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

2. 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/ (probability of dying under age 5 years)
Adult mortality (M/F) (per 1000)……… 560/ (probability of dying between 15 and 59)
Per capita total expenditure on health… (in international dollars, 2000)
Total health expenditure as % of GDP… 8.3
Adult literacy rate, 2000………………… % 
WHO/UNICEF TBS September 05

3. 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

4. WHO/UNICEF TBS September 05
Baseline Survey
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

5. 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

6. 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

7. 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

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

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

10. 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

11. 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

12. WHO/HAI-Africa Collaboration Activities
Assessment of the Pharmaceutical Situation in Kenya (Baseline Survey )
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

13. 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

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