Assessing the pharmaceutical situation in a country provides baseline information on whether its population has access to essential medicines that are of good quality, are efficacious and are being used properly. Results for such assessment can be used as a guide by policy makers and managers to develop and define the necessary changes and priority areas that require support for improved health for all. In the light of the above, WHO supported Kenya in April 2003 to carry out a baseline survey in the pharmaceutical sector to assess the current situation regarding access and use of quality medicines. The survey was carried out using the WHO Operational Package for Monitoring and Assessing the Pharmaceutical Situation in Countries (April 2003 version)
Kenya has the basic structures considered necessary for implementing a national medicine policy. However, no national assessment study has been conducted in the past to evaluate the impact of policy intervention.
Data obtained from this survey show that availability of essential medicines in public health facilities is more than 90% with 97% of public health facilities having greater than 75% availability. 45% of the households surveyed sought healthcare from public health facilities, and 6% of all households surveyed could not obtain all the prescribed medicines due to financial incapability. The cost of treatment of most common diseases in public health facilities demonstrated considerable variation ranging from an equivalent of a quarter of a day’s lowest government salary for the treatment of child malaria in public health facilities to an equivalent of more than a day and a half’s salary for the treatment of adult pneumonia in private pharmacy outlet.
More than 70% of the minimum criteria for adequate conservation conditions were met in only 30% of public health facilities.
There is a general tendency to over-prescribe medicines especially antibiotics. A national median of 78% patients received antibiotics. Irrational dispensing was also demonstrated - in 70% of public health facilities, more than three-quarters of dispensed medicines were inadequately labelled. In 27% of public health facilities, less than half of the respondents understood how to take their medicines. Performance measures suggest there is a considerable need to improve prescribing and dispensing practices in public health facilities.
Prescribers do not have access to key sources of therapeutic information they need in daily practice as Standard treatment guidelines (STG) were found in only 13% and the Essential Drugs Lists (EDL) was found in only 17% of public health facilities. Less than half public health facilities had more than 90% prescribing practice that conforms to the EDL. Only 29% of public health facilities used ORS, the recommended diarrhoea treatment, in greater than 90% of diarrhoea cases.
There is need to investigate the reasons for underperformance identified in the areas affecting access, quality and rational use of essential medicines.