In-depth: TB and HIV: Deadly allies

KENYA: Corruption, erratic drug supply threatens TB treatment

Photo: Gary Hampton/World Lung Foundation

"We have enough TB drugs to take us through the next two years"

NAIROBI, 24 March 2009 (PlusNews) - The last time Daniel Okado*, a tuberculosis (TB) patient, went to his local health centre in Nairobi, the Kenyan capital, for his regular supply of medicine, he found the clinic had run out.

"Even though I got the drugs when I went back, it is inconvenient; TB medication needs consistency," he told IRIN/PlusNews.

Failure to strictly adhere to TB medication increases the likelihood that a patient will develop resistant strains of the disease such as multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). Sources in the Ministry of Health said the country already has an estimated 400 cases of MDR-TB, but is only able to treat about one-tenth of them due to the high cost of treatment.

Although Kenya is able to diagnose 70 percent of TB infections and cure 85 percent of detected cases, an erratic supply of TB medication and vaccines has become common in many public health centres. Government health officials admit that the supply system is seriously flawed.

"We have enough TB drugs to take us through the next two years; the problem is not about the unavailability of drugs, but is purely due to inefficiency," said Dr Joseph Sitienei, head of the division of Leprosy, TB and Lung Disease at the National Aids and Sexually Transmitted Infections Control Programme.

Kenya has 900 TB laboratories for diagnosing the disease and 2,228 health facilities countrywide that should be stocked with TB drugs.

The Kenya Medical Supplies Agency (KEMSA), responsible for the procurement, storage and distribution of drugs on behalf of the government, was investigated for corruption and its CEO was sacked in October 2008, amid claims that the overpricing of drugs purchased during the 2008 post-election crisis had cost the Ministry of Health an estimated US$600,000.

Deep-rooted problems

A task force looking into problems at the agency found that the use of manual rather than computerized systems and poor warehousing were contributing to frequent stock-outs, high levels of expires, damages, obsolescence and a low stock-turn ratio in warehouses.

"KEMSA is a directionless organization that is completely lacking in basic controls and supervision," the report commented. The task force made a number of recommendations to streamline the way drugs are supplied to national health facilities.

Fast Facts
	Kenya had 140,000 new cases in 2008
	The country is ranked 13th on list of 22 high-burden countries worldwide
	More than half of new TB patients are co-infected with HIV
Source: WHO

Aside from the problems in KEMSA, the task force also found there was poor advance planning and the parallel procurement of drugs on an ad hoc, emergency basis by the Ministry of Health. "The parent ministry has continued to treat KEMSA as one of its departments without due regard to its operational autonomy," the report noted.

"The procurement by the ministry is fraught with irregularities, including not adhering to procurement regulations, procuring of goods not required and substandard goods at inflated prices." The ministry also owes over $20 million to KEMSA's suppliers, many of whom have refused to supply more drugs until the debt is honoured.

Although IRIN was unable to contact any KEMSA officials, the organization's website says measures are being put in place to ensure drugs reach health facilities in time; the agency is in the process of automating its systems in an effort to become more efficient.

"TB is not like malaria or any other disease, where people can just skip medication, because when resistance comes in we might face a situation the country can hardly move out of ... we must ensure at all times that TB medicines are made available to those who need them," Sitienei said.

According to the United Nations World Health Organisation (WHO), Kenya had 140,000 new TB cases in 2008. The country is ranked 13th on the WHO list of 22 high-burden countries worldwide, and fifth in Africa; more than half of new TB patients are co-infected with HIV, making TB treatment more difficult.

"This is not the only number of people with the disease, but those whose statistics are recorded; the [actual] number is far higher, and there is a need to step up campaigns aimed at encouraging people to turn up for TB screening," said Sitienei.

Kenya receives most of its TB funding from the Global Fund to Fight TB, AIDS and Malaria but the country's bid for money in the recent eighth round of Global Fund grants was rejected on the grounds of poor accounting for previous funds, putting the future of TB treatment and control at risk.

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TB and HIV: Deadly allies
March 2009

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