The Stop Stockouts Project (SSP) is campaigning for medical staff to report stockouts and has a webpage on their site where this can be done – http://stockouts.org/Report. Stockouts are becoming more and more frequent – this is a disaster particularly for the ARV programme.
The SSP is a consortium of six civil society organisations dedicated to assisting the thousands of people whose lives are threatened by the chronic shortages of essential medicines and children’s vaccines in South Africa. The project was established in 2013, following the Mthatha depot crisis in the Eastern Cape in 2013.
The project was initiated by Section27, Médecins Sans Frontières (MSF), the Rural Health Advocacy Project (RHAP), Rural Health Doctors Association of Southern Africa (RuDASA), the Southern African HIV Clinician Society and the Treatment Action Campaign (TAC) who recognised that monitoring drug stockouts and shortages of essential medicines in primary health care facilities was a national priority.
KwaZulu-Natal, with the highest HIV prevalence rate, is among the provinces hit by the shortages of antiretroviral drugs and other essential medicines, which has developed over the past two months. According to a Daily News report, both SSP and the TAC had raised the alarm bells with the TAC in KZN saying King Edward VIII and Ladysmith Provincial hospitals were some of the affected provincial health care facilities.
“These verified shortages are as of (four) days ago (Friday). King Edward Hospital in Durban and the KZN Health Department requested assistance with second-line antiretrovirals in early August. We were able to get the manufacturer to transfer stock from Johannesburg to King Edward. Beyond that we are the same as the rest of the country: looming stock-outs of first-, second- and third-line antiretrovirals and contraceptives,” said TAC KwaZulu-Natal spokesperson Kevin Mayhew.
A Pietermaritzburg HIV positive woman and Aids activist said clinics were the worst affected by the unavailability of ARVs. “The situation is dangerous in that in some cases, patients get a pill short of their daily dosage. If you take three pills, then you must take those consistently without missing the time. If you take them at 8am, then you must stick to that time, taking the entire regimen.
“Once you default, whether by choice or due to the unavailability of the drugs, then your immune system gets messed up. You develop resistance, and opportunistic illnesses take over. Patients’ (immune) systems will collapse without the medication,” the activist is quoted in the report as saying.
SSP acting manager Lauren Jankelowitz said along with the ARVs, KZN was also out of stock of BCG, a vaccine administered to new-borns to prevent diseases like TB. Jankelowitz said SSP had been in communication with the national health department, which was aware of the situation. “However, no clear plan has been provided for how to address these shortages, beyond identifying and reporting them. Active pharmaceutical ingredient shortages are also to blame and lives are at stake. Following the shortages earlier this year, in mainly the North West when industrial action led to stockouts of essential medicines, the latest stockouts represent a national crisis,” Jankelowitz said.
The report says Mpumalanga is the worst hit, followed by North West, Gauteng, Limpopo, Eastern Cape, Free State, and KZN. Jankelowitz said stock-outs of ARVs interrupted treatment, increasing the risk of opportunistic infections, treatment failure, ARV drug resistance and ultimately death.
The SSP and the Southern African HIV Clinicians Society said the crisis could be arrested by routine monitoring reports, telephonic surveys of facilities to monitor stock-outs, and a hotline where patients and facilities can report stock-outs. “We are at a loss as to how to proceed, and frankly a little stunned at how poorly these stockouts and any clinical guidance have been communicated to healthcare workers on the ground. It’s a ticking time bomb,” Jankelowitz said.
The report says Health Ministry spokesperson Popo Maja admitted there was a shortage of zidovudine/lamivudine and abacavir/lamivudine fixed-dose combinations – which are ingredients in the first, second and third-line ARVs. He said the shortage was as a result of a “challenge” with API, lamivudine and abacavir. “New legislation related to industrial pollution in China, where API is manufactured, impacted on the manufacturers on contract experiencing supply constraints,” Maja said.