Solving the problem of access to cardiovascular medicines: revolving fund pharmacy models in rural western Kenya

Abstract

Availability of medicines for treatment of cardiovascular disease (CVD) is low in low-income and middle-income countries (LMIC). Supply chain models to improve the availability of quality CVD medicines in LMIC communities are urgently required. Our team established contextualised revolving fund pharmacies (RFPs) in rural western Kenya, whereby an initial stock of essential medicines was obtained through donations or purchase and then sold at a small mark-up price sufficient to replenish drug stock and ensure sustainability. In response to different contexts and levels of the public health system in Kenya (eg, primary versus tertiary), we developed and implemented three contextualised models of RFPs over the past decade, creating a network of 72 RFPs across western Kenya, that supplied 22 categories of CVD medicines and increased availability of essential CVD medications from <30% to 90% or higher. In one representative year, we were able to successfully supply 5 793 981 units of CVD and diabetes medicines to patients in western Kenya. The estimated programme running cost was US$6.5–25 per patient, serving as a useful benchmark for public governments to invest in medication supply chain systems in LMICs going forward. One important lesson that we have learnt from implementing three different RFP models over the past 10 years has been that each model has its own advantages and disadvantages, and we must continue to stay nimble and modify as needed to determine the optimal supply chain model while ensuring consistent access to essential CVD medications for patients living in these settings.

Effect of Nurse-Based Management of Hypertension in Rural Western Kenya

“…A central principle of this program was leveraging the existing infrastructure and task redistribution strategy implemented by AMPATH for the treatment and prevention of HIV [ 14 ]. In addition to task redistribution, the AMPATH Chronic Disease Management Program involves a multicomponent care package that includes clinical decision support using health information technology [ 34 ], consistent and secure medication supply [ 22 ], linkage and retention activities [ 23 ], community and stakeholder engagement [ 35 ], and social support for patients. This multicomponent package aligns with all of the World Health Organization health system building blocks: service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance [ 36 ].…”

“…All clinicians received initial training regarding the management of hypertension, ongoing mentorship on a regular basis, and clinical decision support (either paper-based or smartphone-based [ 20 ]). Medications were reliably and continuously supplied by either the Kenya Ministry of Health facility pharmacy or backed up by the AMPATH revolving fund pharmacy program [ 21 22 ]. Patients procured their medicines within the premises of the Ministry of Health facility where the clinical encounter occurred.…”

Supply-chain strategies for essential medicines in rural western Kenya during COVID-19

“…Over the past decade the revolving fund pharmacy model has successfully addressed many supply-chain needs for essential medicines in alignment with the Kenya essential medicines list. 8 – 10 The scheme operates within the catchment area of the Academic Model Providing Access to Healthcare partnership, spanning across seven counties and serving a population of 8 million people in western Kenya.…”

Human-Centered Implementation Research: A New Approach to Develop and Evaluate Implementation Strategies for Strengthening Referral Networks for Hypertension in western Kenya

“…In collaboration with the Kenyan Ministry of Health, AMPATH has established a Chronic Disease Management (CDM) Program, which has enrolled over 40,000 patients with hypertension at over 70 health facilities spanning all levels of the health system (20,21). The multicomponent CDM care delivery package includes task redistribution (22), clinical decision support using HIT (23), consistent and secure medication supply (24), linkage and retention activities (25), community and stakeholder engagement (26), and social support for patients.…”