Shortages of essential medicines have been a problem in North West for years. Now, a new community monitoring report suggests many people are still being turned away from state clinics without treatment or asked to come back a week later.
A recent report by Ritshidze, a community monitoring project started by organisations representing people living with HIV, paints a grim picture of public healthcare services in North West. Titled North West: State of Health, it asserts that the province’s public healthcare system has been in a state of crisis for many years.
“Of major concern is the persistent and widespread shortage crisis across the province that causes people to be sent home from the clinic empty-handed, or with shorter supplies of essential medicines than they need,” the report reads. “We hear too many reports of people waiting long days at clinics, only to be told, when they finally get their turn at the pharmacy, there are no medicines.”
Such reports are indeed not new.
READ: Doctors blow whistle on medicine crisis in North West
In June 2020, Spotlight reported that the Stop Stockouts Project had found that North West had the most shortages of South Africa’s nine provinces during the country’s first Covid-19 lockdown. Shortly before that, doctors blew the whistle on severe shortages of a long list of essential medicines in the province. The province’s health department has been under national department of health administration since April 2018.
The new Ritshidze report, based on information from 56 healthcare facilities in the province, found that 23.5% of people surveyed reported they or someone they knew had left the clinic without the medicines they needed. Medicines that were out of stock included those for HIV and TB, as well as contraceptives and childhood vaccines.
“Community members in North West often tell us that they go to the clinic, only to be sent home empty-handed or with short supplies. Some only manage to stay on treatment by borrowing ARVs [antiretrovirals] or other medicines from friends and neighbours. Others manage to scrape together some money to buy a few pills,” says Anele Yawa, general secretary of the Treatment Action Campaign (TAC), part of the Ritshidze project.
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Yawa says that, for many, it means simply going without their lifesaving treatment. “This puts people with HIV or TB at risk of becoming resistant to their treatment and needing different regimens, often more costly to the government, and, in the case of TB, less effective at leading to a cure,” he says. “At times people can disengage from care altogether because they see no point in going to the clinic only to be sent home with nothing.”
“According to recent reports, the North West department of health has attributed the shortages to three issues: depot staff, clinics not ordering adequate stock and budgetary issues,” says Yawa.
“Some of these don’t stand up to scrutiny. For example, depot staff were suspended over two and a half years ago (February 2019), and blaming them for the access to medicines issues would be tantamount to flogging a dead horse.”
He says one of the issues they witnessed was the termination of pharmacist assistants’ contracts on March 31, which has resulted in an amplification of shortages of staff and some clinics unable to order on time.
He also says that, in some cases, people are doubling up, performing other roles besides that of pharmacy assistants. Sometimes, facility managers have had to use their own vehicles to transport medicines.
Yawa does, however, concede that there are valid concerns about the budgetary constraints faced by the department.
In response to questions from Spotlight, the provincial department of health suggests that suppliers, stock management at facilities and communication shortcomings are to blame for the shortages.
“Sometimes the department does not have certain items that run out, for a number of reasons; among them, it could be that the suppliers have not delivered or the item is in short supply in the market,” says Tebogo Lekgethwane, spokesperson for the North West department of health.
“In certain instances, facilities do not monitor their stock levels, resulting in shortages, whereas the stock is available in the province. If facilities indicate shortages of specific items on time, the management is able to intervene quickly,” he says.
Lekgethwane suggests that part of the solution is better communication.
“Patients and loved ones who might not be getting medicine are requested to interact with their governance structures, which can bring the matter to the attention of the department for intervention. When certain items are running short, it is always allowed to check with other nearby facilities which have more than enough stock. Such items can therefore be taken from other facilities with a surplus,” he says.
Following the launch of their report, representatives from Ritshidze say they have met with the North West health department to discuss their concerns.
“The outcome of the meeting involved an agreement for the parties to further meet and discuss in smaller, specialised teams. Importantly, the North West department of health also acknowledged the inimical effects of the lack of pharmacist assistants, pledging to have 140 additional staff by September 1,” says Yawa.
A representative of the TAC is quoted in this article. Spotlight is published by Section27 and the TAC, but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the SA Press Council.
This article was produced by Spotlight – health journalism in the public interest