Stakeholder Mapping and Their Roles in the Veterinary Antibiotic Supply Chain in Kenya

Abstract

drugs, and weak enforcement of laws and regulations. The livestock sector in most of Sub-Saharan Africa is affected by counterfeit and poor-quality veterinary drugs attributed to the lack of traceability of drugs in markets. To effectively regulate and reduce antibiotic misuse in the livestock sector within Low and Middle-Income Countries, an understanding of the national veterinary antibiotic supply chain will help shed light on the supply chain's complexities and identify nodes in the chain for targeted policy interventions. This study aimed to assess the veterinary antibiotic supply chain in Kenya to understand the flow of antibiotics from import to end-user, identify governance structures, and investigate challenges along the supply chain. Qualitative and quantitative methods were used to collect data in three counties (Nairobi, Kiambu, and Kajiado). Focus group discussions (n=23), individual interviews using structured questionnaires (n=148), and key informant interviews (n=10) were conducted with respondents. Livestock farmers (dairy, pig, and poultry), veterinary drug store workers, and animal health service providers participated in focus group discussions and individual interviews while regulatory authorities, pharmaceutical companies, wholesalers, and pharmaceutical associations participated in the key informant interviews. Quantitative data was analyzed using Microsoft Excel while qualitative data was transcribed into a preformatted template in Microsoft Word organized around key themes related to the study objectives. The key actors along the antibiotic supply chains included primary wholesalers, secondary wholesalers, retailers, animal health service providers, and farmers. All veterinary antibiotics were imported either as finished pharmaceutical products (90%) or active pharmaceutical ingredients (10%). Primary wholesalers were the main importers of veterinary antibiotics. Once in the country, 64% of both finished pharmaceutical products and active pharmaceutical ingredients were distributed through secondary wholesalers, who sold them in bulk to retailers (e.g., veterinary drug stores) or directly to farmers and AHSPs. The remainder (36%) were distributed directly to retailers (14%), farmers (8%), private veterinary clinics (4%), and institutions (2%) and exported to regional markets (8%). Furthermore, there were illegal sources of antibiotics including unlicensed/unauthorised middlemen and online platforms that sold antibiotics directly to retailers, animal health service providers, and farmers. Some of the illegal practices mentioned included sharing of antibiotics among poultry farmers (14%), self-treatment of animals, and failure to observe withdrawal period. Despite presence of various laws and regulations governing the antibiotic supply, their implementation has been a challenge due to financial and human resource constraints. This contributes to over-the-counter sale of antibiotics without prescription, unlicensed businesses selling antibiotics, illegal importation, and counterfeit drugs. It is recommended that policymakers should review and address policy gaps (antibiotic combinations and use of human critically important antibiotics) in the existing policies to ensure prudent use and sale of antibiotics. Furthermore, pharmacovigilance, surveillance, and reporting on antimicrobial consumption, and developing a business model that is aligned with antibiotic stewardship should be initiated. National policy should address interventions on awareness creation and capacity building of different stakeholders along the antibiotic supply chain to reduce misuse.