PROPOSAL FOR MONITORING AND ASSESSING THE PHARMACEUTICAL SECTOR IN KENYA - MOH / WHO USING THE OPERATIONAL PACKAGE FOR MONITORING AND ASSESSING THE PHARMACEUTICAL SITUATION IN COUNTRIES, WHO/EDM

1. INTRODUCTION

Kenya lies on the eastern coast of Africa along the equator with a land area of 582,644 square kilometres inclusive of inland water. The climate and topography are characterised by wide diversions ranging from glaciated mountain peaks (notably Mount Kenya) to cool plateaus, the humid coastal plain, and the vast and hot expanse of arid and semi-arid land which covers the northern half and southern-eastern parts of the country.

Administratively, it is divided into 8 main provinces namely; Central, Coastal, Nyanza, Western, Eastern, Nairobi, Rift Valley and North Eastern. It has a population of approximately 30 million people. The country’s economic growth has been on the decline since 1992 when Kenya embraced the Structural Adjustment Programme recommended by the World Bank and International Monetary Fund. The economy is at its lowest currently with GDP of less than 1.4 percent. The gradual economic decline has had a proportionate decrease on the Health indicators

The HIV/AIDS scourge has taken toll on the Kenyan population and an estimated 2.2 million people are infected with HIV/AIDS. An estimate of 10% of the infected people, 200,000 of them require treatment.

In 1994, the Government of Kenya adopted the Kenya Drug Policy whose goal was “to ensure constant availability of safe cost effective pharmaceuticals for the purposes of prevention diagnosis and treatment of diseases in the Kenyan population.

Public sector medicine supply system has been reformed through the establishment of Kenya Medical Supplies Agency as a body corporate with the mandate of developing and operating a viable commercial service for the procurement and sale of medicines and medical supplies to the public health institutions in February 2000.

Against the above background, there is need for the Ministry of Health to assess the pharmaceutical situation in the country to evaluate the impact of the reforms undertaken towards improving the quality of pharmaceutical care delivery.

The proposed assessment of the pharmaceutical situation in Kenya will indeed help the ministry of Health identify and define the necessary changes and priority areas that require support.

The survey will also help define the relevant strategies and collaboration for the forthcoming WHO technical collaboration with the Ministry of Health in the field of essential medicines as well as measure the impact of WHO input to the implementation of the National Drug Policy.

2. OBJECTIVE

• To collect baseline information on the pharmaceutical sector from available facility data sets, which will provide a clear picture of national and institutional problems so as to assess strategies and priorities required.

3. METHODOLOGY

The evaluation and assessment of the pharmaceutical situation will be based on level I and II indicators as described in the ‘operational package for monitoring and assessing the pharmaceutical situation in countries’ as follows;

i) Level I Indicators

The level I core indicators will be used to assess existing structures and processes in the Kenya Pharmaceutical system. One senior pharmacist from the Ministry of Health headquarters will gather the information through the office of the Chief Pharmacist.

ii) Level II core indicators

Field surveys using level II core indicators will be undertaken using appropriate survey design, sampling and data gathering techniques.

4. BACKGROUND INFORMATION

Administratively, Kenya is divided into 8 provinces with 70 districts. There are five levels of health care units namely; Dispensary, Health centre, Sub-district hospital, District Hospital, Provincial General Hospital and Referral hospitals. Rural Health Facilities (Health centres and dispensaries) constitute approximately 1700 facilities while the hospitals (sub-district hospitals, district hospitals and provincial district hospitals) comprises of 160 institutions. The are 2 referral hospitals namely, Kenyatta National Hospital and Moi Teaching and Referral Hospital.

There are 631 registered private pharmacies and 8 public regional medicine warehouses.

Study population

The study population will be public health facilities treating outpatients and with pharmacy/medicine dispensary units, private outlets and medicine warehouses.

Sampling

Five provinces will be selected from a possible of 8 provinces. Nairobi and Eastern provinces were chosen as the biggest and lowest income generating areas respectively. The other 3 provinces were chosen randomly taking into account reasonable accessibility by the data collectors. The three randomly selected provinces are Nyanza, Rift Valley and Coast province.

LIST OF PROVINCES AND HEALTH FACILITIES SELECTED

KEY:
KEMSA : Kenya Medical Supplies Agency