Staffing Levels, Availability and Pricing of Antimalarial Medicines Among Health Facilities

ABSTRACT

Staffing levels, availability and pricing of antimalarial medicines among health facilities in Embu County, Kenya

Stanley Ndwigah1, Andy Stergachis2, Kennedy Abuga1, Hannington Mugo1 and Isaac Kibwage1

1Department of Pharmaceutical Chemistry, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya.

2Departments of Pharmacy and Global Health, School of Pharmacy and School of Public Health, University of Washington, P.O. Box 357236, Seattle, WA 98105.

Introduction

Malaria accounts for a significant part of the disease burden in poor countries in the tropics, causing over a million deaths a year. Nearly 80 per cent of the population inKenya is at risk of malaria infection.Effective drug treatment continues to be a critical element of any strategy in management of the disease. However, there are challenges in providing access to quality, efficacious antimalarial medicines at affordable cost while ensuring their safe and rational use. These challenges include the emergence of resistance to antimalarial drugs and lack of uniform regulatory control over the supply chain leading to access problems and poor quality medicines circulating in malaria endemic countries.

Methods

The aim of the study was to determine staffing levelsas well asavailability and pricing of antimalarial medicines among health facilities in Embu County, Kenya. The antimalarials of interest were those recommended by the World Health Organization (WHO) and Ministry of Health, Kenya for treatment and prevention of malaria. We assessed staffing levels of health facilities where antimalarials are stocked. Antimalarials were taken from 11 government facilities, 29 private pharmacies, 5 private-for-profit and 3 not-for-profit mission facilities during the period of May - June 2014.

Results

There was substantial lack of qualified personnel offering health care services in Embu County. Only 45 % percent of public facilities had pharmacists offering pharmaceutical care. In the remaining facilities, 27 % were served by pharmaceutical technologists while in the rest pharmaceutical commodities were handled by nurses. Only 14 % of public facilities sampled had dentists. None of the private-for-profit and mission facilities sampled had pharmacists in their staff establishment.Only one private facility had pharmaceutical technologists, all the others being solely staffed by nurses who handled all pharmaceutical commodities.Seven private pharmacies(24%)were superintended bypharmacists. The other 22 private pharmacy outlets (76%) were headed by pharmaceutical technologists.

All public facilities dispensed antimalarials free of charge to malaria patients.Majority of public facilities (91%) had sufficient artemether/lumefantrine tablets in stock. The most available dosage was artemether/lumefantrine 24’s (AL-IPCA®) provided through the Affordable Medicines Facility for malaria (AMFm). Private pharmacies stocked a wider variety of antimalarials. Government and mission facilities did not stock 2nd line antimalarials nor sulfadoxine/pyrimethamine for intermittent preventive treatment in pregnancy (IPTp).

DISCUSSION

In our study, health care workers in public and private-for-profit facilities reported few confirmed cases of malaria. In one public facilityonly 15 confirmed cases of malaria in the period between January 2014 and May 2014,two of which were severe malaria. Some facilities had overstock of antimalarials due to oversupply by KEMSA. In another facility, artesunate injectionhad not been used for 2 years. In addition, a clear gap in terms of the competency of the staff.

It was evident that private pharmacies were well stocked with a wide variety of antimalarial commodities. Government and mission facilities did not stock 2nd line antimalarials and sulfadoxine/pyrimethamine for IPTp. The World Malaria Report released by WHO (2014) reported that only 57% of all pregnant women in the world received at least one dose of IPTp with 15 million of the 35 million pregnant women not receiving a single dose of IPTp.

CONCLUSION

The survey shows a need to staff health facilities with more qualified health care workers to improve the quality of health care. In Embu County, the “push” system used by KEMSA may have led to wastage of medicines in some public facilities due to expiry. Efforts to increase redistribution of antimalarial drugs to more needy counties according to malaria endemicity are necessary.