By Lenah Bosibori
Kenya’s Stop TB Coalition has called on the government to carry out a thorough audit of the tuberculosis (TB) drug supply chain following an expiration of 49,000 TB doses in a warehouse at Kenya Medical Supplies Authority (KEMSA).
Speaking in Nairobi during the second Kenya National TB Champions Summit that brought together all TB champions across the 47 counties, Philip Nyakwana, a member of Kenya’s Global Fund coordinating body for TB, HIV, and malaria said the problem might have come from quantification, planning or the procurement department ordered more than what was required.
“We need to do an audit of our supply chain because there could be so many reasons leading to the expiry, one of the reasons could be we ordered more than what we needed, two, we bought commodities with short expiry dates, another may be at the distribution channel,” said Nyakwana.
Further Nyakwana adds, “That is wasteful because we still incur expenses to destroy them, what was very interesting when we had this story is that what is at the health facility has longer expiry and what is still in store has shorter expiry, was it about distribution or where is the challenge?” queried Nyakwana.
According to data from USAID-themed ‘Kenya Tuberculosis Roadmap Overview Fiscal year 2022, the estimated TB incidence in Kenya was 133,000 in 2021 and an estimated 32,000 people died from TB.
Nyakwana further adds that the country needs a reliable system for tracking and distributing these drugs to prevent future losses.
On the contrary, Nyakwana highlighted that as the doses expire at KEMSA, Kenya lacks doses for children. “The lack of pediatric TB medication has remained a significant concern, with caregivers being forced to split adult tablets for children, which compromises treatment accuracy, hygiene and effectiveness.
According to him, breaking the drugs might not mean the same thing to people, “If you tell a woman in the rural to break, they may not know what amount of water, because what is 5ml might be different from the other, and what is the content and quality, some might think that if water is a lot, it is better,” he said.
Another challenge according to Nyakwana is the issue of hygiene and how they handle the drugs after breaking them. “How do they handle it, because the moment you break the drug, that means you broke the package, how do they handle that drug?” he queried.
“The good thing is that at the national TB programme level, we have a commodity security committee that we engage with to see how to address such an issue so that it does not happen in future, it was shocking to everybody when we had the numbers,” he notes.
Nutrition is another challenge according to Nyakwana, “We have had a lot of challenges with nutrition especially support to people with TB, we have advocated and lobbied the government, at some point there is a breakthrough but we still have a problem on how to support the nutritional component of the patients,” added Nyakwana.
We have done quite several training but the support to implement them is low according to him. “Paralegals are trained, but now they are not linked and also lack support to help them conduct the work they have trained on,” he reiterates.
“It is the responsibility of all the players in the TB world to make sure that these communities are part of those conversations at global and different levels.”
In addition, TB champions from across Kenya emphasized the challenges they face in supporting patients due to limited resources and insufficient training for volunteers.
Evelyne Kibuchi, the Chief National Coordinator for Stop TB Partnership Kenya, pointed to the success of community-driven efforts in improving Kenya’s TB response, particularly in raising awareness around drug shortages.
“Communities must be engaged in TB response, TB response framework was developed by the World Health Organization (WHO) to engage the community,” said Kibuchi.
These communities have been able to bring out issues that have been addressed at national levels. “Last year when we had stock out of TB drugs, it was the communities that brought this issue to our attention because the healthcare workers and the government were not willing to bring out this issue, we appreciate the role they play at the community level,” added Kibuchi.
Kenya has made strides in TB treatment and diagnosis by shortening treatment durations and reducing drug-resistance cases. However, the sustainability of these achievements relies on robust government support, increased funding, and improved accountability at the county level according to Kibuchi.
Kibuchi also highlighted the journey of TB in the country. “When I was starting, issues of human rights violation were gross, you may know that we had a law that provided for patients who failed to take their treatment to be jailed, that was a human rights violation,” she said.
Further, Kibuchi adds for patients who had drug resistance TB those days, came with a lot of challenges, the country could only put on treatment for 40 patients, of drug resistance TB and the treatment took two years, so we had to wait for these 40 to complete their treatment then we go for the ones who had been diagnosed.
Once diagnosed, the story could not end there, Kenyatta National Hospital was the only treatment site which had a very limited capacity and for one to qualify, they had to come with a letter from a chief or church, that said the people in it could be responsible if the patient failed to take medication, also one had to deposit a minimum of Sh 70,000 to take care of their expenses in Nairobi.
There was low social support, and no allowances to the patients, these were still violations of their human rights in accessing healthcare. “It took interventions of communities for TB patients to make a change,” she notes.
“Today we have devolved TB, one can get treatment wherever they are, the diagnosis takes several days, the social protection is working, once diagnosed a patient is given an allowance of sh 6,000 per month for six months to enable them access treatment,” adds Kibuchi.
In addition, treatment has been shortened from 24 months to 6 months, again the treatment used to have a combination of 180 injections for 24 months, it has been reduced to 6 months.
The Stop TB Coalition is advocating for political commitment to declare TB a national health priority, mirroring the successful response to HIV.