Financing and availability of essential medicines before and after introduction of the national hospital insurance fund civil servants and disciplined services medical scheme: a case study of Webuye district hospital, western Kenya

Abstract

Introduction: About 30% of the world’s population is estimated not to have access to essential medicines. Studies done in Kenya have shown that public facilities experience stock-outs of basic essential medicines for about 46 days per year. One of the determinants of access to essential medicines is financing. Introduction of the National Hospital Insurance Fund Civil Servants and Disciplined Services Medical Scheme affords additional funding for a district hospital. Following this, it is expected that the stock-out rate of essential medicines at Webuye District Hospital would reduce. Main Objective: The study aimed to compare availability of essential medicines and funding of essential medicines before and after implementation of the National Hospital Insurance Fund Civil Servants and Disciplined Services Medical Scheme. Methods: This was a retrospective longitudinal before-after study of four years; the latter two of which the National Hospital Insurance Fund Civil Servants and Disciplined Services Medical Scheme package was in operation. The study period was January 2010 – December 2013. Stock control cards from the pharmacy store and accounting records were the main sources of data. Data was extracted into various data collection forms. Data was analyzed using MS Excel, SPSS and STATA. Results were statistically significant when p<0.05. Results: The period after introduction of the scheme experienced a significantly higher allocation for the medicines budget from the Facility Improvement Fund (p=0.008). Actual expenditure onessential medicines were also higher. There was less funding from the government supplier of medicines, KEMSA after introduction of the new scheme (p<0.0001). There was a change in stockout rate after introduction of the new scheme, falling from 21.75% in 2010/11 to 19.47% in 2012/13. The change was however not statistically significant (p=0.099). Regression analysis found that an increase in the amount of Facility Improvement Fund spent on essential medicines was a significant independent predictor of a reduction in stock-out rate, and that a higher rate of unfilled KEMSA orders for a particular medicine predicted a higher stock-out rate. Conclusion Even though financing of medicines through the Facility Improvement Fund increased after introduction of the new scheme, there was no change in the stock-out rate due to prevailing contextual factors