Shock of expired family planning implants State gave women

The government is on the spot for releasing expired and contaminated family planning implants to Kenyan women.

The Nation has learnt that a consignment of implants imported by the United Nations Population Fund (UNFPA) and released by the Kenya Medical Supplies Authority (Kemsa) to Lamu, Kwale, Nyamira and Kakamega counties had grown mould and the recipients have since been advised to halt their usage, with further distribution to other counties suspended.

The implants arrived in October last year and were released to Kemsa in June, after staying for eight months at the port of Mombasa because of clearance bottlenecks amid a shortage of the family planning method.

The consignment of Implanon NXT was held by the Kenya Ports Authority because the government had not budgeted for the tax clearance. The Ministry of Finance and the National Treasury had to write a letter for taxes to be waived, which took time.

When the drugs were released from the port, they were taken to Kemsa for warehousing and onward distribution to counties.

Quality assurance

From the port to the warehouse, the Nation has learnt, quality assurance was done and immediately, the division of Reproductive Health in the Ministry of Health confirmed that the implants could be distributed to counties.

“At Kemsa, we do not procure donor-funded commodities, we only do warehousing and distribution. We had no input. We were just given the distribution list and we took them to counties,” says a source at the agency who sought anonymity.

According to a memo written to the counties that received the consignment, they were told to check the consignment for any sign of moulding, then quarantine the items immediately and return them to the Kemsa warehouse.

“Further distribution of the commodity has been suspended. Lamu, Nyamira, Kakamega and Kwale counties are the only ones affected,” says the memo.

In March, when the Nation learnt that the consignment was stuck at the port, it wrote an email to the UNFPA representative for Kenya, Dr Ademola Olajide, enquiring on the status and why the commodities were stuck yet there was shortage.

“We are in talks with the government and the commodities will be released soon to Kenyans,” Dr Olajide said in a phone conversation in March.

Recall directive

The commodities were released to Kemsa in June and later to counties early this month and two weeks later, counties were asked to stop giving them to women. However, some women in one of the counties had already received the implants.

 “I am not going to give you the exact number of women that have received the method but I can confirm that we have given the method to some women because when they were delivered, we had experienced stock-out for about seven months and when we announced that they are at the facilities, women were coming for them,” said an officer in one of the counties.

The source said they received the recall directive two weeks after the drugs had been delivered.

“You know when they were brought in the boxes, we could not tell that they had moulds until we opened them. They stayed for long without being used.” 

The question that needs to be answered is how contaminated the drugs were and how it is going to affect the women that had received the drug and whether it is okay to remove it after insertion.

Kemsa acting CEO Edward Njoroge confirmed that the agency had recalled part of a pharmaceutical consignment dispatched earlier.

“This is part of our market surveillance and quality assurance processes after the consignment of implanon delivered to the authority for distribution was found to be degraded,” he said.

“As the distribution agency on behalf of the donor and importing agency, we have activated an elaborate recall process as per our operating procedures. This recall is geared at guaranteeing public safety and will be strictly enforced,”

A survey done between November and December last year in 11 counties -- Nairobi, Kilifi, Nandi, Nyamira, Kiambu, Bungoma, Siaya, Kericho, Kitui, Kakamega and West Pokot -- by Performance Monitoring for Action (PMA), Kenya pointed out that stock-outs were still a problem, both in public and private health facilities.

“With time there have been changes in facilities reporting not offering the services and most of them are dispensaries. This could be because of personnel and even materials and stock outs,” said Prof Peter Gichangi, the principal investigator PMA.

The report also indicated that stock-out of intrauterine devices in public health facilities was found to have increased from seven per cent in 2019 to 11 per cent in 2020.

Stock-out of implants remained almost constant, while stock-out of injectables, the most used method, reduced from 13 to seven per cent between 2019 and 2020.

Out of the 822 public hospitals surveyed, 70 per cent reported ordering but not receiving the shipment, 10 per cent increased consumption, seven per cent ordered but did not receive the right quantity while seven per cent did not place an order for shipment.

Disconnect

“We need to look at where the disconnect occurs. Why would you order but not receive the shipment? It is clear there is a disconnect and we need to see a change since it is going to erode the gains,” he said.

However, the survey reported that the usage of short-term acting methods increased from 23 per cent in 2019 to 27 per cent in 2020 while that of long-term methods reduced from 20 to 19 per cent in the same year, with the demand satisfied by modern methods increasing from 74 to 76 per cent.

This means that out of 10 women that needed modern family planning in 2020, eight were able to get the methods. However, the stock-out was still a problem.