Shortage of crucial cancer drug blamed on delay to order

It is cheap, effective and easy to administer, so why are Kenyans in pain for a year without access to morphine?

The Nation has learnt that delays by the Ministry of Health to order a fresh consignment of the drug is responsible for the shortage being experienced in the country.

This begs the question: at what point should procurement of drugs be commissioned? Is it after or before the stock-out?

The Nation has learnt that the shortage started in March last year, the same time Kenya Medical Suppliers Agency (Kemsa) says it made the order.

It is only after the Nation ran the story on a shortage that Kemsa came out giving reasons as to why there were delays and clarifying they have since received 110 packs of 100 grammes of morphine powder.

In a press briefing, Kemsa explained that the manufacturer had experienced challenges in getting the active ingredient required for the production of the powder.

Kemsa placed the order in March 2019 and the actual product was received by the distributor in January.

“Production of morphine only commences once the manufacturer receives a firm order. It takes six weeks to get the export permit, but if the manufacturer has ex-stock, the product is shipped immediately,” says a statement from the agency.

Secondly, the agency clarified that when the consignment arrived at Jomo Kenyatta International Airport, the distributor noted that there was a temperature excursion (a temperature outside of the specified temperature range defined on the label).

A quality check

“This prompted the distributor to contact the manufacturer, and an expert was dispatched to conduct a quality check to ensure there was no compromise on quality,” the statement says. Verification took two weeks.

It also states that the powder is classified as a narcotic and that the approval in both countries importing and exporting is lengthy, as a special permit has to be provided for the product to be released.

Experts have since questioned why the Health ministry did not make the order before the shortage, adding, the consignment received will only sustain the patients for six months.

“Now that it takes like a year for a product to be delivered, it would be appropriate to start the next order immediately. Patients are really in pain,” said Dr Zipporah Ali, a palliative care doctor and executive director of Kenya Hospices and Palliative Care Association.

The country needs 22 kilogrammes a year to sustain all the patients. A kilogramme of morphine powder goes for Sh270,000. This is approximately Sh6 million.

A kilogramme of morphine can support over 1,000 patients for a month.

Dr Ali asked if Kemsa could speed up the delivery of the powder to Kenyatta National Hospital for formulation.

After a long wait for one year, Kemsa has to get approval from the Ministry of Health to deliver the drug to Kenyatta National Hospital (KNH) for mixing.

It’s at the KNH that the powder is reconstituted to oral formulations both for paediatric and adult use. It is then sent back to Kemsa, which then distributes the drug to public hospitals as per an institution’s order.

“I hope this is done as fast as possible if not, the patients have a month ahead to wait for the drug to be delivered into their various hospitals in the country,” she said.

Paracetamols

According to the Kenya Harmonised Health Facility Assessment report for 2018/19, cancer patients have to buy their morphine or take the less effective paracetamols that are mostly available in both public and private hospitals across the country.

The survey ranked the national availability of paracetamol at 77 per cent compared to 10 per cent for morphine.

The survey states that even the few patients who have access to morphine have to contend with the irregular supply of the drug as the country lacks systems to ensure regular supply.