Strengthening pharmaceutical distribution chain in Kenya: a case study of the Kenya Medical Supplies Authority and Dagoretti Sub-County Hospital

Abstract

The increasing demand for medical products continues to put pressure on pharmaceutical supply chains, jeopardising the health system's goal of universal access to safe, effective, quality, and affordable commodities. Evidence-based supply chain management interventions could help address the majority of the challenges. Using the case of Kenya Medical Supplies Authority (KEMSA) and Dagoretti Sub-County Hospital (DSCH), this research aimed to identify factors that affect the performance of Kenya’s public health sector pharmaceutical distribution chain and identify areas for improvement. Specifically, the study aimed to (i) characterize the pharmaceutical distribution value chain linking the central medical store (KEMSA) and use point (DSCH), (ii) identify all non-value-add steps/processes and activities throughout the value chain, and (iii) propose an alternative distribution chain that could perform a similar function with higher effectiveness. A cross-sectional qualitative study design was used to collect data using key informant interviews. Qualitative data was managed in NVIVO and analysed following a thematic approach. Findings highlight four key activities that characterise the pharmaceutical distribution chain in the public sector: 1) demand for pharmaceutical products, 2) procurement, 3) warehousing, and 4) distribution. Besides, the study identified the adoption of technology, training of staff, collaboration between KEMSA and DSCH/counties among the most important value-adding factors. However, having fewer KEMSA distribution facilities and the use of manual procurement activities were identified as the primary non-value-add process reducing the performance of the pharmaceutical distribution chain in the public sector in Kenya. The study, therefore, recommends a shift from a manual procurement process to an online system to improve efficiency by reducing delays in the tendering process. Besides, KEMSA should consider expanding the network of distribution facilities across the country to enhance ease of access to pharmaceutical commodities, enhancing efficiency in service delivery whilst reducing the logistical costs and delays in transporting commodities.