Why has Gauteng run out of ARVs?

Activists are calling for the Gauteng health department to be placed in intensive care, with a strong dose of medicine required to nurse it back to health. According to activist organisation the Treatment Action Campaign (TAC), the province's health system is perpetually hobbled by drug and staff shortages, and broken equipment. 

The TAC has received numerous reports of medicine being out of stock across the province, specifically of antiretrovirals (ARVs), ­epilepsy and blood pressure drugs.

"We started getting emails of shortages of efavirenz [an antiretroviral drug] in [City Clinic] in Germiston," said Steven Ngcobo, TAC Gauteng provincial co-ordinator. "The nurses say they order 1000 boxes but [only] get 200, and shortly after they have to place more orders." He said the complaints started in February this year. 

The reports prompted the TAC to look into potential shortages at clinics across the province. They say that, for weeks now, nurses at Phenduka Clinic on the East Rand have been writing prescriptions for HIV patients and sending them to a pharmacy in town, where they are told to purchase their ARVs – drugs that should be provided for free. 

A Phenduka patient, who asked not to be named, said when she visited the clinic in March to collect her treatment she was handed a prescription instead. "I was told there are no pills. The sister wrote a prescription for me to go buy them in Alberton for a couple of hundred rand. I don't even have that money." 


According to the patient, she "had two pills left that day". She ended up asking her neighbour to share some of hers. "But she said I should go buy my own treatment because there wasn't enough."

Another patient, Khetukthula Hlongwane, said she was given a small supply of ARVs for 10 days, but only after pleading with the health workers. "The nurses treat us badly and shout at us for wanting this treatment and tell us to go and buy it. But where will I get that money? I am unemployed." 

Department of Health vs. suppiers
The TAC said officials at the clinic claimed they had not received sufficient supplies and that depots were out of stock of some medicines. The TAC said it was being given the runaround by the provincial health department when it asked for information on why there are shortages.

Provincial health department spokesperson Simon Zwane said his department was not responsible for the recent hiccups in the system. Instead, he pointed a finger at the suppliers. "To address the issue, the MEC [Hope Papo] has contacted other companies to supply ARVs and meet the demand," he said. "Those companies have already begun distributing." 

But suppliers have also pleaded innocence. Zolani Kunene, a representative for Adcock Ingram, said the 2013/2014 ARV tender award conditions allowed for a three-month lead time to supply initial orders. "All orders thereafter are subject to a six-week lead time. We are currently on course to meet our requirements." 

Another supplier, Aspen Pharmacare, said it had not halted distribution either, and was un-aware of the problem. 

The shortages are not the only challenges faced by the provincial department: it has encountered significant difficulties over the past few years, with matters coming to a head in 2012 when debt accruals led to the nonpayment of drug suppliers and broken equipment that remained unrepaired. 

The province's woes are also not simply an unfortunate anomaly. As recently as October and November last year, the Eastern Cape and Limpopo experienced critical drug shortages of ARVs and TB medicines. In Mthatha in the Eastern Cape, strike action led to the suspension of three-quarters of the medical supply depot workforce, which caused delays in getting the ARVs to clinics. 

There are also national problems. Last year's nationwide shortage of tenofovir, a key ARV drug, forced the national department to source the medicine from alternative manufacturers after the department said that two main producers, Sonke Pharmaceuticals and Aspen Pharmacare, could not keep up with the demand. The companies contended that the department did not order enough supplies, or order them on time. The department's newest ARV tender, to be implemented this month, will source ARVs from different suppliers in an effort to prevent future shortages. 

National office of health standards compliance
Mark Heywood, the executive director of the social justice organisation Section27, said plans to establish a national office of health standards compliance, already under way, would also help to prevent shortages. 

"At least you will have an independent statutory body that ­people could report to and those complaints will be investigated," he said. "The facility should have norms and standards so a person can assess what a clinic should be providing them with and what ­medicines a clinic should always have."

The nurse programme manager at The Southern African HIV Clinicians Society, Nonhlanhla Motlokoa, said another way of eliminating challenges would be to shorten the lengthy, multistep process required to get pills ordered and delivered. "There are too many levels … The medicine starts at the national depot, and from there it goes to the provincial depot, from there it goes to the hospital where it is pre-packed. In other instances you find that suppliers are not paid and they stop delivering the ARVs." Motlokoa said it would be better if medicine was delivered directly to facilities.

Regardless of the steps taken to fix the system, the TAC maintained a long-term, proactive approach is needed, rather than a series of short-term reactionary responses. "When we say there is nothing this side they will deliver and patch here, whereas the other areas [continue to be] without [medication]," the TAC's Gauteng chair Sibongile Tshabalala said of the provincial department. "We are unhappy about that. We want the health system to be normal everywhere."

Ayanda Yeni is a researcher at the M&G Health Journalism Centre. This story is produced with the ­support of the Open Society ­Foundation and is editorially independent of any sponsorship

 

Subscribe to the M&G

These are unprecedented times, and the role of media to tell and record the story of South Africa as it develops is more important than ever.

The Mail & Guardian is a proud news publisher with roots stretching back 35 years, and we’ve survived right from day one thanks to the support of readers who value fiercely independent journalism that is beholden to no-one. To help us continue for another 35 future years with the same proud values, please consider taking out a subscription.

Related stories

How US foreign policy under Donald Trump has affected Africa

Lesotho has been used as a microcosm in this article to reflect how the foreign policy has affected Africa

Covid-19 disrupts HIV and TB services

While data is still trickling in on how much the pandemic affects health systems, there are far-reaching consequences for people living with HIV and tuberculosis.

The challenges of delivering a Covid-19 vaccine in Africa requires a new approach

It is imperative that we train healthcare workers and participate in continent-wide collaboration

Covid-19 sets HIV treatment and testing back

Fewer people are getting tested for HIV than last year. People are also battling to access chronic medication. These are some of the lasting effects of the lockdown and the coronavirus pandemic

Covid-19 is an opportunity to make our circles bigger

Xenophobia stalks us in this moment of crisis; our hope lies in humanity’s capacity to rebuild

Eusebius McKaiser: A witness to Covid-19 stigma

Let us please not repeat the devastating Aids story where people died of shame rather than admit being infected by the virus
Advertising

Subscribers only

SAA bailout raises more questions

As the government continues to grapple with the troubles facing the airline, it would do well to keep on eye on the impending Denel implosion

ANC’s rogue deployees revealed

Despite 6 300 ANC cadres working in government, the party’s integrity committee has done little to deal with its accused members

More top stories

Fake trafficking news targets migrants

Exaggerated reports on social media of human trafficking syndicates snatching people in broad daylight legitimate xenophobia while deflecting from the real problems in society

It’s not a ‘second wave’: Covid resurges because safety measures...

A simple model shows how complacency in South Africa will cause the number of infections to go on an upward trend again

Trouble brewing for Kenya’s coffee growers

Kenyan farmers say theft of their crop is endemic – and they suspect collusion

Unisa shortlists two candidates for the vice-chancellor job

The outgoing vice-chancellor’s term has been extended to April to allow for a smooth hand-over
Advertising

press releases

Loading latest Press Releases…

The best local and international journalism

handpicked and in your inbox every weekday