, despite the commitments made in the Abuja declaration of 1989, the health sector remains neglected and underfunded.
One of the key building blocks of effective healthcare systems is access to high-quality affordable medical products, vaccines and technologies. This however for most patients remains to be a pipe dream as the realities of high cost and poor-quality medicines that have sipped into the pharmaceutical supply chains start to sink in. In this article I delve into 4 factors that affect access to quality medicines in Kenya and what can be done to improve the situation.
I remember once I met a patient who had walked in a hospital, got triaged, saw the doctor, got all the necessary laboratory and radiological investigations done, got a diagnosis and a prescription but left without a single medicine. The reason for this was twofold; one was that the patient had spent all her money in the steps leading up to the full diagnosis, and two, the absolute cost of the medicines was way out of her reach.
This is the reality for most poor Kenyans who are unable to afford lifesaving medicines and suffer in silence in their homes. In a recent presser, the Kenyan Cabinet Secretary for Health, Mutahi Kagwe expressed the government concerns on the current high cost of healthcare in the country and the need to regulate overall healthcare and by extension drug costs.
Currently, the government through the NHIF is trying to reduce the overall costs of healthcare and at the same time move the country’s healthcare model from a largely out of pocket to a universal insurance model. These efforts should be lauded and provide encouragement to other players to provide solutions to this ongoing crisis. It should be stated that encouraging generic prescription writing instead of brands could positively impact on cost of prescriptions.
Substandard medicines are those medicines which for one reason or the other have failed to pass the quality standards that have been set to allow their registration into a market. On the other hand, counterfeit medicines are those that have been intentionally and fraudulently been mislabeled. In both scenarios, these medicines are harmful to the patient as they could prolong hospital stays or even worse cause potentially fatal adverse drug reactions.
Statistics estimate that over 25% of medicines used in developing countries are substandard. Currently the Pharmacy and Poisons Board (PPB) have tried to institute quality control guidelines through the National Quality Control Laboratory (NQCL) on introduction of pharmaceuticals into the market. Unfortunately, substandard and counterfeit medicines still find their way into the Kenyan pharmaceutical supply chain.
To solve these issues concerted efforts must be made by the industry players in the fight against poor quality medicines. The PPB should ensure all the quality tests are done and verified, pharmacovigilance reporting on poor quality medicines should be scaled up and feedback given in a timely manner and hefty fines imposed on those found deliberately engaging in this malpractice.
Resilience refers to the ability of pharmaceutical supply chains to return to a position of normal functioning after experiencing an event that causes operational results to deviate from expectations. When these events happen, supply chains are unable to find the right match of supply and demand and this could mean millions of patients not receiving their medicines.
An example of this is the Covid pandemic whereby most supply chains (not just pharmaceutical industry) experienced a huge disruption of their normal operations due to the disease burden and a vast majority lost their lives due to this. Kenyan pharmaceutical supply chain players should increase resiliency by strategically increasing the number of response options and/or the time it takes to execute those options.
Resiliency can be improved through risk monitoring and control. Pharmaceutical players should have disaster management plans that ensure continuity of pharmaceutical care with zero compromise on quality.
The overall perception of patients when it comes to medicine use has been flawed by lack of information, cultural norms and lack of awareness. Many times, we hear of that aunt or uncle who when sick and diagnosed with an illness chose to engage in traditional, complementary medicines rather that conventional medicines. These traditional drugs end up harming and making their health deteriorate even faster.
As seen with the Covid vaccine whose uptake has been minimal at best, people get caught up in myths, conspiracy theories and half-truths on the legitimacy of the Covid vaccine. There has to be a cultural shift and increased awareness to encourage patients to use conventional medicines. Another aspect is the perception of health insurance. Currently the NHIF uptake among Kenyans stands at 20% and although this is double the figure from a few years ago, this still remains a concern.
It is bare to see that most Kenyans have not really fully understood the benefits of health insurance and seem quite lethargic at the prospect of committing KES 500 monthly towards NHIF payments. What happens is that medicines that would have been covered by the scheme have now to be bought out of pocket which poses a challenge to most Kenyans who largely live from hand to mouth. The Government should continue in earnest in educating the masses on the importance of health insurance and how this could make access to life saving medicines affordable.
In summary the fight to increase accessibility to quality medicines for all needs collaboration between both the private and public sectors. Government should provide the right legislation on quality and cost of medicines and efficiently implement them; pharmaceutical manufacturers and distributors should enhance an integrated quality management system to ensure distribution of quality medicines and patients should be informed on importance of quality medicines and health insurance.
Bevin Likuyani is an experienced pharmacist with over ten years in the industry and has an MBA from the School of Business, University of Nairobi. He is a Certified Supply Chain Professional (CSCP) from the American (Association of Supply Chain Management) the founder of Pharvers and works there as a health supply chain consultant.