Health Minister Aaron Motsoaledi denies claims that there is a shortage of adequate drugs in SA. (Delwyn Verasamy, MG)

Motsoaledi refutes claims SA faces drug shortages

Lisa Steyn
The health minister says the media portrays the department as failing to provide drugs for patients, but supply is also subject to business decisions.

Health Minister Aaron Motsoaledi has hit back at media reports about drug shortages at public health facilities reaching crisis levels. 

Motsoaledi claimed there are "more than adequate" antiretroviral medicines for HIV treatment in each facility and district. He said South Africa was at the mercy of the global pharmaceutical industry for many other drugs.

Reading out a media statement spanning six pages on Sunday at a press briefing, Motsoaledi said a health department investigation into media claims that drug shortages had reached critical levels showed that such reports were incorrect.  

"Our own findings are that there were more than adequate Fixed Dose Combination [a three-in-one antiretroviral pill] available," Motsoaledi said. 

The investigation began when the minister cut a business trip to the World Health Assembly in Geneva short to fly back on Thursday May 21, to address widespread reports about the general unavailability of medicines in the country, which was alleged to have reached crisis proportions. 

Motsoaledi said the whole "saga" started with a national newspaper’s headline about extreme drug shortages in the country, presumably the Time’s story entitled "dying for drugs" published on May 18, which reported the current list of medicines that are out of stock or in short supply around the country runs to six pages and includes antibiotics, tuberculosis medicine, anti-psychotics and antiretroviral drugs.

This report, the minister said, was followed by an ENCA report on May 19 where a patient from Esigodeni clinic in KwaZulu-Natal said in an interview she had not received her antiretroviral medicines and that other people were turned away from the clinic because of a shortage of medicines. She said she developed a rash and had developed piles since skipping her medication.

Motsoaledi explained that a rash was a particularly worrying side effect and would indicate a change in treatment is required, but because the identity of the woman was protected, even from the minister, "we were forced to go on a wild goose chase", he said. 

Through further searching the woman interviewed was identified by the department, but it was found she in fact attended another clinic and she had been supplied with two months of Fixed Dose Combination pills on May 5 this year. Her medical records showed her rash occurred last year and had been attended to at that time.

"Our patients claim a lot of wild things and when we investigate we find it’s not true. We don’t know why people do this," the minister said. He said while there is often suspicion about the truthfulness of government, there is proof that there is no shortage in supply of adult ARV’s at least in KwaZulu-Natal. 

KwaZulu-Natal is one of two provinces where a new cell phone technology that traces drug stock-outs right up to the facility level, is being piloted. "Because of this system we can tell you what is happening in every clinic in KZN, which is why the [ENCA] story … came as a complete surprise to us … If it were any other province we would have been caught with our pants down, but for KZN we have all this information."

Motsoaledi said that the reports had warranted the investigation because the fixed-dose combination programme is the department’s "flagship programme" and needed to be protected. 

He said one of the main advantages was that it was more than 50% cheaper than the alternative (providing each patient with three different pills), costing R14-billion to run versus R29-billion. 

Drug supply subject to 'profit-seeking corporates'
However the minister acknowledged that drug supply in South Africa, like in many other countries, is subject to business decisions made by profit-seeking corporates. "There are lots of essential medicines, which are always in short supply."

This is why a list of medicines was published by the department and subsequently reported on by the Times on May 18. "That list was released on our website as an early warning system to solve particular problems," the minister said. He explained that it was to help provinces and facilities (who were responsible for ordering drugs) to know not to place orders with particular companies struggling to supply particular drugs.

Notably, Mostoaledi explained, there recently was a "severe shortage" of Abacavir (an ARV used for children) because all three suppliers of the drug had difficulty in sourcing sufficient active pharmaceutical ingredients to produce sufficient quantities of both the syrup and the tablets. 

Atop that, one supplier had three batch failures and had to investigate the reasons before stock could be released. Supplies of the drug should normalise by the idle of June and orders fulfilled by the end of June. Patients had been given a drug known as AZT as a replacement when necessary. 

"All these issues at play are beyond my control as government," Motsoaledi said. 

Some of the media reports, and many more before this latest matter made the news, have suggested that one of the biggest issues is non-payment of suppliers. But Motsoaledi refuted this. "At no stage did any company report that the shortages were related to non-payment of ARV’s despite us asking them directly," he said. 

Report on drug shortage
Marcus Low, head of policy at the HIV lobby group Treatment Action Campaign (TAC) said he could not comment on specifics of the media statement on Sunday as he had not had time to review it.  

"Over the last two months, we have picked up from patients telling us they can’t get medicines in Mpumalanga and Limpopo, and hearing the same thing from the Rural Doctors Association [of Southern Africa]. Some of it is  Abacavir, but it’s not just that."

However, Low noted that the Stop Stockouts project, a group of civil organisations that monitors drug stock-outs, and in which the TAC is involved, will publish a report in coming weeks, which shows the national trend when it comes to drug shortages, "and it’s clear that in general the condition has not changed much," Low said.

"What we know from tracking this stuff over the past few years, is some of the problem is supply shortage, but most of the time that’s not the issue, it’s distribution issues … and very poor forecasting." 

Low noted there had been a lot of co-operation from the national department over the past year but "the problem has more to do with wider collapse of the healthcare system and the minister isn’t in a position to fix it in Mpumalanga and in the Free State".

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antiretroviral drugsAaron MotsoalediDepartment of Healththe Times