Lucy Winkie Mecca, BpharmU51/63523/2013

About 30% of the world’s population does not to have access to essential medicines.

Kenyan public facilities experience high stock-outs of essential medicines

Financing is an important determinant of access to essential medicines

NHIF Medical Scheme contributes to financing of essential medicines in public hospitals

Effect of introduction of the NHIF-CSDS Medical Scheme on availability of essential medicines not studied.

Introduction of the scheme may paradoxically compromise availability of essential medicines.

Has the funding for essential medicines increased since the introduction of the NHIF-CSDS Medical Scheme?

Did stock-outs of essential medicines reduce after the introduction of NHIF-CSDS Medical Scheme?

What factors affect availability of essential medicines at Webuye District Hospital?

To compare availability and funding of essential medicines before and after implementation of NHIF-CSDS Medical Scheme.

To compare the proportion of FIF allocated for procurement of medicines before and after implementation of the scheme.

To determine and compare the contribution of the FIF, KEMSA and others to the essential medicines budget before and after implementation of the scheme.

To determine the frequency and duration of stock-outs of essential medicines before and after implementation of the scheme

To explore factors that could affect the stock-out rate of essential medicines.

A retrospective longitudinal before-after study of four years; the latter two of which the NHIF-CSDS Medical Scheme was in operation.

Study period: 1 Jan. 2010 – 31 Dec. 2013

Study site: Webuye District Hospital, Kenya.

145 essential medicines were selected for study

◦ antiretroviral, anti-tuberculosis and contraceptives not included

Authority to Incur Expenditure records

KEMSA Orders Forms and Invoices

Local Purchase Orders and invoices from suppliers

S3 cards on which all hospital receipts are recorded

Pharmacy summary budgets and stock control cards (electronic and manual)

The median of the quarterly FIF allocation for purchase of medicines was significantly greater after introduction of the new NHIF scheme

◦ Kshs 1.04 million vs. 0.70million, p=0.008

The mean proportion of FIF allocated quarterly for purchase of medicines was also higher

◦ this increase was not statistically significant

◦ 9.12 % vs. 7.55%, p=0.0502

Three sources:KEMSAFIFOther Facility

Comparisons were made for

Proportion of essential medicine contributed

Expenditure on essential medicines

Source Hypothesis p-value

KEMSA 2012/13 < 2010/11 0.000

FIF 2012/13 > 2010/11 0.000

Other Facility 2012/13 > 2010/11 0.029

Source Hypothesis P value

KEMSA 2012/13 < 2010/11 0.000

FIF 2012/13 > 2010/11 0.000

Other Facility 2012/13 < 2010/11 0.122

The average monthly stocked-out time reduced in 2012/13

◦ this reduction was not statistically significant

◦ 21.75% to 19.47%, p= 0.099

The first months of the quarter were characterized by a high stock-out rate

Some antibiotics such were never stocked out

◦ amoxicillin capsules and co-trimoxazole tablets

Theatre medicines had low stock-out rates (<2.5%)

◦ Neostigmine, Thiopentone, Suxamethonium injections

Some pediatric preparations and topical preparations had high stock-out rates (>50%).

◦ Co-amoxiclav, Erythromycin, Ibuprofen suspension

FIF expenditure was a significant determinant of monthly stock-out rates (p = 0.025)

Supply from KEMSA was a significant determinant of stock-out rates of individual medicines.

Absence from the KEMSA list or non-supply of orders to KEMSA predicted a higher stock-out rate of individual medicines (p < 0.0001)

Financing through FIF and availability in KEMSA were found to be significant predictors of stock-out rates.

No significant change in stock-out rates most likely due to inadequate financing.

The first months of the quarter had the highest stock-out rates due to winding procurement procedures.

No significant change in stock-out rates of essential medicines after implementation of the NHIF-CSDS medical scheme

The NHIF was implemented into a system that was inadequately funded.

Contextual factors should be taken into account when implementing insurance schemes.

Studies on availability of essential medicines after devolution of health should be done

Thank you