Acute drug shortage in public hospitals condemns the sick to misery

When Agnes Tanui’s daughter fell ill two weeks ago, she put her faith in Kimilili District Hospital, the nearest medical facility, for help. She arrived there minutes after 11 p.m. only to be told by the nursing officer that there were no drugs.

“My daughter had passed out. All the chemists in town were closed. I did not know what to do,” she said.

After 30 minutes of pleading for assistance, the nurse allegedly asked Ms Tanui for Sh1,500 to purchase the necessary drugs from a friend’s chemist.

“The nurse returned a few minutes later with the drugs,” Ms Tanui said. “I then added her more money for the syringes and needles that were to be used that night.”

Hospital administrator Muchilwa Omukoko said that the shortage was not unique to his hospital and that patients are required to meet some of the treatment costs.

An acute shortage of medicine and other essential supplies in public hospitals is creating a trail of misery for patients across the country. A spot check shows that many patients who are unable to pay the extra charges demanded by hospital staff while away their time on the benches of hospital pharmacies with empty shelves.

The patients accuse nurses and other medical personnel of hoarding the drugs and secretly supplying them to private pharmacies.

But Luke Kodambo, the chairman of the National Nurses Association of Kenya (NNAK), says they are just an easy target since they are the first to deal with the patients.

“Officials from the two ministries ( Public Health and Medical Services) are doing little to explain the reasons that led to the shortage. It is not enough to say that hospitals do not have drugs. The public wants to know why, and although we represent the government at these hospitals, we do not have answers for them,” he said.

The shortage has been attributed to a budgetary deficit at the ministry of Medical Services. The ministry recently announced it had received a Sh1 billion bailout. But the package has yet to reach its intended beneficiaries.

Permanent Secretary James ole Kiyapi said his ministry was putting in place measures to ensure such shortages do not occur again and that by March, hospital stocks of drugs and other items will be replenished.

The measures include a recent ministry directive allowing the Kenya Medical Supplies Agency (Kemsa) to directly purchase drugs from local suppliers.

But not everyone is embracing the ambitious plan. The nurses association has accused the ministry of mishandling the shortage and endangering the lives of both the sick and the people who care for them.

Mr Kodambo said the ministry put them at risk by diverting funds for essential non-medical supplies towards the purchase of drugs. The absence of supplies such as latex gloves, proper bedding and syringes in public hospitals, he said, has exposed the caregivers to health hazards.

“This does not solve any problem. They are merely slowing down the progress of one problem and creating another,” he said. But Prof ole Kiyapi disagrees.

“There is no truth to these allegations because the ministry is putting in a lot of money in non-pharmaceutical items as well,” he told the Sunday Nation.

The PS said that the shortage in non-pharmaceutical items was as a result of pending bills to suppliers incurred during the 2008/2009 financial period.

“A percentage of our budget had to go towards settling the bills. As a result our orders fell short of the intended amounts,” he said. Mr Kodambo said many of the local companies that will bid on the supply of drugs to government hospitals have no past records by which they can be judged.

“Most of them will be doing this for the first time. Health isn’t something we should gamble with. How sure are we that the quality of the supplies will be maintained?” he said. “We might end up having patients given expired drugs.”

But the Pharmaceutical Society of Kenya (PSK) dismissed such fears as unfounded, saying quality wouldn’t be compromised even if some of the drugs in government hospitals were to be sourced from local suppliers.

“All the drugs from local suppliers will still be distributed by Kemsa,” said Dominic Karanja, the Pharmaceutical Society of Kenya chairman. “Kemsa cannot have all the drugs in stock at all times.”

Mr Karanja said individual suppliers would not be sending drugs directly to hospitals but to the umbrella body which will, in turn ,sell them to hospitals.

But as administrators bicker over how the drug deficit should be met, a combination of lack of drugs and empty pharmacy shelves continues to condemn many patients to pain, severe illnesses and in extreme cases, death. People living in rural areas are the hardest hit.

At the Coast General Hospital, Mary Katitu is just one of the many waiting for supplies from Kemsa to finally arrive.

She has been on the waiting list for the past four months after being referred from Moi Hospital in Voi.

“I fell down and suffered a fracture on my thigh. But when I was transferred here from Moi Hospital Voi, I thought my troubles were over. I was told that once some ‘metals’ and ‘cement’ were available, my leg would be fixed, and I would go home in a few weeks,” she said from her hospital bed. That was last September.

The 65-year-old mother of two is afraid that she will soon be handed a bill of more than Sh48,000 for her stay in the ward alone.

The hospital charges a bed occupancy fee of Sh400 per day.

Dr Heltan Maganga, the Coast General chief administrator, said although the fee levied on patients is used to buy drugs, it is hardly enough. To have her leg fixed, Mrs Katitu would also be required to pay Sh13,000 to buy the necessary equipment and pay a Sh5,000 theatre fee as well. In addition she will be required to buy the drugs.

“The only way I will afford this is if I call for a harambee (fundraising),” she said.

At Nyeri Provincial General Hospital, Samuel Waithaka, a resident of Kiganjo village, is also staring into an uncertain future. If Mr Waithaka doesn’t raise enough funds soon, he fears he won’t receive better treatment for his breathing complications.

“I can only pray that a friend gets the money I need to get attention from a private hospital,” he said. As minutes tick away and his pain becomes unbearable, Mr Waithaka glances at his mobile phone every so often.

“Someone has promised to send me some money by M-Pesa,” he said.

But he doesn’t know how much the drugs will cost, and he hasn’t been able to find out from hospital staff. “Why would the pharmacist fail to tell me how much the drugs cost? These nurses are either selling them or waiting for bribes before giving us the drugs,” he said. But Mr Kodambo says there is no truth in such accusations.

“There is nothing for them to steal. What will nurses take from empty stores?”

The timing could not have been worse for George Ojwang. In four days he saw his savings dip by Sh6,000 to buy medicine and supplies for his mother-in-law at the Kisumu District Hospital.

He spent it on drugs, purified water to hydrate the patient and latex gloves.

“I have been referred several times to buy things required for treatment. Other than the bed, there is nothing else being provided by the hospital,” he said.

Nyanza provincial director of medical services Dr Ojwang’ Lusi said the money obtained from patients is insignificant in the hospitals’ re-stocking efforts.

In Kakamega, some sick people are turning to herbalists in the hope that they can end their suffering. Asha Anyango, 43, has not been able to get drugs for her diabetes for days. She fears that her condition will get out of hand as she cannot afford the unsubsidised drugs from private chemists.

“I was told there were no drugs at the hospital pharmacy. They turned me away. Where will I go with this piece of paper now?” she said, waving her prescription.

She thinks her hope lies in any of the herbalists who have set up shop on the streets of Kakamega town. PS ole Kiyapi prefers to strike an optimistic note, saying: “Kenyans should rest assured that the worst is behind us and ,in just a few months, things will be back to normal.”

Until then, hundreds will lie unattended to in hospital beds hoping the first consignment of the long-awaited medical supplies reaches them soon.

Reported by Daniel Wesangula, Gitonga Marete, Benson Amadala, John Njagi and Abiud Ochieng