Lucy Winkie Mecca, BpharmU51/63523/2013
About 30% of the world’s population does not to have access to essential medicines.
Kenyan public facilities experience high stock-outs of essential medicines
Financing is an important determinant of access to essential medicines
NHIF Medical Scheme contributes to financing of essential medicines in public hospitals
Effect of introduction of the NHIF-CSDS Medical Scheme on availability of essential medicines not studied.
Introduction of the scheme may paradoxically compromise availability of essential medicines.
Has the funding for essential medicines increased since the introduction of the NHIF-CSDS Medical Scheme?
Did stock-outs of essential medicines reduce after the introduction of NHIF-CSDS Medical Scheme?
What factors affect availability of essential medicines at Webuye District Hospital?
To compare availability and funding of essential medicines before and after implementation of NHIF-CSDS Medical Scheme.
To compare the proportion of FIF allocated for procurement of medicines before and after implementation of the scheme.
To determine and compare the contribution of the FIF, KEMSA and others to the essential medicines budget before and after implementation of the scheme.
To determine the frequency and duration of stock-outs of essential medicines before and after implementation of the scheme
To explore factors that could affect the stock-out rate of essential medicines.
A retrospective longitudinal before-after study of four years; the latter two of which the NHIF-CSDS Medical Scheme was in operation.
Study period: 1 Jan. 2010 – 31 Dec. 2013
Study site: Webuye District Hospital, Kenya.
145 essential medicines were selected for study
◦ antiretroviral, anti-tuberculosis and contraceptives not included
Authority to Incur Expenditure records
KEMSA Orders Forms and Invoices
Local Purchase Orders and invoices from suppliers
S3 cards on which all hospital receipts are recorded
Pharmacy summary budgets and stock control cards (electronic and manual)
The median of the quarterly FIF allocation for purchase of medicines was significantly greater after introduction of the new NHIF scheme
◦ Kshs 1.04 million vs. 0.70million, p=0.008
The mean proportion of FIF allocated quarterly for purchase of medicines was also higher
◦ this increase was not statistically significant
◦ 9.12 % vs. 7.55%, p=0.0502
Three sources:KEMSAFIFOther Facility
Comparisons were made for
Proportion of essential medicine contributed
Expenditure on essential medicines
Source Hypothesis p-value
KEMSA 2012/13 < 2010/11 0.000
FIF 2012/13 > 2010/11 0.000
Other Facility 2012/13 > 2010/11 0.029
Source Hypothesis P value
KEMSA 2012/13 < 2010/11 0.000
FIF 2012/13 > 2010/11 0.000
Other Facility 2012/13 < 2010/11 0.122
The average monthly stocked-out time reduced in 2012/13
◦ this reduction was not statistically significant
◦ 21.75% to 19.47%, p= 0.099
The first months of the quarter were characterized by a high stock-out rate
Some antibiotics such were never stocked out
◦ amoxicillin capsules and co-trimoxazole tablets
Theatre medicines had low stock-out rates (<2.5%)
◦ Neostigmine, Thiopentone, Suxamethonium injections
Some pediatric preparations and topical preparations had high stock-out rates (>50%).
◦ Co-amoxiclav, Erythromycin, Ibuprofen suspension
FIF expenditure was a significant determinant of monthly stock-out rates (p = 0.025)
Supply from KEMSA was a significant determinant of stock-out rates of individual medicines.
Absence from the KEMSA list or non-supply of orders to KEMSA predicted a higher stock-out rate of individual medicines (p < 0.0001)
Financing through FIF and availability in KEMSA were found to be significant predictors of stock-out rates.
No significant change in stock-out rates most likely due to inadequate financing.
The first months of the quarter had the highest stock-out rates due to winding procurement procedures.
No significant change in stock-out rates of essential medicines after implementation of the NHIF-CSDS medical scheme
The NHIF was implemented into a system that was inadequately funded.
Contextual factors should be taken into account when implementing insurance schemes.
Studies on availability of essential medicines after devolution of health should be done
Thank you