Medicine stock outs persist

Mass of medicine
Mass of medicine

Almost 25 percent of health facilities surveyed have gone without HIV or TB medication at least once during the last year, according to new preliminary survey results.

Incomplete medication or none at all

The Department of Health has called the survey a “post-mortem” and says many of the problems revealed have already been fixed. 
In late 2015, the civil society coalition Stop Stock Outs Project telephoned about 60 percent of the country’s public health facilities. As part of the survey, facility staff were asked whether their facility had experienced a shortage of HIV, TB or other essential medicines and vaccines in the last three months.    
According to the survey’s preliminary results, about one in four facilities reported an antiretroviral (ARV) or TB medication stock out. 

Read: Red flag over HIV medicine stock out

In about a quarter of cases, patients were sent home with either incomplete medication or none at all, according Stop Stock Outs Project Manager Susan Tafeni, who presented the data at the Southern African HIV Clinicians Conference in Johannesburg.
The ARV Aluvia constituted the most widely out of stock ARV due to the country’s reliance on a single supplier, AbbVie. Shortages of Aluvia, which is comprised of the ARVs lopinavir and ritonavir, fuelled a shortage of the ARV abacavir as clinicians scrambled to replace Aluvia in patient regimens.

Unable to keep up with national demand

In 2015, South Africa’s sole supplier of Aluvia, Abbvie was allegedly unable to keep up with national demand for the drug, resulting in national shortages. The company has since signed a licensing agreement with the international Medicines Patent Pool to allow generic drug makers to produce the drug. 

Read: South Africa plugs TB vaccine gap

However, no local manufacturers have been able to begin producing the drug due to the agreement’s licensing limitations and inability to undercut Abbvie’s already low prices, according to Tafeni.
About 10 percent of facilities surveyed also reported vaccine shortages in the previous three months. About 13 percent of facilities also reported shortages of the mental health drug haloperidol, which is used to treat conditions such as schizophrenia.
“What’s quite worrying is that (the childhood vaccine) Hexavalent was reported quite frequently as out of stock,” Tafeni added. “This is a concern obviously – this vaccine protects children from six diseases.”

The project has recommended that urgent action plans be developed to target the worst performing provinces of Mpumalanga, Gauteng, Free State and the North West. 

Read: More than one in 10 health facilities hit by drug stock outs

National Department of Health National Department of Health’s Chief Director of Sector Wide Procurement Gavin Steel has called the report a “post mortem", saying that many of the problems identified in the report have been solved. 
“I can argue that the Stop Stock Outs report was a post mortem because many of the issues that they are highlighting are irrelevant, but it was an analysis that told us about the health of the system at a period in time,” he said. 
In November, the Department of Health launched a first of its kind system working with medicine suppliers to prevent stock outs before they happen by comparing detailed manufacturing forecasts against project national drug supply needs. [first of kind system links to]. 

Read: SA hospitals are running out of TB drugs

According to Steele, despite suppliers’ initial resistance to the new system, it may be starting to produce results.

Excluded from ministerial task team

“I think we’re already starting to see good achievements,” Steel said. “Although we’ve had problems with lopinavir/ritonavir and abacavir, we need to also celebrate the fact that we have managed to achieve above a 95 percent availability of the fixed-dose combination (ARV), which is the (ARV) that most South Africans…need for on-going treatment.” 
According to Tafeni, only the Free State, Mpumalanga and Limpopo departments of health have not yet responded to preliminary survey results. Meanwhile, the coalition said it was unfortunate that it had been excluded from a ministerial task team on drug stock outs set up in 2015
 “Unfortunately, Stop the Stock Outs Project wasn’t invited to this,” she said. “We would welcome an invitation to this ministerial task team because we’re obviously working on the ground,” she added. - Health-e News

Read more:

New deal could help end ARV stock outs

Motsoaledi: Shortage of children's ARVs

ARV shortages: DA is convinced the health department is to blame

Image: Medicine from iStock 

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