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Survey uncovers shortages in critical medication

A survey of stock levels of HIV drugs is in stark contrast to health department claims that “there is no shortage”.

South Africa’s drug stock-out problems have worsened, according to the results of a survey by the civil society coalition Stop Stock-outs that was released on Thursday at the Aids conference in Durban. 

The findings are in stark contrast with Health Minister Aaron Motsoaledi’s claims in a press statement on Monday that “there is no shortage of ARVs”. 

The Stop Stock-outs researchers found that one in four public health facilities in South Africa ran out of antiretroviral (ARV) medicines or tuberculosis (TB) medication over a three-month survey period in 2014 compared with one in five facilities that experienced stock-outs in 2013.

Fixed dose combinations (three-in-one ARV pills) were however available at more facilities in 2014 than in 2013 – fixed dose combinations were introduced into the public health system in April 2013 and have been phased in over a two-year period. 

The three provinces in which the situation has deteriorated the most are North West, Mpumalanga and the Eastern Cape. 

In North West, 10 times as many facilities (39%) experienced ARV and TB medication stock-outs in 2014 compared with 2013 (4%).

In Mpumalanga, four out of 10 facilities ran out of medication in 2014 compared with 26% in 2013. In the province’s Gert Sibande district, which is a National Health Insurance pilot site, 41% ran out of ARV or TB drugs. 

In the Eastern Cape, at least half of the facilities in the Alfred Nzo district experienced stock-outs.

The only two provinces that have shown an improvement with regards to TB and HIV drug availability is Limpopo, where 41% of facilities experienced stock-outs in 2013 and 29% in 2014, and the Western Cape where stock-outs improved slightly from 5% in 2013 to 4% in 2014.

Public facility participation

More than 80% of public health facilities in each province, except for the Free State, were willing to participate in the telephonic survey. Researchers spoke to the pharmacist or pharmacy assistant at each facility and enquired whether there were drug stock-outs on the day of the call and in the past three months.   

In addition to HIV and TB drugs, the survey looked at the availability of three childhood vaccines – rotavirus, pentaxim (a five-in-one vaccine that protects against diphtheria, tetanus, pertussis, poliomyelitis and other invasive infections) and measles, as well as essential medicines such as asthma inhalers, epilepsy and hypertension medicines. 

More than one out of 10 facilities reported stock-outs of at least one vaccine. In North West, 43% of facilities ran out of asthma inhalers and in the Northern Cape, 20% did not have regular supplies of hypertension medication. 

Nationally, one in three stock-outs lasted more than a month, which often led to patients being sent home without any medication. 

Researchers analysed the reasons for the stock-outs and found that facilities mostly ran out of medication because of management and logistical problems at provincial depots and clinics, and not because of supplier issues. 

‘Global shortage’

But on Wednesday Motsoaledi issued a statement in which he subscribed the “limited supply of approximately 155 medicines” to the “global shortage of active pharmaceutical ingredients”. Motsoaledi said the supply of 82 medicines had been resolved, the supply of 51 medicines will be resolved within the next three to four weeks and the national health department will secure supplies of the remaining 21 medicines from international suppliers. 

“In the interim, alternative therapeutic medicines will have to be prescribed. These medicines include certain antibiotics, cardiovascular medicines, analgesics, anaesthetic agents and central nervous system medicines,” he said. 

With regards to ARVs, the minister said: “Antiretroviral medicines are not affected by manufacturer supply problems. Most patients on ARVs are taking the fixed dose combination tablet. This is fully stocked at manufacturers and provincial depots. Additionally, there is a buffer stock of fixed dose combinations kept by the national department of health to be used in case of emergencies.” 

The Stop Stock-outs survey found that 75 facilities that supply fixed dose combinations ran out of stock in 2014.

Mia Malan is the founder and editor-in-chief of Bhekisisa. She has worked in newsrooms in Johannesburg, Nairobi and Washington, DC, winning more than 30 awards for her radio, print and television work.