External and internal factors affecting management of hospital drug formularies by health facilities in Nairobi

Abstract

The use of formularies in drugs management is a widely accepted practice and Kenya has adopted the World Health Organization (WHO) drug formulary model to develop its own formularies or essential drug lists. This study explored factors affecting management of drug formularies by both private and public health facilities in Nairobi. Specifically, the study sought to determine the type of formulary in use by various health facilities in Nairobi as well as exploring extents to which both identified external and internal factors influence the management of drug formularies in the said health facilities. A cross-sectional descriptive study was employed where the researcher used stratified random sampling as well as convenient sampling to draw a sample of 189 health facilities from the population. Results: There is 94% awareness of drug formularies, only 41.8% have participated in development of an Standard Treatment Guidelne or a drug formulary. 71.4% of respondents considered drug formularies very important. 73.5% of registered health facilities in Nairobi have adopted the Kenya Essential Ddrug List (KEDL). Out of the 73.5% above, 49.2% of the facilities have developed facility own drug formularies while 26.5% confirmed to not have used the national essential drug list at all. All ministry of health local authority facilities used the National essential drug list. Majority, 93.6% considered their formularies open while only 6.4% considered their formularies closed. Drug promotion poses the greatest influence to drug formulary non compliance while insurance was considered the least external factor in Nairobi health facilities. Under internal factors, lack of pharmacy and therapeutic committees or its equivalent topped the most challenging internal factor affecting the drug formulary availability and compliance. Conclusion: Drug formulary mangement in Nairobi health facilities is not fully developed and is also facing alot of challenges. Recommendations: There is need to base all facilities-own formularies on set standards while exploration of higher levels of formulary management will ensure more benefits to patients. Individual facilities must be more proactive in ensuring they operate within the national medicine policies which is possible through self regulation. Pharmacy and Therapeutic Committee in facilities to be enforced and also for health centres and dispensaries on need basis.