By Samwel Doe Ouma @samweldoe
For Kenya to achieve Universal Health Coverage goals, affordable access to quality and efficacious medicines should be a priority according to expert pharmacists. The pharmacists say that by observing good pharmacy practice, Kenya will not only achieve sustainable affordable essential medicines but also reduce wastage and maintain quality of medicines to patients.
According to Dr. Louis Machogu, President, Pharmaceutical Society of Kenya (PSK), a pharmacist is a key member of the healthcare workforce, who has to take front seat in terms of patient care if Kenya’s venture to achieve UHC is to be realized. He says that primary pharmacy care has to involve a trained pharmacist who is always on the ground to offer care and advice on products use that derives desired best treatment outcomes at affordable prices.
“Medicine spending accounts for up to 67 percent of total health expenditures. A big expense for households, accounting for 45 to 75 percent of out of pocket payments,” he said. Pharmacy and Poisons Board the industry regulator defines poor quality medicines as that which contains fewer active ingredients leading to ineffective treatment.
Medicine may also lose their quality due to poor storing conditions. Dr. Machogu advises that its time practicing pharmacists move away from the traditional perceived roles of selection of drugs and cover the whole continuum of care. Medicine-based interventions, often the main form of healthcare interventions in Kenya constitute about 40 to 90 percent of healthcare cost with 70 percent of Kenyans struggling to meet cost issues while half of this cannot afford it.
WHO recently called on pharmacists to support its drug strategy and urged governments to define the role of pharmacists and make full use of their skills in national drug strategies. They said there is need for government to ensure that quarks are weeded out of the practice.
According to Pharmacy and Poisons Board data, there are around 5000 registered pharmacists and 15,000 pharmacy outlets. PSK says that only six percent of 5000 registered pharmacies have full time resident pharmacists despite being the people who will steer the country to meet UHC. The society further states that for every three pharmacies, two are run by quarks.
To address this vice, the pharmaceutical industry regulator – has introduced a safety code to assist in accessing medicines from qualified pharmacists running registered chemists or pharmacies country wide. In Kenya to qualify as a pharmacist the minimum requirements are a five year undergraduate degree in pharmacy, one year pre-registration training through internship and registration by PPB.
PPBs head of Pharmacy practice Dr. Kariuki Gachoki says that a free SMS code 21031 is able to accurately give details of bonafide pharmacists and premise location with main aim of weeding out quarks endangering lives of patients.
“Pharmacists are the first people patients go for when they have problems and should be competent, qualified and registered by the Pharmacy and Poisons Board to enable them offer advice on the best treatment option and offer good pharmaceutical care,” Dr. Machogu said.
Research shows that imported pharmaceutical products especially drugs, cost much higher in the countries importing them than in the countries of manufacture. It is estimated that over 9000 pharmaceutical products are registered in Kenya but imported drugs demands higher prices in Kenya than in other countries. Example Amaryl, a drug to treat diabetes costs Shs 1144 per packet in Kenya but Shs 90 per packet in Turkey the country of origin.
Industry experts say that parallel importations, of branded medicines from countries in which it sells at a cheaper price or if the product is not available in the local markets, be allowed. The pharmaceutical industry regulator is not opposed to parallel importations following existing regulations but it has received challenges from local producers and distributors who sees the move as a way of slicing their profit margins. PPB anticipates that by allowing parallel importations, cost of branded drugs can be reduced by 60 percent therefore offering affordable healthcare.
Some industry professionals opposed to parallel importations urge government to create incentives to encourage local productions of medicines saying patients need to be advised to embrace local products as quality and efficacious. Local producers also compete with large volumes of imports accounting for approximately 70 percent of pharmaceutical sales in Kenya.
Dr. Machogu cites the Ministry of Health stepwise survey which states that non-communicable Diseases (NCDs) account for over 50 percent of hospital inpatient admissions and over 40 percent of hospital deaths, saying that pharmacists should be able to advise patients on rational drugs use and advise them on drug-food, drug –herb and or drug-drug interactions and cost effective medication options for chronic ailments patients to explore.
Moreover, diabetic, cancer, cardiovascular diseases patients and hypertensive patients are not able to keep up with the medication because of the high cost of drugs. Dr. D.W. Karanja, a Lecturer at the University of Nairobi, addressed the principles of ethics and the functionality of the code in governance and the supremacy and universality in pharmacy practice.
He further emphasized that ethics is a prerequisite for success in the pharmacy professional practice. Unethical and corrupt behaviors of pharmacists leads to counterfeits, substandard and nonimplementation of the law. “Lobbying for good quality products and professionalism in our sector is important the code of conduct is for the good of the patient and professionals should embrace it at all times since selfregulation is considered the best and no country is able to police all its citizens all the time,” he adds.