who medicines work in countries: the kenya example

WHO/UNICEF TBS September 05 1

WHO Medicines Work in Countries: The Kenya Example

Regina M. MBINDYOEDM/NPO, WHO Kenya

KENYAKENYA


General and Health Indicators: Kenya

Total population, 2001…………………… 31.3 million

GDP per capita (US$), 2001……………… 453.2

Life expectancy at birth (M/F), 2002…… 47/49

Child mortality (M/F) (per 1000)………… 99/109

(probability of dying under age 5 years)

Adult mortality (M/F) (per 1000)……… 560/513

(probability of dying between 15 and 59)

Per capita total expenditure on health… 115

(in international dollars, 2000)

Total health expenditure as % of GDP… 8.3

Adult literacy rate, 2000………………… . 73.6%


EDM Support to Kenya (04-05)

Key Issues & Challenges• Inadequate pharmacy laws and policies• Inadequate & irregular supply of essential medicines • Weak drug regulatory mechanisms• Vibrant private pharmaceutical sector • Irrational prescribing and dispensing by health workers• Lack of policy and legal framework for integration of traditional

medicines into health care system • Increasing trends towards regional integration of pharmaceutical

services and regulatory mechanisms

WHO EDM support to Kenya focuses on 5 broad areas:Policy, Access, Quality Assurance, RUM & Traditional Medicines


Baseline Survey - 2003 Joint collaboration of HAI, MOH & WHO. Completed in Dec 03

Highlights of findings: Prescribing according to EDL (81% of medicines prescribed)

30% of population have access to essential medicines

50% of population have access to health facilities (within one-hour walking distance) National Medicines Policy available – last updated in 1994

However: some areas for improvement Over-prescribing common (93% of facilities) (prescribing antibiotics to 50% of patients) No medicines pricing policy, or mechanisms to monitor medicine prices No policy on traditional medicine No coordinated programs to promote rational use of medicines National QC laboratory available, but not operating optimally


EDM Key Activities Implemented in Kenya (2005)

Policy (P)– Formation of IP & Health Group (IPHAG) to articulate & monitor IP issues in MOH

Access (A)– Draft Report of Medicine prices survey produced & disseminated to stakeholders– Capacity Building on Drug Management for MOH procurement Agency (KEMSA)– Technical advice on drug issues to support ART roll-out in the country

Quality (Q)– Installation & training on SIAMED to improve efficiency of Drug Registration– Coordination of Tech. Audits for 2 QC labs pursuing WHO pre-qualification

Rational Use of Medicines (RUM)– Development of National Guidelines for promoting RUM– Training support for 2 nationals on RUM and DTC

Traditional Medicines (TRM)– Commemoration of Africa TRM day– MOH Participation in ongoing review of TRM policy


Progress of EDM Activities – Kenya (2005) EXPECTED RESULT No of Activities

C = Completed; O = Ongoing C O TOTAL

1.1 Capacity to monitor impact of trade agreements & IPR issues on access to medicines increased (P)

3 3 6

2.1 Capacity for medicines supply management in the public sector improved (A) 1 2 3

2.2 Prices and access to essential medicines monitored (A) 2 1 3

3.1 Capacity for information management in drug registration improved (Q) 3 0 3

3.2 Good QC laboratory practices promoted (Q) 1 1 2

4.1 Drug & Therapeutic Committees established in three District hospitals (RUM) 0 4 4

4.2 Training of health professionals on rational use supported (RUM) 0 2 2

4.3 National Guidelines for improving rational use of medicines developed (RUM) 1 3 4

5.1 National Policy on Traditional Medicine, a legal framework and Code of Ethics TM Practitioners developed (TRM)

1 3 4

5.2 Rational Use of TM by providers and consumers promoted (TRM) 2 0 2

TOTALS 14 19 33


Medicine Prices Survey – 2004

General FindingsMost public facilities use ‘course of treatment’ pricing. Lowest prices found in the public sector

Essential medicines more widely available in the mission sector compared to the public sector

Generics widely available in private retail sector – has the highest prices

High generic procurement in public sector - virtually no Innovator Brands of KEDL items

Low procurement prices in both public & mission sectors

Some Policy ImplicationsPromotion of generic prescribing

Policy to support generic substitution

Promotion of price transparency



0

10

20

30

40

50

60

70

80

90

Public Private Mission

IB

MSG

LPG

Availability: KEDL Medicines



0 2 4 6 8 10 12 14 16

Hypertension(atenolol)

Adult ARI(amoxicillin)

Peptic ulcer(ranitidine)

Innov. Brand Most Sold Gen. Lowest Priced Gen.

Private Retail Sector Affordability


WHO/HAI-Africa Joint Collaboration for Action on Medicines in Africa

Goals of the Collaboration Project– Increased access to essential medicines through improved policies and

practices

– Increased capacity & participation of NGOs & consumers in the development and implementation of medicines policy

Joint priority areas of work: medicines policy, pricing, rational use, IPR issues, operational research Project countries: Kenya, Uganda, GhanaSupported by DFID-UKCountry Working Group (CWG) at country level - MOH/HAI/WHO Develop joint work plans for country activities

Mobilize resources for implementation of agreed work plans

Coordinate implementation of joint work plans

Timely periodic reporting to the Project Management Group (PMG)


WHO/HAI-AfricaOverview of Collaboration

Rationale for the Collaboration Synergy of expertise & know- how for greater impact Learn from our different approaches; enhance our commonalities Enhance broad stakeholder participation in policy development and

implementation Empower CSO & build capacity in the medicines field Forge dialogue and links between consumers & MOH Improve coordination and efficient use of resources

MOHCollaborative Activities based onCountry priorities

Likelihood of sustainable impact

Added value in joint activity planning & implementation


WHO/HAI-Africa Collaboration Activities

Assessment of the Pharmaceutical Situation in Kenya (Baseline Survey - 2003)

A Study of Medicine Prices in Kenya (2004)

MOH capacity strengthening on IPR Issues (ongoing) Through IP & Health Advisory Group (IPHAG)

Monitoring the impact of patents on access to medicines

Development of Guidelines for Rational Use of Medicines (ongoing)

Establishment of Drug & Therapeutic Committees (DTC) at all levels (ongoing)


Future Activities for EDM -Kenya (2006 – 2007)

Participate in Review of the National Medicines PolicyInitiate activities to promote medicine price transparencyPromote Rational Use of Medicines in the communitySupport Incorporation of drug management and RUM in pharmacy training curriculaSupport Review of Clinical Guidelines and EDLSupport development of National Policy on Traditional Medicines (TRM), a Legal Framework and Code of Ethics for TRM practitionersCapacity building in GMP, drug management and rational use in the pharmaceutical sector


Asante sana!

Thank You

who medicines work in countries: the kenya example

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