Patients Access to Medicines – A Critical Review of the Healthcare System in Kenya

Abstract

Access to affordable, safe, effective, and quality-assured medicines by a patient is important for good health outcomes. Unfortunately, there is sparse literature published on the pharmaceutical enablers that may increase the sale of a substandard and falsified (SF) medicine to a patient in Kenya. The review highlights some of the factors that may facilitate the entry of SF medicines into the legitimate pharmaceutical supply chain and discusses their impact on patient access to medicines. Lack of essential medicines in public health facilities is an important factor that may contribute to increased demand for medicine-related out-of-pocket expenses from private health facilities, thus a likelihood for a patient purchasing SF medicine from unlicensed and illegal medicine outlets or unregulated websites. The need to increase medicine availability in the public sector by the Ministry of Health (MOH) is emphasized in addition to the strengthening of public procurement to cushion it from corruption and mismanagement. In addition, the MOH should promote local pharmaceutical manufacturing and implement a medicine pricing containment policy to avoid abuse and prevent overexploitation of patients, increase medicine price transparency, and reduce pharmaceutical supply chain distortion. Recommended regulatory reviews include accreditation of unlicensed illegal medicine outlets to facilitate accountability, regulatory oversight, and active surveillance. The national post-market surveillance regulatory capacity should be strengthened to improve rational medicine use. A 3-year diploma course should be replaced with a shorter 1- or 2-year pharmaceutical support staff training not eligible to superintend a pharmacy. The recommended legislative review includes a mandatory clause to enforce generic prescribing and the implementation of generic substitution by health workers. Unethical manipulative pharmaceutical marketing practices should carry stiffer penalties to deter malpractice. Future research areas include investigation of medicine prescribing and dispensing practices, medicine consumption studies, medicine price differences within different health sub-sectors, and between licensed pharmacies and unlicensed illegal medicine outlets.

Utilizing quantitative dried blood spot analysis to objectively assess adherence to cardiovascular pharmacotherapy among patients at Kenyatta National Hospital, Nairobi, Kenya

“…In Kenya, stock outs of essential medications in public healthcare facilities is an important factor which may contribute to the patient unknowingly purchasing poor-quality CVD medications from unlicensed and illegal medicine outlets or unregulated websites. This therefore warrants further investigation in medicine price differences within different health sub-sectors in Kenya and between licensed pharmacies and unlicensed illegal medicine outlets [39].…”

“…In this study if the patient baseline data revealed that the patient had taken their medication as prescribed but the subsequent LC-HRMS analyses showed non-detectable drug in that patient's DBS sample then this suggests that the patient is likely to have unknowingly ingested a substandard or falsified pharmaceutical product and was therefore unintentionally non-adherent. The circulation of poor-quality medicines in the Kenyan market is documented [37][38][39] and the prevalence ranges from 14-38% [38,40]. It is postulated that if a patient ingests such poor-quality medicines their blood drug levels will not reach the required therapeutic levels since such medications contain little no active pharmaceutical ingredient and this can lead to treatment failure [6].…”

“What if I get sick, where shall I go?”: a qualitative investigation of healthcare engagement among young gay, bisexual and other men who have sex with men in Nairobi, Kenya

“…The study was conducted in Nairobi, the capital city of Kenya and home to approximately 150 campuses of various universities and mid-level colleges(30), some of which have health facilities that serve their student population (23)(24)(25). The Nairobi metropolis also hosts more than 1,000 legally registered public and private health facilities (20), including approximately ve recognized non-governmental/communitybased MSM-friendly clinics (22), as well as several community pharmacies (21).…”

“…For instance, our previous work found high prevalence of HIV(18) and STIs (19) among TSMSM in Nairobi, Kenya, indicating an urgent need for concerted efforts to address this dual epidemic and other health challenges in this young population, so as to help prevent long-standing deleterious effects of current ill-health. The Nairobi metropolis has an abundance of public and private health facilities (20) and community pharmacies (21), as well as a few non-governmental/community-based MSM-friendly health facilities (22) where MSM can seek care when needed. Besides, various tertiary institutions within the Nairobi metropolis also have health facilities that offer care to their student population(23-25).…”

Evaluating the Impact of a Digital Hospital Information Management System on the Operational and Financial Performance of Health Facilities in Kenya

“…Level 5 are county referral hospitals also known as provincial hospitals with over 100-bed capacity. Level 6 facilities are the national referral hospitals that also receive patients from other countries in East and Central Africa (26). Counties control level 1-5 facilities while the MoH controls level 6 facilities.…”