Joyce Mulama

NAIROBI, Mar 11 2009 (IPS) – When public health facilities are so often short of drugs that a community worker has to buy basic medicines like painkillers in bulk for use by the community, then there is a problem.
Florence Machai, who works with communities in Lugale, western Kenya is in such a situation. I store Panadols (pain relievers) in my house for people because when they visit the local clinic, they come back with no drugs. They cannot afford to buy the pain killers, she told a public forum held in February to discuss a crippling drug shortage being experienced in public health facilities.

Onyango Wambia, a community health worker in Maseno, Kisumu district in western Kenya decries the lack of drugs in government hospitals and the high cost of drugs in private health facilities. Where I am working, many people are dying because they cannot access drugs in government dispensaries and at the same time cannot afford the high cost of drugs in private chemists.

Wambia, a diabetic, has himself resulted to alternative therapy where he chews eight cloves, ginger and garlic each day to control his blood sugar level. He says they are bitter, but cheap; a dose of diabetic drugs retails in private stores at about 24 dollars, considerably high in a country where government statistics indicate that half the population lives on less than a dollar a day.

If the conventional medicines were available and affordable, I would go back to taking them, Wambia added.

Though authorities have attempted to provide free and subsidised treatment in health facilities, frequent stock-outs of medicines have characterised the public health sector. Worst affected by the crisis are the poor and people in rural areas.
Veronica Kalunde, who provides home-based care to patients in Kibera, a slum settlement in Nairobi, says because there are no drugs in public health facilities, families turn to the private sector where prices are significantly higher, forcing them to take incomplete doses.

People buy small doses and later abandon the treatment midway. They are torn between buying food for the family or medicine, and later forget about the treatment, Kalunde pointed out.

This is dangerous since patients risk developing resistance to diseases, according to health experts like Patrick Mubangizi, a pharmacist and Africa regional coordinator for Health Action International (HAI).

HAI, which is a global network including NGOS, consumers, academics and health care providers, has joined Oxfam and the Kenya Treatment Access Movement to put pressure on the government to end the crisis. The Stop Stock-Outs campaign wants essential medicines restored to hospital shelves for easy access by those who need them.

Essential medicines, as defined by the World Health Organisation, are medicines used to treat common diseases including malaria, pneumonia, diarrhoea, HIV, Tuberculosis, diabetes and hypertension. The WHO requires that these medicines are available in all government health facilities.

But quarterly surveys since 2003 by HAI and the national health ministry conducted to establish availability and access of medicines in public hospitals indicate that rural public health institutions typically have just 50 percent of essential medicines available, while public health facilities in urban areas are marginally better off at 60 percent availability.

In January, the country experienced a shortage of BCG an anti-tuberculosis vaccine given to children before they are two years old. The country had run out in what was said to be another procurement hiccup.

In February, there was a severe shortage of malaria drugs at Nyanza Provincial Hospital in Nyanza province in western Kenya, with hospital officials admitting that the problem had persisted for months. Malaria is the leading cause of mortality and morbidity in the country.

It is inexcusable that Kenyans dependent on public health institutions continue to die and suffer pain and trauma for lack of essential medicines to treat common health conditions, said Mubangizi.

The medical services minister, Anyang Nyong o, announced that there were insufficient stocks of malaria and TB drugs in public health institutions countrywide, saying the available stocks would last only seven months.

The shortage has been blamed on delays in the procurement and distribution of drugs. The Kenya Medical Supplies Agency (KEMSA) is charged with these roles, but its work is hampered by the health ministry, which remits funds for the services. The ministry owes about 21 million dollars to those who supply drugs to KEMSA and as a result, the suppliers have refused to deliver further medicines until their debts are settled.

The health ministry says the matter is being sorted out. Permanent secretary James ole Kiyiapi said on Mar. 5 that payments to suppliers had already begun. But fears abound that if the current situation persists, empty shelves in the pharmacies at public hospitals will continue to be the norm.

It is not only Kenya which is experiencing drugs stock-outs. Malawi is also in the same shoe, with government facilities often running out of drugs for opportunistic infections and malaria, according to Martha Bwathene of the Malawi Health Equity Network.

Malawi s situation is made worse by the fact that 60 percent of the country s health budget is donor funded. Now with the global credit crunch, less and less money may be allocated to the health sector, meaning the stock-outs may go on for a long time, Bwathene said at the Nairobi forum.