Medicine prices are a major determinant of access to healthcare. Owing to low availability of medicines in the public health facilities and poor accessibility to these facilities, most low-income residents pay out-of-pocket for health services and transport to the private health facilities. In low-income settlements, high retail prices are likely to push the population further into poverty and ill health. This study assessed the retail pricing, availability, and affordability of medicines in private health facilities in low-income settlements within Nairobi County. Medicine prices and availability data were collected between September and December 2016 at 45 private healthcare facilities in 14 of Nairobi's low-income settlements using electronic questionnaires. The International Medical Products Price Guide provided international medicine reference prices for comparison. Affordability and availability proxies were calculated according to existing methods. Innovator brands were 13.8 times more expensive than generic brands. The lowest priced generics and innovator brands were, on average, sold at 2.9 and 32.6 times the median international reference prices of corresponding medicines. Assuming a 100% disposable income, it would take 0.03 to 1.33 days' wages for the lowest paid government employee to pay for treatment courses of selected single generic medicines. Medicine availability in the facilities ranged between 2% and 76% (mean 43%) for indicator medicines. Prices of selected medicines varied within the 14 study regions. Retail medicine prices in the low-income settlements studied were generally higher than corresponding international reference prices. Price variations were observed across different regions although the regions comprise similar socioeconomic populations. These factors are likely to impact negatively on healthcare access.
Background: Quality pharmaceutical services are an integral part of primary healthcare and a key determinant of patient outcomes. The study focuses on pharmaceutical service delivery among private healthcare facilities serving informal settlements within Nairobi County, Kenya and aims at understanding the drug procurement practices, task-shifting and ethical issues associated with drug brand preference, competition and disposal of expired drugs. Methods: Forty-five private facilities comprising of hospitals, nursing homes, health centres, medical centres, clinics and pharmacies were recruited through purposive sampling. Structured electronic questionnaires were administered to 45 respondents working within the study facilities over an 8-week period. Results: About 50% of personnel carrying out drug procurement belonged to non-pharmaceutical cadres namely; doctors, clinical officers, nurses and pharmacy assistants. Drug brand preferences among healthcare facilities and patients were mainly pegged on perceived quality and price. Unethical business competition practices were recorded, including poor professional demeanour and waiver of consultation fees veiled to undercut colleagues. Government subsidized drugs were sold at 100% profit in fifty percent of the facilities stocking them. In 44% of the facilities, the disposal of expired drugs was not in conformity to existing government regulatory guidelines. Conclusions: There is extensive task-shifting and delegation of pharmaceutical services to non-pharmaceutical cadres and poor observance of ethical guidelines in private facilities. Strict enforcement of regulations is required for optimal practices.
The African Forum for Research and Education in Health (AFREhealth) held its first symposium in Accra, Ghana, between Aug 1 and Aug 3, 2017. This new organisation is committed to developing health professionals' education and research in Africa, sharing best practices, and reducing health disparities. AFREhealth aims to partner with stakeholders to improve health outcomes, work towards an AIDS-free generation, establish a research agenda for health priorities in Africa, and mobilise vital resources. It is an outcome of the Medical Education Partnership Initiative (MEPI) and the Nursing Education Partnership Initiative. Here we highlight how the achievements of MEPI have inspired the formation of AFREhealth. MEPI was a US$130 million competitively awarded grant by the US President's Emergency Plan for AIDS Relief and National Institutes of Health to 13 medical schools in 12 sub-Saharan African countries and a Coordinating Center at George Washington University, DC, USA. Implementation was led by principal investigators from the grantee institutions, supported by the Health Resources and Services Administration, National Institutes of Health, and the Coordinating Center, between September, 2010 and August, 2015. Each grantee worked with partner institutions in the USA, Europe, and Africa. The goals were to increase the capacity of the awardees to produce more and better trained doctors, strengthen locally relevant research, promote retention of graduates within their countries, and ensure sustainability of the improvements that the project supported. MEPI implementation was overseen by the Principal Investigators Council, which included principal investigators from grantee institutions, and representatives from the US government and the Coordinating Center. Unlike some other donor grants, MEPI grants were awarded directly to the principal investigator at the African institution, who then determined the direction of their programmes within the context of the Request for Application. MEPI generated excitement and hope among the grantee schools and countries, and recorded the following key achievements. First, the African principal investigators expanded MEPI from 13 grantees to over 60 medical schools in Africa by creating in-country consortia that shared resources and experience. This expansion helped to create strong South-to-South and South-to-North partnerships in medical education and research. To date, MEPI has led to the establishment of ten new schools, doubled student intake in some schools, increased postgraduate student numbers three-fold, and improved faculty expansion and retention.1 Second, grantees changed curricular to competency-based models that were more responsive to the health priorities of each country and ensured better delivery of such curricular by creating Medical Education Units to improve the quality of teaching and learning. All schools embraced e-Learning by enhancing infrastructure, improving internet connectivity (including at off-campus satellite training sites), installing more computers, and restructuring library spaces to facilitate e-Learning. The number of students with personal internet-enabled devices increased from 5% to 90%.1 Third, research support centres were established to promote institutional and collaborative research. These centres facilitated training in research methodology, grant writing, scientific writing, and research administration, which help to build a sustainable research environment. These factors improved the schools' ability to attract funding, recruit and retain faculty, and contribute to the national research agenda and sustainability of the programmes. Fourth, joint learning was facilitated through site visits to grantees for peer learning and management support; annual symposia showcased work through scientific papers, posters, and networking; eight content-based Technical Working Groups held face-to-face meetings and monthly virtual meetings on topics such as community-based education, competency-based education, monitoring and evaluation, graduate tracking, library and information sciences, medical education research, and research support centres. Over 376 peer-reviewed publications, including a special supplement in Academic Medicine in 2014,2 communicated the research findings and medical-education-related successes of MEPI. Fifth, the increase in the number of students intending to remain and work in one of the countries (5% to 80% over the study period) and the creation of new postgraduate courses were early evidence of the successful retention of graduates. For example, the University of Zambia introduced 14 new postgraduate courses—mainly in basic sciences—with an intake of 70 students.2 It is too early to tell if MEPI has affected health systems. Looking ahead, high-quality health professionals are needed in Africa to ensure global health security and achievement of African and global health goals. The international community is interested in what AFREhealth can achieve, given MEPI has demonstrated availability of opportunities for collaboration and joint learning in Africa. Sustained MEPI achievements depend on African leadership, continued stability, and economic growth in African countries. These conditions are needed for to create an environment and fiscal space to employ and retain high-calibre faculty and graduates, support research, and maintain educational infrastructure. The first AFREhealth symposium was therefore greatly anticipated, and was a resounding success. We declare no competing interests. The support of the USA government for MEPI and AFREhealth is highly appreciated.
