South Africa is not yet winning the fight against stock outs of essential medicine supposed to be dispensed to vulnerable users of its public healthcare system countrywide. The picture painted by the recently released 2014 Stock Outs Survey similarly contains warning signs of a situation in Limpopo, which contributes to a national crisis as it counts among the five provinces with the largest proportion of facilities reporting stock outs of vital life-sustaining and life-saving medication last year.
The second annual national survey was conducted over the fourth quarter of 2014 and released by the Stop Stock Outs Project (SSP) last Thursday. SSP is an independent civil society coalition that monitors and speaks out about medicine stock outs and shortages, with the aim of achieving a stock out-free health system. It further seeks to ensure that all people have access to the medicines they require and to which they have a right. The SSP consortium consists of Medicins Sans Frontieres (MSF), Section 27, the Rural Doctors Association of Southern Africa (Rudasa), Treatment Action Campaign (TAC), the Southern African HIV Clinicians’ Society and the Rural Health Advocacy Project. The survey results point to ongoing drug stock outs at facilities across the country and highlight a crisis, especially when considering that thousands who have no other option than dependency on the state for their physical well-being are affected. It was found that five of the nine provinces – Limpopo, Mpumalanga, North West, Free State and Eastern Cape – were severely affected as more than one in three health facilities reported a stock out of at least one antiretroviral (ARV) or Tuberculosis (TB) medicine during the three-month survey period.
In an accompanying media release it was stated that the results showed that most medicines were available at South Africa’s medicine depots, but that patients were unable to get their prescriptions fully filled in health facilities because of downstream logistical and management problems, ranging from inaccurate forecasting to storage or transport issues. “In 22% of reported ARV and TB stock outs, patients were sent home with no medication.” It was added that in 35% of cases the patient had been given a smaller supply, switched to an alternative which increased the number of pills they needed to take or a less than optimal regimen was given.
In the executive summary of the report it is stressed that South Africa has among the largest HIV and TB epidemics in the world and that a reliable supply of life-saving medication is a constitutional right as well as critical to personal and public health. Further on in the report it is indicated that, with approximately three million people on antiretroviral therapy (ART) and more than 300 000 treated for TB every year, South Africa puts incredible demands on its health system. The report included survey details on the availability of, among others, vaccines and other essential medicines for conditions such as hypertension and asthma.
The report analysis stressed that an ineffective supply chain can weaken the entire health system’s ability to provide effective health care. It was emphasised that in 20% of the reported stock out cases in both 2013 and 2014, patients were turned away from facilities without medication. “These patients are the most affected by the adverse impact of stock outs. Facing stock outs, many patients will be at risk of developing and transmitting drug resistance, interrupting and even defaulting treatment, and ultimately increased risk of illness and death.”
However, all is not bleak for users of the public healthcare system in Limpopo. According to statistics provided by SSP, two out of five clinics and hospitals in Limpopo reported shortages of at least one ARV/TB medicine during the 2013 survey period. “A huge improvement was seen in 2014 where two out of seven clinics reported a stock out of ARV/TB medicine in Limpopo.”
Counting among the three worst affected provinces hit by HIV and TB medicine stock outs as underscored by the report, 29% of the 266 responding facilities in Limpopo reported stock outs or shortages in 2014 while facilities in the province still had 46% of stock outs of the same medicine lasting more than a month at a time during the same period, it was learnt. According to the key provincial findings it was the lengthiest in the country. As per the figures contained in the SSP survey, 29% of facilities in Limpopo reported at least one ARV/TB stock out in the three-month period prior to contact, as opposed to last year’s 41%. Also 21% of facilities in the province reported at least one ARV/TB stock out on the day of contact.
The study applauded the committed action plans of the Departments of Health in Limpopo, Gauteng, Northern Cape, North West and Western Cape to resolve stock outs of medicine. A departmental overview from each province is attached to the report, including that of Limpopo that has identified common causes and strategies for mediation of stock outs. In the report the problem was addressed by the Office of the Senior Manager for Pharmaceutical Services in the Department of Health in Limpopo, describing the causes for medicine stock outs as very complex with many contributing factors. “Limpopo department is in no denial that there are challenges with regards to (the) availability of medicines at facilities. Despite the challenges that there are, as Limpopo province we are making advances in small pockets and once all complete we should see a turn around. Even where systems are put in place, the issue of stock outs is further compounded by its very dependence on (the) human factor for reporting as well as for prevention thereof.
“As reported above, the Limpopo Department of Health monitors medicines availability and we found it disturbing in many instances that the stock reported as out of stock during the survey period was in actual fact available at the depot. We look into this matter seriously and this calls for us to strengthen our surveillance. We also appreciate the efforts by the SSP and would welcome partnering in order to create alerts for us to assist (to) get to the bottom of the problem.”