Panic has gripped people on antiretroviral treatment after it became apparent that the country may experience drug stock-out by the end of this month (April) if emergency procurement is not made now.

Presentation made by National AIDS and STD Control Programme (Nascop) to Inter-Country Coordinating (ICC) committee held at the National Aids Control Council boardroom on 3rd March 2008 confirmed this.

According to the presentation, stocks for key drugs regimens for over 40 percent of patients being treated using government and Global Fund funds could only last for two months, with ARV stock-outs expected by end of this month.

“Most products are below the required minimum stock level of 12 months, with several others below the critical stock levels of 6 months,” warned the Nascop presentation.

Procurement of ARV drugs worth Ksh 375 million which was expected by February or March is yet to arrive in the country, a development Nascop blames on the post-election situation as well as the tedious cumbersome government procurement bureaucracies. Earliest delivery of these drugs has now been pushed to May.

“This is the third time this is happening. Last year, the government had to rush to U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and UNICEF for ARVs drugs when the stocks ran out,” says a visibly angry James Kamau of Kenya Treatment Action Movement (KETAM).

“What we need systems to be put place to ensure there no stock-outs and those that will integrate the procurement channels of various stakeholder.”

Again, as a stop-gap measure, the government is said to be negotiating with PEPFAR to advance it drugs while it awaits its consignment.

The ICC advisory committee has been tasked to deliberate on the impending ARVs stock-out, look at recommended structure for HIV and AIDS programme management and advice ICC-HIV/AIDS on the way forward, say minutes of the Special ICC-HIV/AIDS meeting held on 3rd March 2008 at the National Aids Control Council boardroom.

In the minutes, it is also recommended that the government goes for new procurement agent for round 7 funds, as one of the solution to the stock-outs nightmare. The procurement committee is further expected to come-up with comprehensive procurement plan that would ensure commodities and ARVs security.

Even as all these recommendations were being made, an earlier report presented to the government late last year had warned of the dire situation the country was in as far as ARV treatment was concerned.

The report, Quantification of ARV drugs for Nascop ART Programme: 2007-2009, says the Kenyan antiretroviral drug treatment programme is being overwhelmed by the number of new patients coming onto to treatment, putting massive pressure on the existing stocks.

And without good planning and efficient procurement procedures, then the country is likely to plunge into problems.

HIV experts too agree that the scale-up of antiretroviral drugs treatment that is putting about 3,500 people on treatment every month is not in tandem with the amount of drugs being procured, causing confusion and problems.

This new trend is likely to occasion stock-outs if the country does not immediately implement a new drug ordering system, says the report, which was presented to Nascop.

By end of July last year, for instance, several drugs were below the minimum acceptable stock levels, a trend likely to continue if not rectified.

From the report, it is emerging that the country has been operating a forecasting system that either under procured or over procured drugs, resulting in constant stock-outs or wastages.

“So far, the antiretroviral treatment (ART) programme has continued to enroll and maintain patients on treatment with little or no buffer stock over the past year,” says the report.

“During this quantification exercise,” the report adds, “the team noted that due to errors in the computer system and the aggregation of data, inaccurate consumption and stock on hand information had been reported for several months. Without accurate and timely reports, wrong procurement planning decisions can arise.”

While lauding efforts to put many patients on treatment, the authors say programme managers will continue to feel pressure of potential stock-outs.

What is also chilling is the report’s caution of a looming crisis in commodity security as there are no clear indications where funds for procuring drugs for patients on the government and Global Funds supply chain will come from starting mid this year. It is estimated that 103, 349 patients will be on treatment from June 2008, yet their fate for drugs is not known.

Says the quantification report: “Even if all the funds available from the Global Fund and the Ministry of Health are utilized from June 2008, it is unclear where the funding for the cohort of patients on the Government and Global Funds supply chain will come from.”

While funds required for lamivudine, one of the drugs in first line treatment is 70,810, only 64, 575 has been funded. The same is with Nevirapine 200mg which has received a funding of 261,613, instead of the required 348,703.

For the August 2007 and July 2008 period, contract orders to suppliers for drugs worth US$ 2,205, 205.18 (Shs 138, 927, 926 at the current rate of Sh63 for a dollar) were yet to be placed by late last year, the report observes. Sources at the Ministry of Health say much has not happened since then.

The situation is not also good for the period August 2008 to July 2009. Apart from the drug Tenofovir, no commitment has been made for purchase of antiretroviral drugs required for the August 2008-July 2009 period. HIV experts are worried that there will be major gaps from July if nothing happens now.

“It is critical to note that much of the period August 2008 to July 2009 is unfunded. Unfunded commodities are those requirements that do not have firm budgetary commitments.

The picture above is therefore quite grim for commodity security beyond the initial 11 month period covered by this quantification,” says the report.

One of the reasons for these funding gap problems maybe due to initial commitments made by the Global Fund and the governments funding problems.

While the Fund had committed to support 42, 500 patients from March 2006 to March 2009, currently over 90,000 people are on ARV treatment following the Rapid Results Initiative of the Ministry of Health. This is beyond the Global Fund expectations and has forced the government to take over treatment of additional patients.

Another over 90,000 people are on treatment programmes run by PEPFAR, Clinton Foundation HIV/AIDS Initiative (CHAI) and MSF among many others, bring the total of people on ARV treatment at over 180,000.

Under this arrangement, the government seems to be the only one lagging behind when it comes to procuring drugs for its patients. Health experts complain that government funds for procuring drugs take long to be available, causing problems in the supply chain. 

For instance, ff the US$ 7.5 million the government set aside for procurement of drugs in the financial year 2007/2008, Kenya Medical Supplies Agency has placed orders for only US$ 5 million, meaning 32 per cent of the finances are yet to be committed for ARVs required for the same period.

From the report, it also emerges that there was no firm commitment by late last year for the drugs – lamivudine/stavudine/nevirapine- and lamivudine/Zidovudine- to be bought using government and Global Fund money. While the drugs were meant for the January and February months, tenders had not been placed, and were still marked as planned shipment.

Other drugs in this state by late year are: Efavirenz, required for shipment by the month of March 2008, lamivudine/stavudine/nevirapine for April and lamivudine for June 2008. 

Considering the procurement process takes about six months, there are high chances that the country will experience problems in drugs provision within this period.

Authors behind this report wants the “the current procurement entities to immediately procure all shipments marked as ‘planned’.”

“For the short term commodity security, it is critical that all procurement entities work as expediently as possible to ensure that the resources committed translate into actual procurements in the shortest time possible to avoid stock outs,” the report adds.

To respond to the funding gaps, the authors of the report recommend that the Ministry of Health and NASCOP lobby the Ministry of Finance and donors for funds to support these patients.

The government should put in place a commodity security strategy policy which anticipates the increase in government contributions should donor funding cease or if there are delays in disbursement of funds.