Ministry of Ministry of Public Health Medical Services and Sanitation Republic of Kenya Access to Essential Medicines in Kenya A Health Facility Survey AccesstoEssentialMedicinesinKenya AHealthFacilitySurvey PublishedbytheMinistryofMedicalServicesandMinistryofPublicHealth&Sanitation www.health.go.ke December2009 Anypartofthisdocumentmaybefreelyreviewed,quoted,reproduced,ortranslatedinfullorinpart, providedthatthesourceisacknowledged. Itmaynotbesold,orusedinconjunctionwithcommercialpurposesorforprofit. ThisdocumentwasproducedwiththesupportoftheWorldHealthOrganization(WHO)KenyaCountry Office,andallreasonableprecautionshavebeentakentoverifytheinformationcontainedherein. Thepublishedmaterialdoesnotimplytheexpression ofanyopinionwhatsoeveronthepartofthe WorldHealthOrganization,andisbeingdistributedwithoutanywarrantyofanykind–either expressedorimplied.Theresponsibilityforinterpretation anduseofthemateriallieswiththereader. InnoeventshalltheWorldHealthOrganization beliablefordamagesarisingfromitsuse. Usersofthispublicationareencouragedtosendanycommentsandqueriestothefollowing addressfromwhichadditionalcopiesmaybeobtained: TheChiefPharmacist MinistryofMedicalServices AfyaHouse,POBox30016ͲGPO,Nairobi00100 Email:[email protected] TableofContents LISTOFTABLES............................................................................................................................III LISTOFFIGURES..........................................................................................................................III ABBREVIATIONSANDACRONYMS...............................................................................................IV FOREWORD..................................................................................................................................V ACKNOWLEDGEMENTS................................................................................................................VI EXECUTIVESUMMARY.................................................................................................................1 1.INTRODUCTION........................................................................................................................5 1.1BACKGROUND.............................................................................................................................................5 1.2IMPLEMENTATIONOFTHESURVEY..................................................................................................................7 1.3OBJECTIVES.................................................................................................................................................7 2.COUNTRYBACKGROUND..........................................................................................................8 2.1HEALTHSECTOR...........................................................................................................................................9 2.1.1Healthstatusandindicators......................................................................................................................................9 2.1.2Healthpolicyandstrategicplanning.......................................................................................................................10 2.1.3Healthsystemstructure,statusandchallenges......................................................................................................10 2.1.4Healthpartnershipandcoordination......................................................................................................................11 2.2PHARMACEUTICALSECTOR...........................................................................................................................11 2.2.1NationalPharmaceuticalPolicy...............................................................................................................................12 2.2.2Regulatorysystem...................................................................................................................................................12 2.2.3Medicinessupplysystem.........................................................................................................................................13 2.2.4Medicinesfinancing.................................................................................................................................................14 2.2.5Rationaluseofmedicines........................................................................................................................................15 3.STUDYDESIGNANDMETHODS...............................................................................................16 3.1SAMPLING................................................................................................................................................16 3.1.1Sectorssurveyed......................................................................................................................................................16 3.1.2Samplingofregions(provinces)...............................................................................................................................16 3.1.3Samplingofdistricts................................................................................................................................................16 3.1.4Samplingoffacilities................................................................................................................................................17 3.1.4Selectionofpatients................................................................................................................................................17 3.1.5Selectionofprescriptions........................................................................................................................................17 3.1.6Selectionofmedicinestosurvey.............................................................................................................................17 3.2DATACOLLECTION.....................................................................................................................................17 3.2.1Organizationofdatacollection................................................................................................................................17 3.2.2Adaptationoftools..................................................................................................................................................18 3.2.3Selectionandtrainingofdatacollectors.................................................................................................................18 3.2.4DataCollection.........................................................................................................................................................18 3.3DATAENTRYANDANALYSIS..........................................................................................................................18 3.4MONITORINGOFMEDICINEPRICESANDAVAILABILITY(MMEPA)........................................................19 3.5LIMITATIONSOFTHEDATA...........................................................................................................................19 4.RESULTSANDDISCUSSION.....................................................................................................20 4.1DEFINITIONOFTERMSANDCONCEPTS...........................................................................................................20 i 4.2AVAILABILITY.............................................................................................................................................21 4.3PRICINGANDAFFORDABILITY.......................................................................................................................26 4.4GEOGRAPHICALACCESSIBILITY......................................................................................................................32 4.5MEDICINESQUALITYͲRELATEDFACTORS.........................................................................................................33 4.6RATIONALUSEOFMEDICINES.......................................................................................................................35 4.7HEALTHPROFESSIONALSPROFILES.......................................................................................................42 5.SUMMARYOFRESULTS..........................................................................................................46 6.DISCUSSION............................................................................................................................48 7.CONCLUSIONS........................................................................................................................51 8.RECOMMENDATIONS.............................................................................................................52 ANNEXES....................................................................................................................................54 ANNEX1:SUMMARYLISTOFINDICATORSANDCORRESPONDINGSURVEYFORMSUSEDFORDATACOLLECTION..............56 ANNEX2:LEVELIISURVEYFORMS.....................................................................................................................57 ANNEX3:CHARACTERISTICSOFOUTPATIENTSINTERVIEWED...................................................................................72 ANNEX4:LISTOFDATACOLLECTORS..................................................................................................................73