In 2015, about a quarter of close to 2 500 surveyed public health facilities in South Africa experienced stock-outs of HIV treatment or tuberculosis medicine and one in ten experienced stock-outs of childhood vaccines. That’s according to the consortium group Stop Stockouts’ third national survey, of which the results were released on Friday.
But the health department’s deputy director-general for regulation and compliance, Anban Pillay, says “the methodology overestimates the extent of the stock outs”. “It’s closer to 10% of clinics that experience stock-outs.”
According to Pillay “the study makes the error of counting patients that received medicines as well”. “In some instances, the cause of the stock-outs is not supply chain issues, but rather global supplier issues. The study also reported clinics which had implemented back-up plans, such as borrowing drugs from other facilities, as clinics with stock-outs, when, in actual fact those facilities had drugs in stock, and didn’t send patients home without their medication, even though it was borrowed stock.”
Stop Stockouts conducted telephonic interviews with staff in 2 463 facilities between October 1 and December 11 last year. A stock-out was defined as the “complete absence of a specific formulation and/or dosage of medicine at a given public health facility”.
The Stop Stockouts group was formed in 2013 and comprise of the activist and social justice orgnisations Doctors Without Borders, SECTION27, Treatment Action Campaign, Rural Health Advocacy Project, Southern African Clinicians Society.
Patients leave without medicine
Of 699 stock-outs that were reported on the day of contact, 23% resulted in patients leaving the facility with no medication and 4% in patients leaving with incomplete regimens.
“Stock-outs remain a serious threat to the South African public healthcare system. When read with results from previous years, the 2015 survey demonstrated the ongoing need to address stock-outs at all levels of the supply chain,” the authors note.
Almost three quarters (70%) of the stock-outs of ARV or TB medicine lasted for longer than a month, which the survey report’s authors describe as “unacceptably long”. The provinces which reported the worst stock-outs – Mpumalanga, Free State and Gauteng – also reported the longest stock-outs.
In Mpumalanga more than half (58%) of facilities reported at least on antiretroviral or TB drug out of stock, up from 40% in 2014 and in Gauteng 39% compared to 25% in 2014.
But Pillay says at least two antiretroviral drugs – Aluvia and Abacavir – ran out because the supplier ran out of stock, because it didn’t produce enough stock.
The type of vaccines running out differed from province to province. In Limpopo, almost one out of three (28%) of facilities were out of the Hexavalent vaccine on the day of contact. Hexavalent is a combined vaccine against diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae type B and hepatitis B. In the Eastern Cape, Free State and KwaZulu-Natal, about 4% of facilities were out of measles vaccines on the day of contact.
Pillay says Hexavalent also ran out because the supplier did not produce enough of it. But the Stop Stockouts report points out that South Africa’s current patent laws often favour drug supply by a single company, preventing other companies from filling the gap. The stock-out of some drugs, such as the pediatric formulation of the antiretroviral drug, LPV/r, was ascribed to “a single supplier’s inability to meet demand and patent monopolies creating barriers to accessing alternative supply sources”. “This suggests a need for national policy reforms to avoid over-reliance on single suppliers,” the authors suggest.
Stop Stockouts received formal responses to the findings from all provincial health department, except for the Free State, Mpumalanga, Limpopo and the Western Cape.
The report concludes: “Universal access to treatment will only be feasible when stock-outs can be all but eliminated in the public sector. The only way to ensure stock-outs are overcome is to listen to the voices of the people whose lives depend on medicines being available in their health facility.”