Background
In 2015, 415 million people were living with diabetes globally.1 In Kenya, between 2.1 and 6.7 percent of adults were estimated to be living with diabetes in 2015.2 To support government efforts to improve availability and affordability of essential diabetes medicines and technologies (EMTs), PATH, under the No Empty Shelves: Diabetes supplies there when needed project, surveyed patient access points to measure pricing and availability of select diabetes EMTs, and conducted an assessment identifying strengths and weaknesses in the Kenya supply system for these EMTs.
Methodology
The pricing and availability survey was based on World Health Organization/Health Action International (WHO/HAI) methodology and focused on essential medicines for diabetes, hyperglycemia, hypertension and dyslipidemia. The supply chain assessment was based on the Rapid Assessment Protocol for Insulin Access (RAPIA).3
The list of diabetes EMTs surveyed was based on the 19th WHO Model List of Essential Medicines4 and the WHO Implementation Tools Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Care in Low Resource Settings.5 The pricing and availability survey was conducted through visits to outlets for diabetes EMTs (n=77) and the supply chain assessment via interviews with key stakeholders (n=55). Both collected information on products distributed through public and private health facilities, private pharmacies, and faith-based organizations (FBOs) or nongovernmental organizations (NGOs) facilities. The study was conducted in 2015.
Findings
Availability. Overall availability of diabetes EMTs was low. Public sector availability averaged across tertiary, secondary, and primary levels of care found no medicine available at the WHO GAP (Global Action Plan) target (80 percent). Reviewing public sector availability by level of care, (Figure 1 above), found only tertiary level facilities had some medicines and technologies available at the GAP target (80 percent) or higher.
In private sector pharmacies only 4 of 10 medicines reached 80% availability. Across all products, diabetes-specific technologies, such as glucometers, had the lowest availability.
Affordability. Based on the lowest paid government worker’s daily wage, a person with Type 1 diabetes would pay 57% of their monthly salary for a one month supply of insulin and other medicines, blood glucose strips, and syringes in the public sector.6 A person with Type 2 diabetes would pay 11% of their salary to purchase medicines and blood glucose strips. Diabetes technologies, in particular blood glucose test strips and insulin syringes, contribute a high proportion of treatment costs. Type 1 and Type 2 diabetes therapies cost higher at private pharmacies than in the public sector.
Supply chain. Supply chain challenges impacting availability and affordability of diabetes EMTs include: limited government financing, delays in disbursing funds, lack of accurate quantification data, limited quality assurance regulations for medical devices and diagnostics, and unavailability of some diabetes technologies for public sector procurement by the Kenya Medical Supplies Authority.
C
onclusion
To improve patient access to affordable, quality EMTs for diabetes, the following measures should be considered: Increase government funding for EMTS for NCDs, and include these items in the National Health Insurance Fund; Establish policies allowing lower level health facilities to detect and manage diabetes and co-morbidities to support equitable availability of diabetes EMTs; Strengthen the public sector financial process to improve timely disbursement of funds; Build health facility personnel capacity in quantification and stock management of NCD EMTs; Strengthen quality assurance regulations and testing capacity for medical devices and diagnostics, and allow for public sector procurement of diabetes technologies.
Implementing such measures can help improve the personal health of citizens and the economic well-being of families and communities in Kenya.
References
1.
International Diabetes Federation (IDF), IDF Diabetes Atlas, 7th ed. Brussels. IDF 2015. Available at http://www.diabetesatlas/resources/2015-altlas.html.
2.
International Diabetes Federation (IDF), IDF Diabetes Atlas, 7th ed. Brussels. IDF 2015. Available at http://www.diabetesatlas/resources/2015-altlas.html.
3.
Beran D, Yudkin JS, de Courten M. Assessing health systems for type 1diabetes in sub-Saharan Africa: developing a ‘Rapid Assessment Protocol for Insulin Access.’ BMC Health Services Research. 2006;6:17.
4.
WHO. 19th WHO Model List of Essential Medicines. Geneva: World Health Organization. 2015.
5.
WHO Implementation Tools. Package of Essential Non-communicable Disease Interventions for Primary Care in Low Resource Settings. Geneva: WHO; 2013
6.
Based on the daily wage of the lowest paid government worker, calculated on a one month’s salary over a 30-day month. Treatment regimens are based on type 1 and type 2 diabetes combination therapies for adults with hypertension and hyperlipidemia comorbidities.
Conflict of Interest Disclosure: Project activities were led by PATH and financed through a partnership with Novo Nordisk. Findings presented were developed in accordance with PATH policies and were not influenced by Novo Nordisk. This poster does not contain any trade names. This poster does not cover any unapproved uses of specific drugs, other products or devices.

Availability and affordability of essential diabetes medicines and technologies and supply chain functionality in Kenya