Kenya’s Ministry of Health says KEMSA achieves a 90–92% order fill rate, yet access to essential medicines at patient level remains as low as 51% in some facilities. Closing this gap will require stronger hospital pharmacy systems, better stock management and accountability beyond procurement.
The medicine may have been supplied. Has the patient received it?
When a public health facility runs out of an essential medicine, patients experience the consequences immediately. They may be asked to buy the medicine from a private pharmacy, return on another day, switch treatment under clinical guidance or go without the medicine altogether.
These experiences reveal a critical weakness in health supply chains: delivering medicines to a facility does not automatically mean that patients can access them.
Kenya’s Ministry of Health brought this challenge into focus on 13 October 2026, reporting that the Kenya Medical Supplies Authority (KEMSA) has an order fill rate of 90–92%, while access to essential medicines at patient level remains as low as 51% in some facilities. The figures were highlighted by Principal Secretary for Medical Services Dr Ouma Oluga during the KEMSA National Conference on Health Product Procurement and Supply Chain in Naivasha.
The figures point to a need to look beyond warehouse performance and assess what happens after medicines reach health facilities. They do not, by themselves, establish the precise causes of the gap or imply that patient-level access is 51% nationally. Nevertheless, they raise an important question for Kenya’s health system: how can supply chain performance be measured by whether patients actually receive the medicines prescribed to them?
Where the supply chain loses patients
The journey from procurement to treatment involves several interconnected stages. Medicines must be accurately forecast, purchased, received, stored, distributed within facilities, prescribed appropriately and dispensed to patients.
A breakdown at any stage can undermine the entire process.
1. Procurement does not always reflect actual demand
When orders are based on incomplete consumption data or outdated forecasts, facilities may receive insufficient quantities of high-demand medicines while accumulating excess stock of less frequently used products.
Seasonal disease patterns, changing patient volumes, new treatment guidelines and local outbreaks can all affect demand. Procurement planning must therefore draw on reliable facility-level data and regular communication between pharmacists, clinicians, county health teams and suppliers.
2. Stock can reach a facility without reaching the dispensing point
Medicines may be available in a central store but unavailable in a particular ward, clinic or dispensary. Weak internal distribution, delayed requisitions, poor stock visibility and inadequate inventory management can create shortages even when the facility has stock elsewhere.
This makes facility-level monitoring essential. Health managers need to know not only what was delivered to a hospital but also what is available where patients receive care.
3. Expiry, wastage and poor stock rotation reduce usable supplies
Medicines that expire before use represent both a financial loss and a missed opportunity to treat patients. Inadequate storage, weak stock rotation and poor forecasting can contribute to avoidable wastage.
Facilities need clear procedures for tracking expiry dates, transferring usable stock where permitted, maintaining appropriate storage conditions and documenting losses.
4. Financial and administrative constraints can disrupt replenishment
Supply chain performance depends on more than logistics. Procurement budgets, payment delays, outstanding obligations, ordering procedures and coordination between national suppliers and county governments can affect the reliability of replenishment.
Where responsibilities are fragmented, shortages can persist even when individual institutions meet some of their own performance targets.
Why the gap matters for patients and health financing
Medicine availability is a core measure of whether health services deliver on their promise of accessible care.
For patients managing tuberculosis, HIV, diabetes, hypertension, cancer or other chronic conditions, interruptions can create additional visits, transport expenses, lost working hours and uncertainty about treatment. The clinical consequences depend on the medicine, condition and length of interruption, but the risk is especially important where continuity of treatment is essential.
When patients must purchase medicines privately because public facilities lack stock, costs can shift from the health system to households. Those unable to afford alternatives may delay treatment or leave without the prescribed medicine.
The gap also affects public spending. Governments and development partners may finance procurement, warehousing and distribution, yet the intended health benefit will not be fully realised if medicines are unavailable at the point of dispensing.
This is why medicine availability should be treated as both a supply chain issue and a health financing accountability issue. Decision-makers need to understand what was purchased, what was delivered, what remained usable, what was dispensed and where patients encountered barriers.
Moving from warehouse metrics to patient-level accountability
The Ministry of Health has called for hospital pharmacists to work more closely with doctors, nurses and other health professionals to improve forecasting, prevent stock-outs, reduce wastage and promote the safe use of medicines. It has also emphasised functional Medicines and Therapeutics Committees, with pharmacists participating in decisions on medicine selection, procurement, costs and patient safety.
These measures are important, but closing the gap requires a coordinated approach across national, county and facility levels.
First, measure availability where patients receive care. Order fill rates should be considered alongside facility stock-out rates, the availability of tracer medicines, prescription fulfilment and the frequency with which patients are asked to purchase prescribed medicines elsewhere.
Second, improve visibility of stock throughout the system. Digital inventory tools can help facilities track receipts, consumption, expiry dates and outstanding orders. Their effectiveness depends on reliable data entry, connectivity, staff capacity and the ability of managers to act on the information.
Third, strengthen demand forecasting. Procurement decisions should use consumption patterns, disease burden, service utilisation and facility-level needs rather than relying on historical allocations alone. County pharmacists and facility teams should have a meaningful role in determining requirements.
Fourth, make Medicines and Therapeutics Committees functional. These multidisciplinary teams can review medicine use, prioritise essential products, assess prescribing practices and identify recurring gaps between supply and clinical need.
Fifth, establish clear accountability for shortages. When an essential medicine is unavailable, facilities should document the shortage, its duration, the affected service and the corrective action taken. County and national managers should use this information to distinguish procurement failures from internal distribution problems, forecasting errors or other operational constraints.
Finally, protect the patient from avoidable costs. Facilities should communicate clearly about medicine availability and appropriate alternatives. Any substitution must follow clinical guidance, and patients should not be left to navigate supply chain failures without information or support.
What Kenya can build on
Kenya has already identified supply chain strengthening, digital systems and local pharmaceutical manufacturing as priorities in its efforts to improve access to health products and technologies.
The Ministry of Health has also highlighted the need for improved coordination between KEMSA, county governments and hospital pharmacists, with procurement informed by actual demand and consumption patterns.
These reforms offer an opportunity to align procurement performance with the outcomes that matter most to patients. However, digital platforms and improved ordering processes will not solve every problem on their own. They must be supported by adequate financing, trained pharmacy personnel, effective governance, reliable data and clear responsibilities for responding to shortages.
The next step is to use measurable patient-level indicators to determine whether these reforms are translating into more reliable access to essential medicines.
HealthSignal Africa takeaway
Kenya’s medicine supply challenge is not simply about getting products into warehouses or delivering orders to facilities. It is about ensuring that medicines are available, safe, appropriate and affordable when patients need them.
The reported difference between KEMSA’s order fill rate and patient-level access is a signal that health system performance must be assessed across the entire supply chain. The figures warrant closer investigation into facility-level availability, dispensing and the reasons patients may leave without prescribed medicines.
For policymakers, county governments, health financing partners and facility managers, the priority is clear: connect procurement data with dispensing data, identify where the system is failing and hold the relevant institutions accountable for closing the gaps.
Ultimately, a medicine supplied is an input. A medicine appropriately dispensed to the patient who needs it is the outcome that health systems must deliver.
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