It was reported that the use of PETS has had a major policy impact in the health sector. For instance in the 2004 PETS, some of the deficiencies or inadequacies identified with regard to medical supplies were attributed to a top-down approach whereby the medical requirements of health facilities were planned and procured at national, provincial or district level with no participation from the relevant health facility management. As a result of these findings there have been changes made in the Kenya Medical Supplies Agency's (KEMSA) distribution system and acquisition of medical supplies is now bottom up.