Sunday, 22 May 2011

MALARIA: Kenya: The cost of "affordable" medication

Isaiah Esipisu : 19 May 2011
Nairobi — On the streets of Nairobi, James Odhiambo goes from one pharmacy to the next in search of anti-malarial drugs marked with the Global Fund's logo of a green leaf. He is looking for this specific brand because he understands that it is more than ten times cheaper than the same drug produced by different manufacturers.
He finally buys it from Nila Pharmacies along Accra Road - the sixth outlet he has visited this morning.
"My brother was yesterday evening diagnosed with malaria at a private clinic in Dandora suburb upon his arrival from a two week holiday in the lakeside city of Kisumu. That is why I have come to town to search for drugs," says Odhiambo holding a prescription from the Samaritan Health Clinic - where his brother was diagnosed.
However, Odhiambo says his brother could not buy anti-malarial drugs from the clinic where he was tested because the available drugs were expensive costing 400 Kenyan Shillings (KES) (five dollars). This is the average price of anti-malaria drugs in Kenya.
"We have always seen these subsidised drugs being advertised all over in the media. We were not going to waste the entire 400 KES - equivalent to two days' wages - on a similar dose," said Odhiambo, who works as a casual labourer in the city.
The drugs Odhiambo is referring to are subsidised through the Affordable Medicines Facility - malaria (AMFm). All drugs manufactured under the scheme have the logo of a green leaf. It is managed by the Global Fund with support from the United Nations, the UK Department for International Development and related donors.
Kenya was one of the very first countries in Africa to implement the scheme in August 2010, where a dose for an adult was supposed to retail at 40 KES or 50 cents, and a dose for children under the age of five would cost 10 KES.
However, many pharmacies across the country took advantage of the subsidy to maximise profits. "Two months ago, we requested our reporters from different parts of the country, including rural areas, to check on retailing prices of the subsidised anti-malarial drugs. As a result, we discovered that pharmacists sold them at varying prices ranging from 80 KES (one dollar), to 240 KES (three dollars)," says Gatonye Gathura, the chief science reporter at the Nation Media Group in Kenya.
A pharmacist at a private pharmacy in Buruburu Estates in Nairobi told IPS that she had to inflate the price simply because if she sold the drugs at the recommended retail price, it would not make any economic sense to her - considering her costs of transporting it from the distributors, and other inputs.
According to Harley's Ltd, the distributor of one of the brands recommended for subsidy, a dose for an adult should be sold to retailers for 26 KES (over 25 cents) to be sold to consumers at the recommended price of 40 KES (50 cents).
But like many other pharmacists, Linda Atieno's pharmacy did not stock the subsidised drugs. "If I sold a dose of unsubsidised Coartem drugs for example, I make a profit of up to 200 KES (over two dollars). This compares poorly with the profit I would make from a dose of the subsidised version of Coartem - which is 14 KES," she says.
In order to reduce instances where pharmacists are inflating the cost of the subsidised drugs, the Kenyan government has embarked on awareness campaigns through the media to inform Kenyans of the availability of the drugs, and the recommended prices per dose.
According to Dr John Logedi, the deputy program manager at the Division of Malaria Control, the awareness campaign will help consumers make an informed choice and enable them to seek outlets that sell the drugs at the right price.
Technically, the government of Kenya does not have control over drugs sold in pharmacies in the private sector because the pharmaceutical market in the country is based on 'a willing seller, willing buyer' concept.
So far, the subsidised drugs in Kenya are distributed through both the public and the private sector.
However, despite difficulties in searching for pharmacies that stock the subsidised drugs and sells them at the correct prices, Odhiambo admits that the subsidy program is a great relief to many people with a meagre income like his. "Most of us cannot afford the unsubsidised drugs that cost up to 600 KES (over seven dollars). The subsidy is therefore good news to most of us," he said.
In marginalised rural areas such as Turkana, private pharmacies are yet to begin stocking the subsidised drugs, despite the launch of the programme several months ago. "We have the subsidised drugs in public health centres within Turkana Central. But not in private pharmacies," said Dr Gilchrist Lokoel, the Turkana Central Medical Officer of Health at the Lodwar District Hospital.
Phase one of AMFm is already under implementation in nine pilots in eight countries. They include Cambodia, Ghana, Kenya, Madagascar, Niger, Nigeria, Tanzania (mainland and Zanzibar) and Uganda.

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