E-drug: Re: Supply crisis of BMS ARVs in Kenya
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With all due respect, I would like the problem of ARV stock outs to
be looked at from both the supply and demand ends. Recently
(early March 2002), the 10 major HIV/AIDS treatment centers in
Nairobi and the Mission for Essential Drugs and Supplies (MEDS)
had a meeting with BMS and MSD reperentatives over this issue
and other pertinent issues came to light as well which I will attempt
to highlight
1. Kenyan treatment centers are recieving a good number of
prescriptions from the surrounding countries like Somali,
Rwanda,DRC, Tanzania either directly or these people are coming
for treatment in Kenya and obtaining drugs from Kenya
2. Patients prefer to collect drugs for periods as long as 6 months-1
year at one go leading to stock ruptures (usually, supply for long
term prescriptions should be done monthly).
3. There is an element of suspected fraud where prescriptions come
from unregistered medical practictioners, chemists and though
suspicious,it is difficult to confirm
4. The number of patients being put on ARV therapy is increasing
rapidly, making it abit difficult to sustain the supply pipeline.Infact
some treatment center could not cope with the numbers (requiring
additional staff to handle ARV dispensing)
5. Patients collect drugs from various treatment centers using the
same prescription or a photocopy and there is no way of
knowing/tracking them as they move around It thus emerged that
demand forecasting for the suppliers is difficult at this stage and
will only be possible when the situation stabilizes This situation has
also occured with supply of ARV products from Roche and GSK I
am aware that both MSD and BMS supply their drugs to specific
treatment centers for which a contract has been signed, While GSK
and ROche and Boerhinger use the normal distribution network
Other pertinent issues from our meeting were as follows
1. The pharmacists are not well versed with these drugs and this
limited knowledge extends to nutritional support for HIV patients
and basic counselling skills
2. The treatment centers seem to be requiring more staff to
specifically handle HIV patients yet their is no "profit" from these
drugs. How are these costs to be absorbed?
3. Pharmacists need some basic guide book on the pharmacology of
ARVs (my hospital and one other have developed some, but can
only supply for in house use due to costs)
4. There is need for wider distribution of ARVs with accompanying
training (the Ecumenical Pharmaceutical Network and MEDS are
already doing training for prescribers in church based healthcare
facilities)
5. Most patients are not willing to listen to instructions on how to
use their medication (stigma?) There is more that came to light as
we shared our experiences and we have some action plans.The
Only major problem is, we have agreed to sell these products at
very reduced rates just like the companies have reduced the prices
and so the hospitals (treatment centers)find it costly to invest in
training, personnel although the goodwill is there
MSD has offered to give some basic training to the pharmacy
personnel at the treatment centers but what about the other
dispensers in other outlets? The Pharmaceutical Society of Kenya
has put a team together to look at the logistics of doing such
training but obviously a society which survives on members
subscription for funding may not be able to do this alone. Just
thought a picture from my end may shed some more light on this
issue
Dr Atieno Ojoo
Gertrude's Garden Childrens' Hospital
P O Box 42325-00100
GPO, Nairobi
Kenya
Tel; 254 2 763474-7
Fax; 254 2 763281
Email; mojoo@gerties.org
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