/ 11 June 2015

Editorial: Unhealthy state of affairs

Minister of Health Aaron Motsoaledi used to acknowledge problems promptly
Minister of Health Aaron Motsoaledi used to acknowledge problems promptly

On Thursday the civil society coalition Stop Stock Outs released the results of its second national survey of drug stock-outs in public health facilities. The survey researchers found that drug stock-outs have worsened, particularly in the case of antiretrovirals (ARVs) and tuberculosis medication. Many of these stock-outs lasted for more than a month. Patients were sent home without drugs.

Stock-outs of chronic medication affect more than drug adherence: one patient who participated in the survey lost her job because, for a month, she had to take a day off work every week to go to her clinic to see whether her ARVs had arrived. Another woman spent most of her money on transport to her clinic instead of on food.

One of the important findings of the survey, which covered more than 80% of public health facilities in South Africa, was that medicines mostly ran out because of bad management and logistics.

In Limpopo, Health Minister Aaron Motsoaledi’s home province, the provincial health department for instance found in many cases that, when drugs were reported as out of stock, the medicine was in fact available at the depot – but the drugs could not be traced because there was no proper record-keeping system in place. Motsoaledi has chosen to deny this situation. This week he insisted that there is no shortage of antiretrovirals.

Instead of acknowledging the logistical challenges at hospitals and clinics, he has tried to shift the focus to the failings of suppliers and the unavailability of certain ingredients (mostly not for the drugs covered in the survey).

Until about two years ago, Motsoaledi had a strong, positive relationship with civil society. He acknowledged problems promptly, was exceptionally accessible and worked with activists to fix the public health system. But this situation has changed drastically.

Over the past two years, the minister has often ignored issues pointed out by civil society. Activists find it much harder to engage with him on problems such as the Free State’s collapsing health system. He did meet with the Treatment Action Campaign last week to discuss the stock-outs, but generally he is increasingly inaccessible.

The minister needs to be wary of not letting denialism become the easy way out, as some of his predecessors did.