South Africa is experiencing widespread shortages of essential medicines, including folic acid, epilepsy medication, contraceptives and antibiotics, with some products out of stock for months and desperate patients leaving health facilities empty-handed, reports News24.
An investigation by Rapport – sparked by a tip-off about a contraceptive shortage in the private sector – points to a national crisis felt at every level. Various sources, from pharmaceutical manufacturers to pharmacists, doctors and clinic staff, have confirmed the issue.
The Department of Health’s internal “hot list”, which tracks national stock levels, shows that numerous products have been out of stock for months and that some shortages could last until November. Among the biggest backlogs are simvastatin 10mg (for cholesterol) with more than 1.6m outstanding orders; folic acid 5mg, with about 1.58m orders outstanding; mebendazole 500mg (for deworming) – 1.93m; and various forms of paracetamol, amoxicillin, iron supplements and contraceptives.
In the Western Cape, a nurse said they are turning patients away who need blood pressure and cholesterol medication, while Dr Michael le Roux, a specialist physician in Cape Town, said they now frequently have to prescribe alternative medication. “Patients then have to adjust to new effects and side effects. In the private sector, there are more substitutes available, but they are usually more expensive.”
Graeme Leon, the chief healthcare officer of Clicks, said they are experiencing shortages, but alternatives are generally available. There is a shortage of Triphasil and Nordette, but alternative contraceptives have been sourced.
Tambu Jonheran, Dis-Chem spokesperson, said they are not experiencing shortages and offer alternatives where necessary.
Rapport’s investigation indicates the shortages can be attributed to several factors, including problems with the single exit price (SEP) system and South African Health Products Regulatory Authority (SAHPRA) interventions that are hampering local manufacturers.
The war in the Middle East is also a factor, as ships are now being rerouted, delaying delivery times by up to a month.
The SEP – the regulated price at which all schedule 2 and higher medicines must be sold – is a major problem, a supplier says. The government sets the annual increase, and for 2026, it is just 1.47% – well below inflation (3.6%) and salary increases (6%).
Manufacturers are halting production of medicines that are losing money, and distributors are cutting delivery routes to reduce costs.
The local manufacturing industry is in crisis, Dr Stavros Nicolaou, chairperson of Pharmisa, told the health parliamentary portfolio committee in August. He said 2 500 workers have been retrenched in the past 18 months.
“The only facility for making oral contraceptives has shut, and there is no longer any domestic capacity to formulate penicillin or produce the active pharmaceutical ingredient for paracetamol.”
SAHPRA is apparently also contributing to the problem. “They simply shut down a facility for a month or three,” said a Johannesburg pharmacist. “We’ve been struggling for months to get eye drops. Patients with glaucoma can go blind without them.”
An Ekurhuleni pharmacist said factories are sometimes closed for trivial reasons, after which stocks of cheap but vital medicines dry up. “We struggled for a long time to get Phenobarb. an epilepsy tablet costing just 30c each. The alternative treatment costs hundreds of rands more… my poor patients cannot afford it.”
Medicine availability in the public sector is also hampered by overdue payments. The Eastern Cape Department of Health alone owes suppliers more than R1bn.
Anri Hornsveld of the Pharmaceutical Society of South Africa said the shortages are serious and have been ongoing for about two years. The search for alternatives has significantly increased workloads.
“Pharmacists must reassess the prescription, consult the prescriber, check therapeutic alternatives and often deal with medical-scheme authorisation or co-payments.”
SAHPRA’s Section 21 process – through which the authority grants special permission for a medicine to be used for purposes beyond its registered indication – is a useful emergency measure for providing alternative medicines, but is struggling under current conditions.
Health Department working on it
The national Department of Health cannot say how many patients have been turned away without their medicines at its facilities over the past six months, spokesperson Foster Mohale said. The national availability of medicines in the public service is above 80%, but this does not mean all medicines are available everywhere.
He added that when shortages occur, the department shifts stock between facilities or sources alternative medicines or suppliers. On folic acid, he said the supplier has obtained stock and is now distributing it.
On retrenchments and scale-backs at local manufacturers, Mohale said these cannot be attributed to the department’s procurement policy. The government is trying to maintain a balance between affordability, quality, security of supply and support for local production, he claimed.
According to Mohale, some manufacturers have been temporarily closed, or certain production lines have been halted due to regulatory interventions.
Last month, the department initiated talks on local production with the pharmaceutical industry, SAHPRA, the Medicines Pricing Committee and the Competition Commission. According to a joint statement, the department subsequently undertook to consider an extraordinary adjustment to the SEP.
They are also looking at improved co-operation between SAHPRA and the industry to limit operational disruptions and “transparent, predictable and consistent rules for public sector procurement”.
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