A Survey of Medicine Prices in Kenya - 2004
(2005; 57 pages)

Resumen

Background: In order to document the prices patients pay for medicines in Kenya, with a view to providing policy guidance on medicine prices, a survey of the availability and prices of 45 medicines was undertaken in the public, mission and private sector pharmacies in Kenya between October 18 and November 5 2004.

Methods: The survey was conducted using the WHO - HAI methodology as described in the Manual: Medicine Prices: a new approach to measurement 2003 edition. The Manual provides guidelines and tools for a systematic survey of the prices of a standard core list of medicines, and allows for a supplementary list of medicines that are selected on the basis of their importance in treating major national health problems.

Public procurement prices were obtained from the Kenya Medical Supplies Agency (KEMSA), and mission sector procurement prices from the Mission for Essential Drugs and Supplies (MEDS).

Availability of, and the prices patients would pay for the innovator brand (IB), the generic equivalent with the highest sales nationally (most sold generic - MSG); and the generic product with the lowest price at each facility (lowest priced generic - LPG) was assessed in 157 outlets, comprising 53 public health facilities, 57 private for profit outlets and 47 mission health facilities, in a national survey covering all the 8 administrative provinces in Kenya.

Results: When assessing availability of those survey medicines that are in the KEDL, public sector availability was found at 65%, slightly higher than the mission sector which was 61%, but below private sector availability of generic equivalents at 82%.

Innovator brands were more widely available in private retail outlets, being 41% for items in the KEDL, and 36% for the whole range of products in the survey. In comparison, the public sector hardly kept any innovator brands, while the mission sector availability of innovator brands was only 6.8% for the medicines in the KEDL.

The procurement prices for the public and mission sector were 61% and 74% of MSH international reference prices respectively . However, these competitive procurement prices do not appear to be reflected at the patient price level, as the ratios of procurement price: patient price reflect very large mark ups of 287% in the public sector and 358% in the mission sector.

The private sector had the highest patient prices relative to the international reference prices, with innovator brands having a median of more than 17 times the international reference price, whereas the LPG was more than 3 times the international reference prices. In comparison, the mission sector patient prices of the innovator brands and the LPG were on average, 8.5 times and 3 times the international reference prices respectively. The public sector offered the lowest patient prices, with the LPG at just under 2 times the international reference prices. In addition, many public health outlets offered medicines for free, specifically for the under-5 year olds, pregnant mothers, and treatments for malaria and PMCT of HIV.

The lowest paid Kenya government worker, earning 166 Kenya Shillings per day (US $2.045), needs between 1.1 and 4.3 days' wages to purchase one months' dose of the recommended treatment for hypertension (Atenolol) in the private sector using the LPG. Similar treatment using the innovator brand requires between 9 and 10.5 days' wages. In contrast, using the LPG, the same worker would require only 0.2 days' wages for one month's hypertension treatment in the public sector; and 0.4 days' wages in the mission sector.

For one month's treatment of peptic ulcers, the same government worker would require 3.6 days' wages on either LPG Ranitidine or Omeprazole in the private sector. For the same treatment in the private sector using the innovator brands, the cost goes up to 27.5 days' wages for Omeprazole and 13.4 days' wages on Ranitidine.

Considering that more than half of Kenya's population lives on less than 2 US dollars a day, these treatments are even less affordable to the majority of the population. The inability to afford treatment is even more profound where more than one member of the household requires medicine, a common situation in many households.

Conclusions: Public and mission sector procurement of medicines in Kenya achieves very competitive prices and could be relied upon to alleviate the cost of medicines in Kenya. It was noted however that these procurement prices did not translate into affordable patient prices, as large mark ups in both sectors inflated the patient prices.

Prices of medicines vary a great deal across sectors and across the different regions of Kenya. The price of medicines, particularly in the private sector remains a critical barrier to access to health by the majority of the people of Kenya. Increased reliance on generics in the private sector could lead to more cost-effective utilisation of resources and increased access to health services by the low-income patients. In addition, there is need to improve the availability of essential medicines in the public sector at prices that patients can afford.

Recommendations: The following recommendations are made based on the observations and conclusions of this study:

  1. To improve availability of medicines and further reduce medicine prices there is urgent need to enhance the efficiency of the public procurement agency and establish supportive linkages with the mission sector procurement system.
  2. A medicine pricing policy needs to be developed and implemented in order to achieve a greater level of transparency, uniformity and predictability in the pricing of medicines in Kenya. Such a policy will be of great assistance in the determination and effective implementation of pro-poor interventions aimed at increasing access to essential medicines.
  3. Consider reference pricing for medicines in the private sector to prevent excessive prices e.g. determine level of prices compared to a basket of countries of similar wealth distribution and health coverage.
  4. Promote prescribing and use of medicines by generic name in all sectors through the development of a formal generic prescribing and substitution policy enshrined in law.
  5. Develop and implement a strategy to positively influence attitudes of health providers and the public towards generic medicines with appropriately designed interventions to address concerns.
  6. Repeat the medicines price survey at suitable intervals to monitor the effects of policies and other interventions on medicine prices.
 
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