NAIROBI, 30 November 2010 (IRIN) - Every year thousands of Kenyans go without essential medicines because of poor supply chain management, corruption and insufficient funding of the health service, say civil society members.

"The health system lacks the capacity to run effectively - many health workers are not skilled enough, for example, to request for drugs before they run out," said Christa Cepuch, programmes director for Health Action International (HAI) Africa.

She noted that according to a 2008 government survey, 42 percent of people administering drugs in the public health system are untrained.

Under Kenya's drug supply system, health centres receive standard kits containing essential drugs from the Kenya Medical Supplies Agency, but this system has been criticized as too rigid and unable to cope with health facilities' varied needs. The country is piloting a new "pull" system where drug supply is based on orders from health centres, in the hope that this will improve the ability to provide essential drugs in the quantities required.

"Facilities will only receive drugs based on utilization and need so that we avoid situations where drugs are stolen or wasted because they were supplied to a facility that doesn't need them," Francis Kimani, Kenya's director of medical services, told IRIN.

But activists say merely changing the drug supply system may not be enough to address the supply problems. "There is a need to overhaul the system from the ground up, to clean up the whole system," said Patricia Asero of the East Africa Treatment Access Movement.

Frequent stock-outs

Drug shortages are frequently reported by the country's media, with major hospitals reporting sometimes lengthy stock-outs of drugs to treat malaria, tuberculosis and HIV, among others.

A 2009 Kenyan study  published in the American Journal of Tropical Medicine and Hygiene found that two years after Artemisinin combination therapy (ACT) was introduced as the first-line treatment for malaria, one in four surveyed facilities had none of the four recommended weight-specific ACT treatment packs in stock while three in four were out of stock of at least one of the packs. The shortages sometimes lasted several weeks.

This, according to the authors, caused health workers to prescribe a range of inappropriate alternatives. Some of the main reasons for the stock-outs were delays in procurement, poor management of stock flows and a lack of funds to purchase new drugs.

According to Kimani, the government was working to improve the efficiency of the national drug supply system. "The government has recently allowed the Kenya Medical Supplies Agency to purchase drugs directly from local suppliers in a bid to stem shortages, and we hope this will help in reducing stock-outs of essential drugs," he said.

Corruption

Asero noted that corruption was a major problem, with drugs frequently "disappearing" from health facility stores. "Where I come from in Migori [Nyanza Province], a shipment of drugs might arrive one day and within a week you go to see the doctor and he tells you they are out of stock. In one week? I don't think so," she said.

According to HAI's Redemtor Atieno, many government pharmacists set up private pharmacies to sell stolen government medicines.

The government can ill afford to lose medicines; as it is, the budget for drugs is inadequate to cover national needs and has diminished over the past few years.

Funding gap

Kenya now spends 8.87 percent of the national health budget on medicines, down from 10 percent in 2009-2010 and 12 percent in 2008-2009. The country spends an average of US$14 per person per year on health, less than half the World Health Organization's recommended $34.

"That budget works out to roughly 56 Kenya shillings per person - enough to buy you maybe four Paracetamol," said HAI's Cepuch.

The Ministry of Medical Services has, according to Kimani, requested additional funds from the Treasury to purchase essential drugs to prevent further shortages.

However, Atieno noted that more money would not solve the problem of erratic drug supplies until the system was completely overhauled.

"We need to know exactly how to fix the supply chain, we need to address corruption and we need to train health workers - otherwise it's like we are throwing money away," she said.