Transcript WHO Medicines Work in Countries: The Kenya Example KENYA Regina M. MBINDYO EDM/NPO, WHO Kenya WHO/UNICEF TBS September 05

WHO Medicines Work in
Countries: The Kenya Example
KENYA
Regina M. MBINDYO
EDM/NPO, WHO Kenya
WHO/UNICEF TBS September 05
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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%
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EDM Support to Kenya (04-05)
Key Issues & Challenges
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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
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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
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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
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Progress of EDM Activities – Kenya (2005)
No of Activities
EXPECTED RESULT
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
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19 6
33
Medicine Prices Survey – 2004
General Findings
Most 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 Implications
Promotion of generic prescribing
Policy to support generic substitution
Promotion of price transparency
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Medicine Prices Survey – 2004
Availability: KEDL Medicines
90
80
70
60
50
IB
MSG
LPG
40
30
20
10
0
Public
Private
Mission
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Medicine Prices Survey – 2004
Private Retail Sector Affordability
Peptic ulcer
(ranitidine)
Adult ARI
(amoxicillin)
Hypertension
(atenolol)
0
2
4
Innov. Brand
6
8
Most Sold Gen.
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12
14
16
Lowest Priced Gen.
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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, Ghana
Supported by DFID-UK
Country 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)
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WHO/HAI-Africa
Overview 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
Collaborative Activities based on
MOH
Country priorities
Likelihood of sustainable impact
Added value in joint activity planning
& implementation WHO/UNICEF TBS September 05
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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)
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Future Activities for EDM -Kenya
(2006 – 2007)
Participate in Review of the National Medicines Policy
Initiate activities to promote medicine price transparency
Promote Rational Use of Medicines in the community
Support Incorporation of drug management and RUM in
pharmacy training curricula
Support Review of Clinical Guidelines and EDL
Support development of National Policy on Traditional
Medicines (TRM), a Legal Framework and Code of Ethics for
TRM practitioners
Capacity building in GMP, drug management and rational use
in the pharmaceutical sector
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Thank You
Asante
sana!
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