That only one in 10 patients with cancer, renal failure, heart, lung and sickle cell diseases, burns and other life-threatening illnesses in public hospitals can access morphine, a drug that alleviates severe and unrelenting pain, means the Ministry of Health has neglected palliative care.
The Kenya Harmonised Health Facility Assessment report for 2018/19 shows that patients with severe pain have had to make do with paracetamols or buy more effective medicines such as morphine. About 1.5 million Kenyans need palliative care, which includes access to affordable opioids, but a majority die in grief and pain, yet the country can easily ensure constant supply of inexpensive off-patent morphine that can retail at as low as Sh16 per milligramme or free of charge.
Last year, Kenya was praised, alongside Rwanda and Uganda, for having started making its own morphine solution, which was distributed to hospitals and hospices across the country through Kenyatta National Hospital and Kenya Hospices and Palliative Care Association (Kehpca), a non-governmental organisation.
From September 2016, they have been able to distribute over 20,000 bottles. A patient on an average dose of 10mg/ml every four hours requires one bottle-and-a-half for a month. This enabled thousands of patients to access free morphine in far-flung areas such as Lodwar and Kilifi. However, Kenya has had stock-outs since last June, leaving patients at the mercy of well-wishers who send donations to poor countries.
In coming years, the burden of non-communicable diseases that are mostly diagnosed in advanced stages will be huge, and so is the demand for effective pain medicines. As the government works to improve life for its citizens, it must also consider how to help them die well. In the Quality of Death Index report by Economist Intelligence Unit, which measures the quality of palliative care available to adults, Kenya ranks poorly as it struggles to provide adequate services for every citizen.
It is time that the Health ministry actively puts in place policy changes that support increased access to palliative care.
It should ensure the imported morphine powder used to reconstitute the oral solution is in the country on time to avoid stock-outs and that it is promptly distributed to patients countrywide. Without palliative care, health coverage will not be universal.