How drug prescriptions inflict pain, cost lives

 Imported medicines contributes to high drug prices.[Courtesy]

On average, a Kenyan pays multiple times more for the same type of medicine than someone in India or the United Kingdom (UK).

Surveys done by the World Health Organization (WHO) and Health Action International (HAI) have found that medicine prices in Kenya's private sector are often several times higher than international reference prices.

Kenya's prices for many generic medicines are generally higher than those in India and several other emerging economies. Kenyan patients bear a relatively heavy financial burden as a result of expensive prescription drugs, most of it paid out-of-pocket.

PS at the State Department for Medical Services Dr. Ouma Oluga explains it this way: “If you go to any chemist or any hospital, 45 per cent (or nearly half) of the cost of our medicines is just middleman fees and freight.”

The PS was speaking during the launch of Kenya Health Products and Technologies (HPTs) Local Manufacturing Strategy 2026-2030, which took place this week.

Oluga stated that the key reason why medicines are very expensive in Kenya, and by extension in Africa, is because “we do not manufacture: we rely on imported products.”

According to Oluga, Kenya, as a matter of urgency, needs to start producing medicines and vaccines locally.

He noted: “During COVID-19, we took more than a year just to get vaccines. This was despite the Kenyan government spending more than 8 billion paying for the vaccines. We learnt our lessons during the pandemic. If you don't have the factories locally, then you cannot be guaranteed that you will get the products when you want them.”

Oluga reiterated that if Kenya can start producing “at least 70 per cent” of its medicine needs, turning the status quo on its head, drug prices will come down drastically: in many cases falling by half.

“The painkillers that you're buying at Sh100, if we were to manufacture them locally, you'd buy them at Sh55,” he said. “And that will have a very huge impact in reducing the cost of healthcare to our citizens.”

According to the Directorate for Health Products and Technologies at the State Department of Medical Services, the strategy positions Kenya’s healthcare as an investment opportunity.

If implemented as designed, it will yield adequate, quality and affordable HPTs, something that is integral in realizing the highest standards of quality healthcare for the population.

“The reason there are lots of complaints about SHA’s cancer cover is not that the cover is small but because drugs prescribed to a patient are so expensive. You will find a prostate cancer patient being directed to take a drug that costs Sh145,000. By the time they are taking the third tablet, the cover is exhausted. If these drugs were manufactured locally, it wouldn’t be the case,” Oluga noted.

Natasha Muloko, a long-time kidney patient, knows exactly how the cost of medicine can ruin a patient’s life, becoming the actual impediment to long-lasting solutions.

Natasha underwent transplant surgery in 2012. The surgery was successful.

“After the surgery I was given drugs, anti-rejection medicine, to last me 3 months. After the three months I went back to the hospital to get more of the medicine: they gave me a quote of Sh100,000 for a month’s worth.

“I couldn't afford it. So I went to a pharmacy where I was told I could only buy box by box, at Sh26,000. And the box would only last me 17 days. So, I opted to go to Kenyatta (KNH). Over there, I was told the drugs are often taken up as soon as they arrive.

“We went to another private facility that agreed to give us on a day-to-day basis at Sh2,500 per day,” she says.

The financial strain that kept her moving from one place to another, hoping to get the drugs she needed to prevent the kidney from rejecting, finally came to a head after six months.

In search of cheaper medicine, she went back to her doctor, who then prescribed the drug’s generic version, and the family proceeded to procure them through an importer.

“By the time we were getting those generics, I had pushed like three days and four hours. That’s how the kidney failed, and I was back into dialysis. Which again, at the time, was costing Sh9,500 per session. I needed 8 sessions per month.”

Natasha is still on dialysis today.

Dr. Nazila Ganatra is the Director for Health Products and Technologies at MOH. She says even among established factories, Kenya is only utilizing 40-50 per cent of total manufacturing capacity.

“Their machines are idle two-thirds of the time. If harnessed, the overall result will be drug prices coming down,” she said.

The strategy, she says, emphasises commercialisation of locally manufactured vaccines through Kenya Biovax, contingent on PPB achieving maturity level 3 (ML-3) status.

Dr. Oluga alluded to an ‘uncomfortable’ meeting between the ministry (represented by CS Duale and himself) on one hand and WHO officials who, it seems, were demanding full implementation of ML-3 in Kenya, for purposes of ensuring a minimum level of quality assurance.

“Achieving ML-3 would be good for Kenyan manufacturers' ability to export what they produce; beyond taking care of the country’s medicine needs,” Dr. Oluga pointed out.

“We will continue working with governments, the Pharmacy and Poisons Board, industry, and partners to strengthen regulatory capacity, support quality assurance, promote access to quality-assured health products, and advance implementation of the strategy,” a representative of the WHO regional director for Africa said while reading a speech.

The strategy’s objective is to bring together a fragmented local manufacturing ecosystem: pulling together research, regulation, trade, product development, financing, human capital, and health data systems.

Kenya’s Universal Health Coverage (UHC) Policy 2020–2030 promotes accessibility, affordability, adequacy, and quality of Health Products and Technologies.

A report (with MOH) that evaluated the local medicine manufacturing landscape showed that despite having 694 medicine formulations manufactured locally, only 220 were in the Kenya Essential Medicines List.

Ironically, Kenya is the leading pharmaceuticals producer in East Africa and the third-largest exporter in Africa. At least 70 per cent of HPTs exports are to its neighbors. According to MOH, local manufacturers prefer to service private sector and export markets due to various challenges including delayed payments by the public sector, higher local competition, favourable policies in other countries and inaccessibility of the local markets.

Kenya Medical Supplies Authority (KEMSA) and Mission for Essential Drugs and Supplies (MEDS) are the two largest centralised procurement entities for HPTs for the public sector and faith-based organizations, respectively.

Dr Vimal Patel, MD, Cosmos Ltd, the Chairperson of the Federation of Kenya Pharmaceutical Manufacturers (FKPM), intimated that Kenya should offer more incentives as it seeks to increase manufacturing of HPTs locally.

Oluga, on his part, said the incentives offered are good enough to get the private sector rolling. Several incentives provided to support local manufacturing include: zero-rated or exemption from value-added tax and import duties for Active Pharmaceutical Ingredients (APIs) or raw materials, machinery, and equipment used for pharmaceutical manufacturing, and waivers on customs duties for imported inputs and machinery for local manufacture of medicines.

“We have also given energy incentives. Factories within special economic zones pay just Sh21 per unit, which is way less than normal billing,” Oluga added.

In 2021, Partnerships for African Vaccine Manufacturing (PAVM) was established by the African Union (AU) and the Africa Centres for Disease Control and Prevention (Africa CDC) to enable vaccine manufacturing in 5 hubs across Africa and supply more than 10 per cent of the required doses by 2025, more than 30 per cent by 2030 and more than 60 per cent by 2040.