Fights among health parastatals and inefficient procurement processes that take close to one year have led to a shortage of drugs and equipment in hospitals, an audit has revealed.
According to a Global Fund report released this week, before an order for any drug is made, the processes followed and the parastatals that have to clear it make the process unbearable.
It notes that on average, it takes (from procurement initiation to delivery) 349 days (11 months) for Covid-19 commodities, 406 days (13 months) for malaria, 278 days (nine months) for HIV and 348 days ( 11 months) for TB.
In the process, patients suffer as the Kenya Medical Supplies Agency (Kemsa) waits for the order to be cleared, then about 180 days (six months) for the goods to be purchased. HIV-positive patients have been the most affected.
In 2021, several antiretroviral drugs were missing in the market because of the long procurement process. The audit, conducted from January 2018 to April 2021, reveals that bottlenecks in procurement initiation, and ineffective planning, coordination and execution involving many stakeholders complicate the process.
Before an order is made, the National Disease Programmes within the ministry has to raise procurement requests, which are reviewed and authorised by the Health Principal Secretary before their submission to the National Treasury for approval.
Inefficiencies and bottlenecks
Thereafter, the Treasury instructs Kemsa to initiate procurement. The Local Fund Agent then pre-reviews bids to ensure competition and transparency when awarding tenders. Review timelines for each stakeholder’s input are neither defined nor tracked, resulting in inefficiencies and bottlenecks. The process can even take months.
The procurement of Covid-19 commodities was mainly caused by the delays in sharing specifications from sub-recipients and long response times from the Kenya Bureau of Standards.
“The lack of effective coordination between various partners, coupled with the lengthy procurement process for Global Fund-funded commodities, has adversely affected the supply of HIV and Malaria commodities,” says the report.
“With no clear review accountability for each stakeholder involved, it took on average 345 days, almost a year from initiation of a procurement to delivery of commodities for sampled malaria, HIV, TB and Covid-19 commodities.”
The slow process, according to the report, has also affected how the funds awarded to the country are used. In the case of Covid-19, it cites low utilisation, which undermines key programme activities and leads to a shortage of commodities.
However, for the private sector, their money is centralised; they focus on saving money and getting things done quickly.
Drug availability
While private entities do not take nearly as much time in research, they do a thorough job of understanding their suppliers before signing a contract — an easy way to decrease the time spent procuring items. It takes a month at most from the time the goods are ordered to the time they are in the market.
The report states: “Due to gaps in the planning of health commodity procurements, purchases in Kenya consistently result in long completion times. This affects the availability of health commodities at all levels, resulting in stock-outs and shortages of key HIV, malaria, TB and Covid-19 commodities at central (Kemsa) and lower (health facility) levels.”
The report says planning and coordination are critical, given the scale of commodities procured by Kenya, the involvement of other partners (including the government and the US) in procuring HIV and malaria commodities, and the different procurement plans of these partners.
“Kemsa procures on behalf of three main partners (Kenya, the US government, and the Global Fund) and, therefore, any delayed or halted procurement from one partner affects drug availability across the supply chain,” it adds.
The report also highlighted that Kenya has not been able to fully utilise the money that it was allocated for the war on Covid-19. The Global Fund designed and implemented the Covid response mechanism to provide countries with resources for swift response.
Kenya received Sh3.8 billion between June and December 2020.The first amount of $16.6 million was approved in June, $8.3 million in August, and $12 million in December. BY DAILY NATION