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

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%  WHO/UNICEF TBS September 05

EDM Support to Kenya (04-05) Key Issues & Challenges 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 WHO/UNICEF TBS September 05

WHO/UNICEF TBS September 05 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 WHO/UNICEF TBS September 05

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 WHO/UNICEF TBS September 05

Progress of EDM Activities – Kenya (2005) EXPECTED RESULT No of Activities 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 6 2.1 Capacity for medicines supply management in the public sector improved (A) 1 2 2.2 Prices and access to essential medicines monitored (A) 3.1 Capacity for information management in drug registration improved (Q) 3.2 Good QC laboratory practices promoted (Q) 4.1 Drug & Therapeutic Committees established in three District hospitals (RUM) 4 4.2 Training of health professionals on rational use supported (RUM) 4.3 National Guidelines for improving rational use of medicines developed (RUM) 5.1 National Policy on Traditional Medicine, a legal framework and Code of Ethics TM Practitioners developed (TRM) 5.2 Rational Use of TM by providers and consumers promoted (TRM) TOTALS 14 19 33 WHO/UNICEF TBS September 05

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 WHO/UNICEF TBS September 05

Medicine Prices Survey – 2004 Availability: KEDL Medicines WHO/UNICEF TBS September 05

Medicine Prices Survey – 2004 Private Retail Sector Affordability WHO/UNICEF TBS September 05

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) WHO/UNICEF TBS September 05

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 MOH Collaborative Activities based on Country priorities Likelihood of sustainable impact Added value in joint activity planning & implementation WHO/UNICEF TBS September 05

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) WHO/UNICEF TBS September 05

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 WHO/UNICEF TBS September 05

WHO/UNICEF TBS September 05 Thank You Asante sana! WHO/UNICEF TBS September 05