Unpaid provincial Health Department accounts, regulatory disputes with SAHPRA, and manufacturing pressures are among the reported causes of a widespread medicine shortage in South Africa – this despite President Cyril Ramaphosa’s intervention last year, reports News24.
A task team that was established a year ago and which has met three times, has failed to resolve the issues, with critical shortages worse than ever.
In fact, the Department of Health’s latest internal report for September, which tracks national medicine stock levels, shows that new shortages are emerging faster than existing problems can be resolved, reports News24’s sister publication Rapport.
Reasons cited include the manner in which the SAHPRA applies regulations, tender processes, and a shortage of active ingredients caused by production challenges in India, among other countries.
Exacerbating these factors is the non-payment by provincial Health Departments of accounts totalling hundreds of millions of rands. Several medicines are in stock but are not being delivered until the provinces settle their outstanding bills.
The Auditor-General (AG) said provincial debt stood at R24bn at the end of last year.
In the Eastern Cape, North West, the Northern Cape and KwaZulu-Natal, current budgets are used annually to service historical debt, eating into new allocations.
The Western Cape, the only province which has been able to settle its debt, told Rapport that supply levels remain insufficient to restore the normal two to three-month buffer stock. It could reportedly take another four to six months before stock levels stabilise and buffer reserves are rebuilt.
A presidential task team comprising government institutions and pharmaceutical manufacturers was established in September to tackle the challenges in the pharmaceutical industry, under the leadership of Dr Alistair Ruiters, the president’s special adviser on investment promotion.
Ruiters said they were considering, other things, regulated medicine prices. Tender processes are also under scrutiny.
“Every time we issue a tender, we need to look at how local manufacturers can be involved,” he said.
SAHPRA’s processes and regulations are also under discussion, including its practice of shutting down production lines for unnecessarily long periods. Pharmacists said this has contributed to a shortage of phenobarbitone – a cheap epilepsy medication.
The most significant deterioration was in amlodipine for hypertension, where back orders have climbed from around 1.2m to more than 4.6m units within a month. Shortages of rosuvastatin for cholesterol management, metformin for diabetes, and several psychiatric medicines including olanzapine and pregabalin have also been reported.
Among the health products with the largest backlogs are iron tablets (more than 2.2m units), methyl salicylate ointment for muscle and joint pain (2.4m units), mebendazole for worm infections (2m units), folic acid tablets (1.6m units), and certain contraceptives, with more than 1.5m units on back order.
A new challenge appearing in the September report is logistical delays at the Durban harbour.
Ruiters said the task team’s first priority is to establish a relationship of trust between the Department of Health, the regulatory authority and the pharmaceutical industry. “We don’t have the solutions yet, but at least there are now constructive conversations.”
News24 article – Medicine shortages worsen a year after Ramaphosa set up task team
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