PMID- 33214173
OWN - NLM
STAT- MEDLINE
DCOM- 20210624
LR  - 20210624
IS  - 2059-7908 (Print)
IS  - 2059-7908 (Electronic)
IS  - 2059-7908 (Linking)
VI  - 5
IP  - 11
DP  - 2020 Nov
TI  - Solving the problem of access to cardiovascular medicines: revolving fund 
      pharmacy models in rural western Kenya.
LID - 10.1136/bmjgh-2020-003116 [doi]
LID - e003116
AB  - 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.
CI  - (c) Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Tran, Dan N
AU  - Tran DN
AUID- ORCID: 0000-0002-8332-8196
AD  - Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, IN, USA 
      tran.nk.tina@gmail.com.
AD  - Pharmacology and Toxicology, Moi University College of Health Sciences, Eldoret, 
      Kenya.
AD  - Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
FAU - Manji, Imran
AU  - Manji I
AD  - Pharmacy, Moi Teaching and Referral Hospital, Eldoret, Kenya.
FAU - Njuguna, Benson
AU  - Njuguna B
AD  - Pharmacy, Moi Teaching and Referral Hospital, Eldoret, Kenya.
FAU - Kamano, Jemima
AU  - Kamano J
AD  - Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
AD  - Medicine, Moi University College of Health Sciences, School of Medicine, Eldoret, 
      Kenya.
FAU - Laktabai, Jeremiah
AU  - Laktabai J
AD  - Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
AD  - Family Medicine, Moi University College of Health Sciences, School of Medicine, 
      Eldoret, Kenya.
FAU - Tonui, Edith
AU  - Tonui E
AD  - Pharmacy, Kericho County Referral Hospital, Kericho, Kenya.
FAU - Vedanthan, Rajesh
AU  - Vedanthan R
AUID- ORCID: 0000-0001-7138-2382
AD  - Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
AD  - Department of Population Health, New York University Grossman School of Medicine, 
      New York, NY, USA.
FAU - Pastakia, Sonak
AU  - Pastakia S
AUID- ORCID: 0000-0003-4259-695X
AD  - Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, IN, USA.
AD  - Pharmacology and Toxicology, Moi University College of Health Sciences, Eldoret, 
      Kenya.
AD  - Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
LA  - eng
GR  - PEPFAR/PEPFAR/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - England
TA  - BMJ Glob Health
JT  - BMJ global health
JID - 101685275
SB  - IM
MH  - *Financial Management
MH  - Health Services Accessibility
MH  - Humans
MH  - Kenya
MH  - *Pharmacies
MH  - *Pharmacy
PMC - PMC7678234
OTO - NOTNLM
OT  - cardiovascular disease
OT  - descriptive study
OT  - diabetes
OT  - health services research
COIS- Competing interests: Sonak Pastakia serves as a consultant for Abbott and Becton 
      Dickinson on work unrelated to the study being presented here. The other authors 
      declare that they have no competing interests.
EDAT- 2020/11/21 06:00
MHDA- 2021/06/25 06:00
PMCR- 2020/11/19
CRDT- 2020/11/20 05:42
PHST- 2020/06/09 00:00 [received]
PHST- 2020/09/17 00:00 [revised]
PHST- 2020/09/20 00:00 [accepted]
PHST- 2020/11/20 05:42 [entrez]
PHST- 2020/11/21 06:00 [pubmed]
PHST- 2021/06/25 06:00 [medline]
PHST- 2020/11/19 00:00 [pmc-release]
AID - bmjgh-2020-003116 [pii]
AID - 10.1136/bmjgh-2020-003116 [doi]
PST - ppublish
SO  - BMJ Glob Health. 2020 Nov;5(11):e003116. doi: 10.1136/bmjgh-2020-003116.