Kenya: Kemsa Laxity, Red Tape Worsen Patients' Pain

18 February 2020

A weak healthcare system and systemic bureaucracy in government institutions has led to the suffering of thousands of terminally-ill patients for close to a year now due to shortage of oral morphine.

Since June last year, over 30 government hospitals and 24 non-government facilities that rely on the government to supply them with the pain medication have had to do without it, turning to other pain relievers, which are ineffective for severe pain such as that of cancer.

Oral morphine is used to alleviate the pain of terminally-ill patients, pain that less potent painkillers such as paracetamol and brufen cannot mute.

Stakeholders in the health sector blame the needless crisis on bureaucracy at government level and Kenya Medical Supplies Authority (Kemsa), which procures the drug on behalf of the government.

INSUFFICIENT STOCK

Kenya Hospice and Palliative Care Association (Kehpca) Chief Executive Officer Zipporah Ali says they have been forced to source for the oral morphine themselves to supply the many hospitals in Kenya that offer palliative care. But it has not been enough.

"Long before the drug ran out, we had informed the Ministry of Health so that they could start the process of acquiring it, but thanks to the bureaucracy in government and at Kemsa, the morphine came about two weeks ago. But even then, it is only 11 kilogrammes, which cannot last beyond six months," says Dr Ali, who is not sure when the distribution of the medication to hospitals will commence.

For the last four years, Kehpca has been working with the Ministry of Health in partnership with Kenyatta National Hospital (KNH) and Kemsa to ensure there is morphine for patients, specifically those in public hospitals and hospices.

The Ministry of Health is responsible for putting out a tender - Laborex Pharmaceuticals won the tender to supply oral morphine.

ORAL MORPHINE

The drug comes in powder form; Kemsa then takes it to KNH for reconstitution in paediatric and adult oral formulations. The medication then goes back to Kemsa, from where the hospitals are supposed to make their orders.

Constitutionally, patients are supposed to receive oral morphine free of charge; however, since it is unavailable they are forced to buy it from private hospitals.

Mr Eliud Muriithi, the director of commercial services at Kemsa, confirmed that only injectable morphine is available.

Dr Ali, who is a palliative care doctor, does not recommend injectable morphine for chronic pain.

"Patients would have to be injected four times per hour. This is not practical. The injection is only used as a start doze to reduce severe pain; then the patient moves to oral morphine," she explains.

NHIF COVER

The World Health Organisation recommends oral morphine since it is very effective, cheaper and with fewer side effects. A patient needs just 100mls for 10 days, which goes for Sh500.

Kenya needs 22 kilogrammes of morphine powder per year. A kilo of morphine powder goes for about Sh270,000. "A kilogram of morphine can support over 1,000 patients for a month," says Dr Ali.

Worth noting is that this drug is not covered by the National Hospital Insurance Fund. Asked why patients are not covered, NHIF officers contacted by the Nation could not respond.

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