Kenya has the basic structures that are considered necessary for implementing a national medicine policy. However there is no strict framework that ensures adherence to the requirements. Because of the characteristics of medicines which make them different from other goods, technical and material support from the government is required in order to develop strategies and priorities required to keep pace with development in medicine administration and management. Improved performance in legislation and regulation is necessary in order to achieve the objectives of the NDP of providing all Kenyans with safe, effective and affordable pharmaceuticals that are of good quality.
The pharmaceutical sector baseline survey gave a good indication of availability of essential medicines in health facilities in Kenya: more than 9 in every 10 public health facilities had more than three quarters of the essential medicines needed to treat common illnesses. However, essential medicines must not only be available but also affordable in order to improve access to all Kenyans. And although various level II core indicators illustrate that medicines represent a significant expenditure for households, there is a crucial need for comprehensive and reliable medicine pricing data to better define the affordability of medicines for Kenyans.
Only 1 out of every 10 public health facilities had a stock-out duration of more than three months. This gives some indication about the reliability of medicine supply as well as level of efficiency in management of medicine stocks. However, there is still need to develop ways of improvement so that medicines are in stock 100% of the time. More than 1 out of every 10 public health facilities had one or more expired medicines on their shelves and 6 out of 10 public health facility medicine store rooms met more than half the minimum criteria for adequate conservation conditions. Strategies to improve medicine storage conditions and the quality assurance system should be developed to ensure more than 90% availability of quality medicines everywhere in the country.
In Kenya, there is a general tendency to over-prescribe medicines, especially antibiotics. 78% of patients received one or more antibiotics while all the cases of URTI were prescribed antibiotics. Antibiotics and injections are two important but commonly overused and costly forms of medicine therapy. More than 1 in 5 public health facilities prescribed one or more injections to more than half of the patients, though, injection is a type of medicine therapy, which should be used only when oral therapy is not available. Irrational dispensing is also prevalent in public health facilities with only about 10 % of prescribed medicines being labelled appropriately. Prescribers tend to use brand names when prescribing. Essential medicines are widely used in public health facilities (81 % of prescribed medicines are on the KEDL) probably because government procurement is limited to medicines on the essential medicine list. STGs were found in only 13% of public health facilities indicating that prescribers lack the key source of therapeutic information they need in daily practice. There is need for an official continuing education system on rational use of medicines for prescribers and dispensers as this is one of the most cost-effective ways to improve medicine use and thus improve health and reduce costs.
Finally, although the baseline survey reveals numerous positive and encouraging characteristics of Kenya’s pharmaceutical sector, there are also significant weaknesses, which need urgent attention in order to improve the sector and make medicines more accessible. The study makes an extensive list of priority recommendations, which should be considered as a comprehensive base on which to build work plans, budgets, timelines, and monitoring and evaluation plans. Given dedicated budgets and broad stakeholder involvement, the pharmaceutical sector can be successfully strengthened to reach the ultimate goal: universal access to good quality and affordable essential medicines for Kenyans, including the poorest and most vulnerable.