Simple solution: A fixed-dose combination ARV pill should make distribution and patient compliance easier.
Simple solution: A fixed-dose combination ARV pill should make distribution and patient compliance easier.

Forty percent of 70 Eastern Cape health facilities ran out of HIV or TB drugs in May, and in almost a quarter of cases medical staff was forced to send patients home without treatment.

These statistics were according to a new report released on Tuesday by a health coalition at the 6th South African Aids conference. Only 7% of the facilities were able to switch patients to another drug, or drug formulation, for lack of the original regimen. The coalition, driven by advocacy organisation Médecins Sans Frontières, surveyed facilities in the Mthatha catchment area.

Drug stock-outs lasted, on average, 45 days at a time and remain almost as common and severe as they were five months ago, when the coalition analysed the impact of a management and drug supply crisis at the Mthatha depot. It was estimated that thousands of people were forced to interrupt their HIV treatment – potentially leading to tens of excess deaths over the course of the year.

History of dysfunction
"It seems very little was learnt from our report in January to the Eastern Cape health authorities. It is unacceptable that there has been little or no change. We demand that Eastern Cape minister for health Sicelo Gqobana take leadership to end these stock-outs," said Treatment Action Campaign general secretary Vuyiseka Dubula. 

According to the report, the Mthatha depot has a long history of dysfunction. "The recent crisis has been particularly acute and began around October 2012. The Eastern Cape health department's decision to suspend 29 depot staff [members] without a plan to provide services in their absence contributed significantly to the crisis," stated the report. "The ongoing stock-outs are in part the result of this still unresolved situation, as well as chronic regional supply chain inadequacies and national drug shortages."

The coalition's May 2013 follow-up survey revealed "the cruel impact" of the "collapse of the depot", which still does not have a full-time manager and is operating with half the usual number of packing staff members.

"The depot's dysfunction is an on-going violation of a number of legal rights and obligations. The state of the depot cannot be allowed to continue at the cost of human lives. The Eastern Cape health department appears to be unable or unwilling to address the problems, despite knowing of them for several years and despite immense support from civil society. We demand to see the national minister of health use his powers in terms of section 100 of the Constitution to intervene on an emergency basis to provide health services in line with national standards," said John Stephens of the advocacy organisation Section27.