Effect of devolution of health services on availability of medicines for Non-Communicable Diseases: a case study of the Makueni County Referral Hospital
Kenya has witnessed a rapid epidemiological shift, with a surge in non-communicable diseases (NCDs) like diabetes and cardiovascular diseases, which often require lifelong treatment and can lead to impoverishment. One driver of excessive expenditure is medicines and related products. To prevent impoverishment from NCDs, counties must strengthen the management of commodities. However, frequent stock-outs at public facilities suggest weaknesses in supply chain management. This study sought to establish the effect of devolution of health services on the availability of medicines for NCDs at the Makueni County Referral Hospital in Makueni County. To achieve this, the study employed a mixed methods approach. First, the availability of selected medicines for NCDs was described before and after devolution (2011-2012 and 2017-2018). Then, the reasons underlying observed patterns, and staff perception on factors that may have influenced availability, both examined through in-depth interviews. The study found that three cardiovascular products, nifedipine, enalapril and hydrochlorothiazide were mostly unavailable pre-devolution. Post devolution, availability of nifedipine and hydrochlorothiazide improved substantially with enalapril availability remaining a challenge post devolution. Tracer diabetes medicines, metformin and glibenclamide had steady availability pre and post-devolution period. However, Insulin had good availability post devolution. Asthma drugs (salbutamol inhaler, salbutamol nebulising solution and budesonide inhaler) had higher stock out post-devolution.The relatively affordable amoxicillin, paracetamol and ibuprofen had good pre- and post-devolution availabilities, with ceftriaxone, a much more costly antibiotic, only having good availability post-devolution. Reasons for the increased availability included increased funding, better structured quarterly orders, better collaboration across actors, better public participation and an overall increase staff numbers. The study recommends that other health financing avenues be sought and that the county government reviews medicines budgets frequently. The study also recommends that county government should encourage public participation so as to know areas that need improvement.