Blame game over TB drug shortage as patients suffer
Earlier this year, Karis*, 46, from Ruai, Nairobi County, was diagnosed with genitourinary tuberculosis at the Kenyatta National Hospital (KNH).
According to the father of two, after being diagnosed with the disease, which also affected his spine, he was immediately put on medication, a treatment that was supposed to last a year.
Everything was going well until the end of November -- eight months into his treatment -- when he went to the hospital clinic and suddenly there were no more drugs.
“I always went to the clinic where normally I took a one month’s supply of drugs, but this time around, I was surprised to be told that there wasn’t any.”
What followed was a series of shuffles from hospital to hospital, hoping to find relief, only to be forced to discontinue his treatment time and time again.
He had visited nearly ten facilities in Nairobi but had not been able to secure enough medication to last him a month, as is usually the case.
“I had to travel to a health facility in Meru where, on Monday, December 11, I was lucky to at least receive a month’s dosage.”
This has taken a toll on him.
“With the frequent hospital visits, I have spent all my money, and what makes matters worse is that with my current state of health, I cannot go back to my usual work as a trader,” he adds.
This is the experience of many TB patients across Kenya. For months now, the country has been grappling with a shortage of TB drugs, and for some patients, the issue may have become a tired one.
But in reality, the situation seems to be getting worse by the day, with TB patients at risk of becoming seriously ill due to lack of treatment. And many more Kenyans will be at risk of contracting the disease.
Sources say the situation is so bad that some facilities near or within the capital have stopped screening for TB.
According to a Nairobi-based TB advocate who spoke on condition of anonymity, some chest clinic doctors, who have now been threatened not to speak to the media, are turning away patients untreated.
“In November, one of the facilities he works with turned away more than 100 patients who needed drugs, out of which 10 were newly diagnosed with TB.”
TB champions typically support their communities by screening for TB, referring suspected cases to hospitals and contact tracing, and advocating for TB patients' rights to quality health care.
Wait for drugs
He says they are currently receiving drugs in bits and pieces, but not all of their patients have started treatment.
“At times we screen for TB and when they go to the health facility they are diagnosed with the disease, only to be told to go back to the community while they wait for drugs.”
And so they too have become relaxed about testing. “We think by doing so, we are only making the situation worse because what happens if we find out that indeed someone is ill? It is just adding more stress to an already bad situation,” he explains.
This is despite the fact that the National Tuberculosis, Leprosy and Lung Disease Programme, which is responsible for technical guidance and supervision of TB and leprosy control programmes, maintains that TB drugs are available.
According to the programme's head, Immaculate Kathure, the programme had distributed anti-TB drugs to all counties as of November 7, with more stocks available at Kenya Medical Supplies Authority (Kemsa) for redistribution.
“Any county that has exhausted their stocks places an order for re-supply as needed through the routine ordering system in place. We immediately process their request and dispatch through a G4S account,” Dr Kathure said.
Additional medicine
According to the programme, only Nairobi County placed a request for additional medicine and they received a replenishment.
“The Kenya Medical Supplies Agency (Kemsa) stocks as of Friday, December 8, 2023 are as follows: 7,000 patient packs. These are currently under distribution to all 47 counties with the last dispatch happening today (December 11), 14,852 packs of RHZE and 18,478 patient packs received from Global Drug Facility last week. We are also expecting further stocks in the coming months,” added Dr Kathure.
She added: “I have checked and confirm that any patient diagnosed with TB and not on treatment is a failure on the part of the county teams and is a misrepresentation of the true status of the commodities.”
On the other hand, data from Kemsa, which procures, stores and distributes drugs on behalf of the government, shows that up to 31 counties have received drugs.
According to Dr Norah Maore, Nairobi County Pharmacist, there is currently no shortage of drugs.
“We have a one-month supply of drugs in the county, which we received a week ago, which we take to different facilities. Generally, we have been receiving drugs and right now we are okay,” she said.
One-month supply
But even if that were the case, a one-month supply is considered a shortage.
“This is because as per the World Health Organization (WHO) guidelines, there should be at least a 3-6 months’ buffer stock,” explains Stephen Shikoli, the national coordinator of the Network of TB Champions Kenya.
Meanwhile, there is growing concern among some TB stakeholders in the country about how serious Kemsa is about sharing information about the drug shortage scenario.
“We usually have the first-line TB drug meetings, which are usually held weekly, involving the National TB Program, Kemsa, CSOs and the Ministry of Health MoH. But in the last three consecutive meetings, Kemsa has either not shown up or when someone shows up, they have excuses for not responding,” said Peter Owiti from the Network of TB Champions and also a board member of Stop TB Partnership.
At the first-line drugs follow-up meeting on December 13, the Network of TB Champions asked Kemsa to provide the names of the pharmacies to which the drugs had been sent so that they could monitor the TB drug situation, but the drugs agency said it could not disclose them.
Kenya is one of the countries most affected by the TB drug shortage and the situation could be attributed to a combination of factors, the most important of which is domestic financing, according to Dr Lucica Ditiu, the executive director of the Stop TB Partnership.
Experiences budget delays
She said that Kenya is one of the few countries that pays for up to 70 per cent of TB treatment with its own money, and sometimes experiences budget delays.
But Dr Ditiu says there could also be internal problems with the supply chain, as well as a lack of adequate response to diagnosis when needed.
"Kenya is doing well when it comes to diagnosing people and children with TB. We appreciate the efforts, but the response speed isn’t adequate," she said.
With the drug shortage, Dr Ditiu says the country could be on the brink of disaster.
“The undiagnosed TB cases lead to increased infection within communities, resulting in more people developing a disease that could have been prevented,” she added.
Meanwhile, experts say the TB drug shortage is bad news for a country like Kenya, which is already among 30 countries with a high TB prevalence, recording 150,000-160,000 cases annually. Shockingly, only 50 to 60 per cent of these cases receive treatment and an alarming 50,000-70,000 TB cases remain undiagnosed.
Of the undiagnosed cases, 25,000-35,000 people have open TB, meaning they are infectious without being aware of it.
In 2021, TB claimed 1.6 million lives and more than 10 million people contracted the disease. Yet it remains woefully neglected and underfunded in many countries, with more than 95 per cent of TB deaths occurring in low-income countries.
According to Dr Ditiu, partners such as the Global Fund and USAid need to step in to ensure the effective delivery of TB drugs.
"The Kenyan government also needs to be prepared and budget for TB drugs. There should also be a push for the government to mobilise and commit to the procurement of the drugs."
Our efforts to reach the Ministry of Health for comment were unsuccessful.
