At least in one in every five public health facilities has run out of HIV and/or tuberculosis (TB) drugs in the last two months, with medicine shortages in the country being "far beyond previous estimations", according to pressure group Stop Stock Outs Project’s latest report, which was released on Thursday.
During September and October this year the group conducted telephonic interviews about drug shortages with senior nurses and pharmacists at 2 139 of the 3 826 public health facilities that provide HIV treatment to patients in the country.
The Stop Stock Outs Project has urged the health department to develop a "concrete high level national strategy with clear timelines" to address drug shortages.
But ministry of health spokesperson Joe Maila, has slammed the report as "an extreme exaggeration". "We know for a fact that this report is inaccurate because the department already has a monitoring system in place which shows otherwise."
According to the report, the drug shortages might, however, be even worse than the survey had found, as a two month survey is "likely to underestimate the true extent of stock-outs and number of patients affected over time".
Describing the situation as a "national crisis", Stop Stock Outs warned that the situation is a threat to the lives of patients as well as to the government's extensive antiretroviral (ARV) programme through which an estimated 2.4-million people receive treatment. South Africa’s treatment programme is the largest in the world.
The group, which includes organisations such as Section27, Medicines Sans Frontieres (MSF) and the Treatment Action Campaign (TAC) found that while more than a third of facilities borrowed drugs from nearby hospitals or clinics to give to patients, 20% sent patients home with no medication at all.
The Free State is the hardest hit by drug shortages with over half of the facilities in the region reporting stock-outs, followed by Limpopo and Mpumalanga respectively.
"Patients in the Free State are frustrated – people are defaulting on treatment because they have no choice when they go to facilities and they are turned away without drugs," said Sello Mokhalipi the TAC’s provincial spokesperson.
He said these patients have a high risk of developing resistance to the drugs, which means they have to be switched to a more expensive, less available combination of ARVs with more initial side effects. "What if the second line regimen doesn’t go well with them? They might even end up losing their lives because of this negligence."
Facilities’ stock of vaccines were also surveyed by the group with 33.5% of facilities surveyed in Limpopo reporting shortages which, according to the report, "could contribute to avoidable disease, particularly in children".
MSF medial coordinator Gilles van Cutsem said that while stock-outs of HIV drugs are a serious problem the "massive growth" of the ARV programme is "unprecedented" and "the health system had to very rapidly adapt to this enormous pressure".
However, according to Van Cutsem, there is "no excuse" for vaccine or TB drug shortages.
North West faired best in the report with only 4.4% of facilities affected by stock-outs in the last three months, followed closely by the Western Cape with 4.9% of sites reporting shortages. The North West’s single depot supplies all health facilities in the province via hospital pharmacies.
"Numbers of patients in the North West are much smaller than in other provinces but it’s been reported that the province keeps buffer stocks and this has mitigated the impact of supply and demand mismatch," said Van Cutsem.
The consortium had previously investigated HIV medication stock-outs at the Mthatha depot in the Eastern Cape and found that 28 of the 70 facilities surveyed experienced drug shortages between March and May this year.
Maila accused the Stop Stock Outs Project of failing to acknowledge the health department’s progress, such as the improvement in the Eastern Cape, in the report.
In response, Van Cutsem said: "It seems the situation in Mthatha has indeed improved after the two previous reports – one of which found that 40% of facilities served by the depot experienced stock-outs. That has dropped to less than 20% now. But the situation is not yet satisfactory."
Health Minister, Aaron Motsoaledi had previously stated his intention to do away with the depot system altogether in favour of a system where hospitals order drugs directly from suppliers. This new approach is currently being piloted in Limpopo and KwaZulu-Natal.
"We have the biggest ARV programme in the world so we are bound to have some problems but we completely reject the notion that this is a national crisis," Maila said.