Family planning

Kenya: Shock over expired family planning implants the state gave to women

The government is about to release expired and contaminated family planning implants to Kenyan women.

The Nation has learned that a batch of implants imported by the United Nations Population Fund (UNFPA) and released by the Kenya Medical Supplies Authority (Kemsa) in Lamu, Kwale, Nyamira and Kakamega counties had developed mold and recipients have since been notified to discontinue their use, with a suspension of distribution in other counties.

The implants arrived in October last year and were delivered to Kemsa in June, after remaining eight months at the port of Mombasa due to bottlenecks due to a shortage of family planning method.

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

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

Quality assurance

From port to warehouse, the Nation learned, quality assurance was done and immediately the Department of Health’s Reproductive Health Division confirmed that the implants could be distributed to counties.

“At Kemsa, we don’t buy donor-funded products, we only do warehousing and distribution. We didn’t have any contributions. We were just given the distribution list and took them to counties,” a source told the agency, who requested anonymity.

According to a written note to the counties that received the shipment, they were told to check the shipment for any signs of mold, then immediately quarantine the items and return them to the Kemsa warehouse.

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

In March, when the Nation learned that the shipment was stuck at the port, she wrote an email to the UNFPA representative for Kenya, Dr Ademola Olajide, inquiring about the condition and why the products were blocked when there was a shortage.

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

Recall directive

The products were delivered to Kemsa in June and later to counties earlier this month and two weeks later counties were told to stop giving them to women. However, some women in one of the counties had already received the implants.

“I’m not going to give you the exact number of women who received the method, but I can confirm that we gave the method to some women because at the time of their delivery, we had been experiencing stockouts for about seven months and when we announced that they were in the facilities, women came to get them, ”said an officer in one of the counties.

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

“You know, when they were brought into the boxes, we couldn’t tell they had molds until we opened them. They sat for a long time without being used.”

The question that needs to be answered is how contaminated the drugs have been and how this will affect women who have received the drug and whether it is acceptable to remove it after insertion.

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

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

“As the distributing agency on behalf of the donor and importing agency, we have activated a recall process developed in accordance with our operational procedures. This recall is to ensure public safety and will be strictly enforced,”

A survey carried out 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 , stressed that stock-outs remained a problem, both in public and private health facilities.

“Over time, there have been changes in facilities reporting not offering the services and most of them are dispensaries. This could be due to staff and even materials and stockouts,” said Professor Peter Gichangi, Principal Investigator of PMA.

The report also states that stock-outs of intrauterine devices in public health facilities increased from 7% in 2019 to 11% in 2020.

Stock-outs of implants have remained almost constant, while stock-outs of injectables, the most widely used method, fell from 13% to 7% between 2019 and 2020.

Of the 822 public hospitals surveyed, 70% said they ordered but did not receive the delivery, 10% increased their consumption, 7% ordered but did not receive the correct quantity, and 7% did not spend order for shipment.

Disconnect

“We need to look at where the disconnect is happening. Why would you order but not receive delivery? Clearly there is a disconnect and we need to see change because it will erode the gains,” he said. -he declares.

However, the survey indicated that the use of short-acting methods increased from 23% in 2019 to 27% in 2020, while that of long-acting methods increased from 20% to 19% in the same year. , the request being satisfied. by modern methods from 74 to 76%.

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