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Title: Supply chain challenges affecting
access to IFA, Calcium, Oxytocin and
Misoprostol in Kakamega County, Kenya
Crispin Ndedda1, James Riungu2, Rebecca Njuki3 and Alex Muturi4
Micronutrient Initiative, Kenya 2,3,4 Centre for Population Health Research and Management
1
ABSTRACT
12
10
7
I
0.7
I
2
2.3
I
4
6.5
I
8
• Both quantitative and qualitative techniques were
applied including desk reviews, semi-structured
questionnaires, inventory reviews, observation, and indepth interviews.
Maximum
stock
Minimum
stock
I
• A cross-sectional, descriptive study was conducted in
Kakamega central, Mumias and Matungu districts of
Kakamega County, Kenya.
14
I
Conclusion: streamlining the supply chain entails
addressing policy issues, advocacy for local manufacture,
strengthening forecasting and quantification capacity as
well as carefully thought out procurement processes.
16
I
Results: Procurement through agencies was most cost
effective. There were frequent prolonged stock-outs of
these commodities; no calcium supplements to give to
pregnant women for the prevention of pre-eclampsia
and eclampsia; no calcium policy and service delivery
guidelines and job-aids on the same, and calcium was
not included in the essential drugs list. Only 12% of the
combined IFA formulations found in the market met the
recommended doses for antenatal supplementation. Low
knowledge on forecasting and quantification was evident
among health managers.
16
I
Objective: To conduct a supply chain assessment in
Kakamega County, Kenya to identify facilitating factors
and barriers to uninterrupted availability of IFA, oxytocic
drugs, misoprostol, magnesium sulphate and calcium.
Methods: Cross-sectional survey comprising both
qualitative and quantitative methods.
METHODS
Stock status at Central level
0
0
I
Combined
IFA
I
FeSO4
0
I
Folate
I
MgSO4
0
0
I
Oxytocin
I
Zinc
I
ORS
I
Misoprostol Vitamin A
Months of stock
• In-depth interviews involved policy makers in
health sector, senior Ministry of Health officials and
stakeholders in maternal child health in Kenya.
• A total of 19 health facilities were randomly selected
and 151 ANC and 275 under-five exit interviews were
conducted.
• Quantitative data was harvested from inventories at
Kenya Essential Medicines Supply Agency (KEMSA)
warehouses, Division of Family Health and Health
facilities over the previous 12 months.
• Data was collated and analysed using Stata software
and Atlas TI software, for quantitative and qualitative
data, respectively.
Stock status at Facility level
100
100
0
3.7%
0
5.7%
24.3%
80
80
60
60
38.1%
8.8%
96.3%
40
40
94.3%
18.5%
16.7%
48.6%
Calcium
IFA
<3 months of stock
52.8%
13.3%
66.9%
20
20
00
41.5%
Misoprostol
Oxytocin
3 to 6 months stock
40.0%
Zinc
30.5
ORS
>6 months stock
Iron and folic acid in market
96%
• Consumption data is largely unavailable and rarely
used to guide quantification.
30
• About 70% of health facilities had inadequate (less
than 3 months) stock of IFA.
• Most of the IFA is sourced from outside the country.
There is widespread availability of the combined iron
and folic acid formulation.
• Only 23% of the IFA stocks available in the market met
the WHO supplementation dosing requirements.
10
14%
I
• Misoprostol was largely unavailable in health facilities
because the policy does not allow its use in primary
level facilities.
23%
40
20
• Central medical stores have inadequate stocks of IFA
and abundant stocks of Oxytocin.
32%
50
I
• To inform formulation of innovative solutions to
supply chain challenges for the selected commodities
to ensure uninterrupted and sustained availability of
commodities.
60
I
• To assess key components of the supply chain to
understand the barriers and facilitating factors for
selected MNCH commodities (iron and folic acid
(IFA), calcium, oxytocin and misoprostol) in Kakamega
County, Kenya.
IFA
I
OBJECTIVES
70
I
• Availability of high-quality pharmaceuticals is a prerequisite for reduction of maternal and newborn
mortality.
80
I
• Despite major progress, Kenya is among the countries
that are not on track for meeting Millennium
Development Goals 4 and 5 (Kassebaum 2014).
90
I
• Reducing maternal and new born mortality is a major
public health concern globally.
RESULTS
68%
I
BACKGROUND
77%
0
Local
Foriegn
IFA sources
Single
Combined
IFA presentations
Incorrect
Correct
Appropriate dose preps
CONCLUSIONS
In conclusion, streamlining the supply chain entails
addressing policy issues, advocacy for local manufacture,
strengthening forecasting and quantification capacity as
well as a carefully thought out procurement process.
Main challenges to be addressed include the lack of
policy and guidelines on calcium supplementation for
pregnant women; low local manufacturing capacity; high
prices in the private sector; low knowledge on forecasting
and quantification among health managers and service
providers; poor inventory management and storage
facilities.
Acknowledgements
The authors would like to acknowledge the financial and
technical support of Micronutrient Initiative, KEMSA and
the Ministry of Health Kenya. [email protected]