Kenya public sector

The impact of waivers on service providers capacity to adjust to increased utilization needs to be assessed. Some evidence suggests that the introduction of waivers has created additional pressure in areas where capacity was already limited. The elimination of primary school fees has also had a large impact on the number of children going to school, and thus on the number of teachers and textbooks needed. While some countries such as Kenya have been successful in replacing lost funds, others such as Malawi have not been able to replace the lost revenues (Wilson 2006 World Bank 2007f). In Colombia, the introduction of vouchers for secondary schools placed additional stress on schools that had already reached full capacity. At that time, 1992, the secondary enrollment rate was only 75 percent overall, and as low as 55 percent for the poorest quintile of the population. The capacity constraint was overcome with a unique partnership between the private and public sectors (Braun-Munzinger 2005). ... 

Our supply chain data (Table 8.1) show that the public sector wholesaler in each country had bought a higher proportion of the tracer essential medicines from local manufacturers than had the private wholesalers. The faith-based wholesaler in Kenya (MEDS) was the most likely of all to source these medicines locally. All Kenyan wholesale sectors, furthermore, were more likely than their Tanzanian counterparts to buy these essential medicines from their local manufacturers (Table 8.1). Finally, while Tanzania buyers sourced medicines from Kenya ( other African for Tanzania in Table 8.1 is largely Kenyan), the Kenyan buyers bought little from non-Kenyan African suppliers. 

Kenyan local-level experience echoes this complexity. There, public sector lower-level facilities obtained their KEMSA supplies through the local district hospital. The parallels to the basket funds were the Health Sector Services Fund (HSSF) and Facility Improvement Funds (FIF), and they also used fees and charges. In addition, there was in Kenya a widespread local culture of borrowing between public facilities, especially when patients could not afford to buy medicines in the shops, and especially in the rural districts in these circumstances. 

Tanzania, which investigated supply chains from local producers and importers into the health sector. Qualitative interviews and quantitative data collection on availability, somce and price of a checklist of tracer medicines and other essential supplies were conducted in hoth countries. In Tanzania, 42 health facilities (public, faith-based and private), pharmacies and drug shops across four very diverse districts were visited (Tibandebage et al., 2014), while in Kenya, 55 health facilities, pharmacies and shops were interviewed in a comparative study (Kariuki et al., 2015). Following these supply chain studies, wholesalers, manufacturers and poUcy and regulatory stakeholders were interviewed in both countries in 2013-14. This chapter draws also on some of these interviews, alongside secondary data somces. 

The public, donor and non-profit procurement of medicines is important for medicines access. However, in both countries, half of medicines access or more relies on private sector wholesaling and importing. The interviews with private facilities and shops demonstrate that, in both countries, private retailers and clinicians rely almost wholly on private wholesalers. While most smaller buyers had little influence over the sources of the medicines they bought, many had opinions on the best sources of medicines, as did their patients. Asked systematically about the comparison between locally produced and imported medicines, the respondents views varied according to their clientele. Some high-end private hospitals in Kenya, when procuring medicines, specified brands preferred by their patients, notably from European suppliers. Some pharmacies in better-off areas also said there was resistance to locally made branded generics. 

These data were collected in Kenya before the decentralization reforms that have allowed counties to diversify procurement sources for public health sector supplies. 

Country of origin of tracer essential medicines, by procurement sector, Tanzania and Kenya, 2012-13 Pharmacy dispensing fee fee in rands (R) plus permitted mark-up (%), by band of SEP in rands (R) and date of publication of schedule... 

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