Why access to affordable drugs holds the key to achieving UHC

KEMSA Acting Commercial Services Director Dr Simon Wahome, Acting Operation Director Dr Gared Nyakiba look on as Acting CEO John Kabuchi displays part of a consignment of assorted essential medical supplies valued at more than Sh200million dispatched to various counties. [Jenipher Wachie, Standard]

Last month, Homa Bay Governor Gladys Wanga opened Rachuonyo East sub-County Hospital in a glittering ceremony.

The residents cheered, but at the back of their minds was the question of availability of medicines and equipment.

Many a times, public hospitals lack medicines and generally health commodities, which forces patients to seek private service providers, whose rates are high.

And as Kenya seeks to achieve Universal Health Coverage (UHC) by 2030, health commodity security is one of the four pillars of UHC.

The Ministry of Health acknowledges there is a problem and commits to solving it to ensure UHC succeeds.

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Health Cabinet Secretary Susan Nakhumicha says the biggest challenge lies in supply chains of Kenya Medical Supplies Authority (Kemsa), which has promised to remove bottlenecks that may deny Kenyans affordable healthcare.

Kemsa is the State-owned sole supplier of Health Products and Technologies (HPTs) to public health facilities.

Kemsa Chief Executive Andrew Mulwa says the authority has undertaken timely procurement procedures and is promptly paying suppliers for affordable health products to be accessible to all Kenyans.

It has also reviewed contracts to get best value for money and take advantage of economies of scale. Dr Mulwa assures that the board is mainstreaming ethics into all business processes through continuous staff sensitisation.

"The authority is planning to revise and update over 35 policies, which will ensure staff operate within the procedures and regulations," Mulwa said. "The management recently reviewed its risk registers, identified existing operational gaps, and developed mitigation measures to rid corruption."

The commitment to transparency has given Afya House hope that the trust deficit between stakeholders will be eliminated as procurement processes will be fair, efficient and compliant with regulations.

Kenya's UHC policy states that availability, accessibility, quality, and pricing of medicines, vaccines and health products and technologies is a crucial component and challenge to UHC.

Nakhumicha worries that the high costs of HPTs will obstruct the delivery of affordable, high-quality medical commodities.

Since health is a devolved function, county governments are key purchasers of health commodities and, thus, the most prominent clients of Kemsa.

Kirinyaga Governor and Council of Governors (CoG) Chair Anne Waiguru says counties are focusing on local manufacturing as a critical contributor to the availability, quality, and affordability of HPTs.

Kenya currently imports most medicines, with the United Nations COMTRADE database on international trade showing the cost of imports of pharmaceutical products was $776.76 million in 2021.

President William Ruto also admits that Kenya spends billions of shillings to import pharmaceuticals and, on July 14, put the figure at Sh140 billion annually.

Such figures have led to calls for local HPT manufacturers to do their bit so the cost of healthcare can come down.

"The sector has already set clear policy objectives on increasing the value of purchases from local firms to 50 percent," says Waiguru, adding that county governments are encouraging local firms to update their manufacturing capabilities with them and ensure that appropriate databases are maintained, and validation is undertaken during the annual business license renewal process.

In April, the media reported that prices of crucial imported medical supplies, including cancer, hypertension, and kidney disease medicines, had increased significantly due to the weakened shilling.

"Most of the medical supplies, be it medicines, surgical supplies, or medical equipment, are imported, and due to currency devaluation and supply chain challenges, several vendors have sent us notices and revised prices," Rashid Khalani, the CEO of Aga Khan University Hospital, told the media. "On average, the costs have increased by 12 to 15 per cent."

To ensure the medicines reach their intended destinations, KEMSA and county governments say they are investing in technology that will enhance end-to-end visibility in the supply chain and track the movement of healthcare products from the point of origin to that of consumption.

Waiguru says an elaborate e-LMIS (Logistics Management Information System) will help address the timeliness and completeness of reporting health commodities data, given the limitations in staff capacity.

"Moving forward, county governments should develop and adopt a standard policy on the use of e-LMIS, incorporate e-LMIS in the county health legislation with requirements for reporting by facilities, and jointly invest in a suitable e-LMIS that is interoperable with other health systems as well as county core information systems," she says.

The World Health Organisation (WHO) recommends developing and implementing a "medicines pricing policy to achieve a greater level of transparency, uniformity, and predictability in the pricing of medicines, including the consideration of reference pricing for medicines in the private sector."

According to a 2019 study, medicines account for up to 60 percent of healthcare costs in developing countries, including Kenya, and even when medications are available, patients have to pay for them.

Yet in Kenya, only seven percent of income for low-income earners is available for healthcare costs, including medicines.

"Owing to low availability of medicines in the public health facilities and poor accessibility to these facilities, most low-income residents pay out-of-pocket for health services and transport to the private health facilities," write Dennis Ongarora and others in the study titled Medicine Prices, Availability, and Affordability in Private Health Facilities in Low-Income Settlements in Nairobi County, Kenya.

The Kenya Demographic and Health Survey 2022 shows that out-of-pocket (cash) payments are the most common means of payment for both inpatient and outpatient expenditures, with only one in four Kenyans (26 percent) having some form of health insurance.

With the national rollout of UHC planned for later in the year, such scenarios will be a thing of the past.