Hospitals are facing a drug shortage due to an amendment to the law that barred county governments from buying medical supplies from any agency except the Kenya Medical Supplies Authority (Kemsa).
But now, Kemsa cannot meet the needs of counties and has been turning them away, leaving millions of patients at the mercy of private chemists.
In letters written by Kemsa to hospitals run by counties, the agency says it does not have the capacity to supply reagents for laboratories and sometimes basic antibiotics.
Even when the county is spending its own money as is laid out in the Constitution, Kemsa is supposed to give them approval.
The 2013 Kemsa Act, amended in May 2019, introduced a jail term of two years or a penalty of Sh2 million for anyone who defies the decree.
On November 2019, Port Reitz Hospital, a Level Four hospital in Mombasa County that serves about one million people, received a letter from Kemsa informing it that the agency was out of stock for the products the hospital had requested.
In a letter signed by Kemsa CEO Jonah Manjari, the agency acknowledged that the situation was dire and they could “consider a temporary arrangement”.
A similar letter was written to Nakuru Level Five Hospital, whose catchment is more than five million people, and attached to it was a long list of products that were not available.
The hospital’s administration complained about its inability to offer antisepsis antibiotics to patients who have undergone a caesarean section.
Isiolo County Health Chief Officer Ibrahim Alio said that he has been waiting for weeks for an approval for reagents that he needs to purchase.
Mr Alio said: “I write emails, and after a long wait, then I have to come to Nairobi to plead to use money that the county has generated to buy essential drugs for use in the hospitals.”
His Makueni County counterpart, Dr Andrew Mulwa, said he “already filed a complaint to the Ministry of Health about the issue.”
Dr Mulwa, who is also the chair of the caucus of the county executives for health, said that they had given the Ministry of Health and the government a month to “act right”.
Now, health experts say the bill signed in May 2019 was a carefully hatched plan to keep monopoly in the hands of a few people at the Health ministry.
Some sources in the government are questioning the timing and the position of the bill — just before the launch of the Universal Health Coverage (UHC).
Kemsa was given 70 per cent of the billions for UHC to provide counties with medicine.
While some counties such as Nyeri and Isiolo had been receiving their drugs on time, the same cannot be said of Kisumu and Machakos
The Council of Governors has lodged a case challenging the legality of the bill, since health is a devolved function and counties have the constitutional autonomy to run their health systems on their own.
After 2013, when the health function was devolved, county hospitals shifted in procuring medication.
Before devolution, hospitals in what are now counties operated under the “push” system, where drugs and other medical kits were distributed by the national government.
This caused a lot of inequity, because the needs of some of the regions were not met in this “one shoe fits all approach”.
Then devolution ushered the “pull” system, where each facility is supposed to order drugs depending on its needs, such as the disease burden of the catchment areas it serves.
They would order the medicine from Kemsa, and pay for them. To meet their needs, counties were also free to purchase medical supplies from any other source.
It is not clear now why the law would stop the counties from spending their own money.
Contacted for comment, Kemsa acknowledged it does not have the capacity to meet the needs of counties, especially supplying laboratory commodities, and the management was “working round the clock to fix it”.
“The restrictions on where to buy medicine is ‘for quality assurance’ so that counties do not purchase medicine that was not fit for use.” added Kemsa.
“Those are the rules, we do not question,” read the statement.