As part of its third annual survey, the civil society coalition Stop Stock Outs Project telephoned about 60% of the country's public health facilities in late 2015. Health-e News reports that 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. In about a quarter of cases, patients were sent home with either incomplete medication or none at all, according to Stop Stock Outs Project manager Susan Tafeni. The coalition includes organisations such as the Treatment Action Campaign, Medecins Sans Frontieres and the Rural Doctors Association of Southern Africa.
After the project;s previous two annual national medicine stock out surveys faced criticism regarding their methodology, this year’s survey has received University of Cape Town ethics approval.
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 patients' regimens.
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 non-profit organisation Medicines Patent Pool to allow generic drug makers to produce the drug. 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% of facilities surveyed also reported vaccine shortages in the previous three months. About 13% 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 is quoted as saying. "This is a concern obviously – this vaccine protects children from six diseases." The hexavalent vaccine protects children from illnesses such as diphtheria, tetanus and polio.
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.
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 is quoted as saying
In November, the Department of Health launched an allegedly 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. According to Steele, despite suppliers' initial resistance to the new system, it may be starting to produce results. "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% 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 material Stop the Stockouts Project report