Imran Manji is a Clinical Pharmacist at USAID-AMPATH and an Adjunct Assistant Professor at the Purdue University College of Pharmacy. Based in Eldoret, Kenya, he graduated from the University of Nairobi in 2006 and joined the Moi Teaching and Referral Hospital, one of the partner institutions of AMPATH, in 2008. He oversees the pharmacy activities of AMPATH’s Primary Health Care and Chronic Disease Management Program.
Over the last 13 years, AMPATH (a partnership between Kenya’s Moi University School of Medicine, Moi Teaching and Referral Hospital, and a consortium of North American academic health institutions) has successfully scaled HIV care across Western Kenya, in partnership with the Kenya Ministry of Health, and is treating over 160,000 HIV-positive patients. In recent years, the Ministry of Health (MOH) and AMPATH were determined to extend existing HIV programs into models of primary care, maternal and child health, and chronic disease management, capable of meeting the health challenges of communities that go beyond HIV.
Revolving Fund Pharmacies can help keep essential medicines available to patients
The biggest challenge we ran into was a severe limitation of available drugs within the supply chain of the Ministry of Health: 60 to 70% of essential medicines are out of stock at health facilities run by the government, leaving many patients without critical medication or under-treated. It often forces patients to buy their drugs at private sector pharmacies, slamming them with prices up to 10 times higher than at government facilities and offering medicines that could be of questionable quality.
In their aspiration to provide an affordable and efficient alternative for the commercial sector, Moi University and AMPATH found Grand Challenges Canada. With the help of a $100,000 seed grant, we rolled out a business model called Revolving Fund Pharmacy (RFP).
The idea is simple yet effective: the RFPs provide back-up supplies of crucial medications in the event that pharmacies in government health facilities run out of supplies. With the support of the Ministry of Health, drugs are sold from the RFP at a small cost. Prices are slightly higher than the government pharmacy but much lower than the private outlets.
The money collected is used to help the RFP restock, thereby ensuring continuous availability of essential medicines, with any excess money going towards running of the health facility. All established Revolving Fund Pharmacies have become independent and sustainable. The longer-term goal is to create a paradigm shift so that resource-constrained patients are viewed as a viable market, switching the focus from giving out free drugs to charging reduced user fees in order to trigger sustainability.
After 18 months, our project was able to open 12 pharmacies, serving a total of 300,000 patients. All locations were able to maintain essential drug availability of over 90%. And there’s more. Because of the RFP, we now have the opportunity to provide an innovative primary healthcare insurance product, in partnership with the Kenya Ministry of Health, which offers the opportunity to shift the focus of disease management from one of acute care to one of chronic disease management and prevention.
Overall, we consider our project, supported by Grand Challenges Canada, innovative in many ways. First and foremost, it is helping to tackle an important challenge in global health: the access to affordable and effective medication, especially in rural locations, with a novel approach. Secondly, it is introducing a business model, promoting sustainability, social impact and independence from external funding by using a market model approach. An additional benefit is job creation: this innovative approach has generated 12 jobs so far.