Abstract:
Availability of medicines for treatment of cardiovascular
disease (CVD) is low in low-income and middle-income
countries (LMIC). Supply chain models to improve the
availability of quality CVD medicines in LMIC communities
are urgently required. Our team established contextualised
revolving fund pharmacies (RFPs) in rural western Kenya,
whereby an initial stock of essential medicines was
obtained through donations or purchase and then sold at a
small mark-up price sufficient to replenish drug stock and
ensure sustainability. In response to different contexts and
levels of the public health system in Kenya (eg, primary
versus tertiary), we developed and implemented three
contextualised models of RFPs over the past decade,
creating a network of 72 RFPs across western Kenya, that
supplied 22 categories of CVD medicines and increased
availability of essential CVD medications from <30%to
90% or higher. In one representative year, we were able to
successfully supply 5 793 981 units of CVD and diabetes
medicines to patients in western Kenya. The estimated
programme running cost was US$6.5–25 per patient,
serving as a useful benchmark for public governments to
invest in medication supply chain systems in LMICs going
forward. One important lesson that we have learnt from
implementing three different RFP models over the past 10
years has been that each model has its own advantages
and disadvantages, and we must continue to stay nimble
and modify as needed to determine the optimal supply
chain model while ensuring consistent access to essential
CVD medications for patients living in these settings.
