Sub-Standard Pharmaceutical Services in Private Healthcare Facilities Serving Low-Income Settlements in Nairobi County, Kenya

Abstract

Background: Quality pharmaceutical services are an integral part of primary healthcare and a key determinant of patient outcomes. The study focuses on pharmaceutical service delivery among private healthcare facilities serving informal settlements within Nairobi County, Kenya and aims at understanding the drug procurement practices, task-shifting and ethical issues associated with drug brand preference, competition and disposal of expired drugs. Methods: Forty-five private facilities comprising of hospitals, nursing homes, health centres, medical centres, clinics and pharmacies were recruited through purposive sampling. Structured electronic questionnaires were administered to 45 respondents working within the study facilities over an 8-week period. Results: About 50% of personnel carrying out drug procurement belonged to non-pharmaceutical cadres namely; doctors, clinical officers, nurses and pharmacy assistants. Drug brand preferences among healthcare facilities and patients were mainly pegged on perceived quality and price. Unethical business competition practices were recorded, including poor professional demeanour and waiver of consultation fees veiled to undercut colleagues. Government subsidized drugs were sold at 100% profit in fifty percent of the facilities stocking them. In 44% of the facilities, the disposal of expired drugs was not in conformity to existing government regulatory guidelines. Conclusions: There is extensive task-shifting and delegation of pharmaceutical services to non-pharmaceutical cadres and poor observance of ethical guidelines in private facilities. Strict enforcement of regulations is required for optimal practices.

Patients Access to Medicines – A Critical Review of the Healthcare System in Kenya

“…There is also a need to enact legislative reforms to make it mandatory for healthcare providers in the public sector to prescribe medicines using the generic name rather than the branded name. 83 In addition, a law should be enacted to empower pharmacists to implement generic substitution 86 , 87 and explicitly prohibit unethical manipulative marketing practices with stiffer deterrent penalties.…”

“…Such untrained personnel learn the art of medicine dispensing and transcription of prescriptions from a licensed health facility or pharmacy due to task shifting practices often practiced by ptechs and pharmacists. 83 However, after either retirement, redundancy, or resignation they feel that have gained “enough experience” to operate their own unlicensed retail medicine outlet. 83 Wafula et al, 79 in an earlier study, documented the presence of illegal unlicensed retail medicine outlets.…”

“… 83 However, after either retirement, redundancy, or resignation they feel that have gained “enough experience” to operate their own unlicensed retail medicine outlet. 83 Wafula et al, 79 in an earlier study, documented the presence of illegal unlicensed retail medicine outlets. A poor patient especially those in the informal sector and slum dwelling areas, faces a lot of challenges in accessing quality health services.…”

“…Such practices include unethically gifting or pay-rolling a healthcare worker whenever a particular medicine brand is being prescribed or dispensed. 83 In some instances, Med Reps even collude with prescribers to have a statement, “do not substitute” included as a footnote on personalized prescription pads offered to them as gifts. Such unethical practices may induce prescribers to “force” patients to procure specific brands of medicines without due consideration of their cost and quality.…”

Determinants of adverse drug reactions reporting in retail chemists in Nairobi County, Kenya

“…One particular article notes that the sheer number of untrained and unregulated medicines dispensers is troubling. 11 This further exposes the public to adverse drug reactions due to medication errors or lack of proper medicine use counselling.…”