An Israeli soldier works on a tank near the border with Gaza on Saturday.
On April 4, Pamela Mantyi left her house in Naledi in Soweto at 3.45am to go to the Chiawelo clinic to fetch her monthly stock of insulin injections.
She’s a diabetic and the injection, Actraphane 30, keeps her blood sugar levels under control. Actraphane 30 is on the health department’s essential medicines list, which means public health facilities have to provide it to patients.
But when she was finally seen by a nurse at 11am, she was told that the clinic had run out of the medicine and she should return the following week.
For the entire month of May she visited the clinic each week, only to be told that there was either only enough stock for a week’s supply of her injections or no stock at all.
Mantyi had to pay R20 return taxi fare each time she visited the clinic.
“I am unemployed and I cannot afford to buy my own medication,” she says. “My neighbour’s daughter buys treatment for her on her medical aid, so sometimes I can borrow treatment from her. But I think she’s getting tired of me now, because when I went there the other day she told me she doesn’t have [medication], but I know she has.”
Mantyi finally got her supply in the first week of June. But another stock-out could happen at any time.
Stock-outs survey
On Thursday, the civil society coalition Stop Stock-outs released the results of its second national survey on drug stock-outs at the national Aids conference in Durban. The country’s drug stock-out problems have worsened, the survey found.
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 asked whether there were drug stock-outs of essential medicines on the day of the call and also in the previous three months.
The Stop Stock-outs researchers found that one in four public health facilities (25%) ran out of antiretroviral (ARV) medicines or tuberculosis (TB) medication in the last quarter of 2014, compared with one in five facilities (20%) that experienced stock-outs in 2013.
The provinces where the situation has deteriorated the most include the North West, where almost 10 times as many facilities (39%) experienced ARV and TB medication stock-outs in 2014 compared to 2013 (4%), and Mpumalanga, where 40% of facilities ran out of medication in 2014 compared with 26% in 2013.
In Mpumalanga’s Gert Sibande district, which is a National Health Insurance (NHI) pilot site, 41% of facilities ran out of ARV or TB drugs in late 2014.
In the Eastern Cape, at least half of the facilities in the Alfred Nzo district experienced stock-outs.
Improvements and vaccines
The only two provinces that have shown an improvement in TB and HIV drug availability is Limpopo, where 29% of facilities experienced stock-outs in 2014 compared with 41% in 2013, and the Western Cape, where the figure improved slightly from 5% in 2013 to 4% in 2014.
The survey also looked at the availability of three childhood vaccines – the 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 and medication for epilepsy and hypertension.
More than one in 10 facilities reported stock-outs of at least one of these vaccines. In the 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, a third of stock-outs (33%) lasted for more than a month, which often led to patients being sent home without any medication.
“Regular drug stock-outs pose serious problems and challenges to the kind of National Health Insurance system that the health minister wants to implement,” says Mark Heywood, the executive director of social justice group Section27.
“Our NHI is founded on the district health system and the notion of primary healthcare. Systems for the supply of essential medicines of all sorts, not just ARVs and TB medicine, are critical for the functioning of a district health system. If we can’t get that right, and this survey shows that we’re failing in that regard, then the building blocks for an NHI aren’t there.”
Worse in NHI pilot site
He says what is most worrying is that the situation is at its worst in a NHI pilot site such as Gert Sibande, where effective drug supply systems are supposed to be developed so that other districts can base their systems on a tried and tested method.
“Clinics there run out of everything,” Heywood says. “An NHI would never work unless there is a functioning drug system in place.”
Researchers 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.
But on Wednesday, Health Minister Aaron Motsoaledi issued a statement in which he ascribed the “limited supply of approximately 155 medicines” to the “global shortage of active pharmaceutical ingredients”.
He said the supply of 82 medicines has been resolved, that the supply of 51 medicines would be resolved within the next three to four weeks and that the national health department intends to secure the other 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.
The minister added: “Antiretroviral medicines are not affected by manufacturer supply problems. Most patients on ARVs are taking the fixed-dose combination [a three-in-one ARV] 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 the case of emergencies.”
Although the Stop Stock-outs survey found that more facilities stocked fixed-dose combinations in 2014 than in 2013, 75 facilities that supply them experienced stock-outs in 2014.
