New report confirms medicines stockout crisis

The Treatment Action Campaign (TAC) welcomes the release of the second report of the Stop Stockouts Project (SSP) today at the South African AIDS conference in Durban. TAC is a member of the SSP consortium that also includes the Rural Doctors Association of South Africa, the South African HIV Clinicians Society, Rural Health Advocacy Project, SECTION27 and Doctors Without Borders (MSF). 
The new report found that one in four facilities had experienced at least one stockout of an HIV, TB medicine or vaccine over a three month period toward the end of 2014. This is worse than the one in five found in the previous SSP report. While it is hard to estimate how much of this variation is due to chance, we can say with some confidence that the overall stockouts situation has either stayed the same or got worse since the previous report.
A notable positive in the report is that there were very few stockouts (only 75) of the standard first line HIV treatment (the one pill, once a day fixed-dose combination of tenofovir, emtricitabine and efavirenz). There were however frequent stockouts of other first line HIV medicine, second line HIV medicine, paediatric HIV medicine, isoniazid preventive treatment (IPT) for TB, and medicine for complicated TB.
The report identified Mpumalanga, Limpopo and North West as the provinces with the most HIV and TB medicine stockouts. Of particular concern is that TAC members in Limpopo and Mpumalanga have reported a spike in stockouts after the period covered in the report. While response rates in most provinces were very good, we are concerned by a steep drop in responses in the Free State (which may mask the severity of the problems in that province). This suggests that healthcare workers in the Free State are afraid to speak out about the problem of medicines stockouts.
“The report provides further confirmation that the regular stockouts of essential medicines reported by our members is a systemic problem,” says Anele Yawa, General Secretary of the TAC. “Just as some provincial governments struggle to distribute textbooks, provinces are struggling to distribute medicines to the people who need it.”
Representatives of the SSP, including TAC members, presented the report and discussed the stockouts crisis for two hours with the Minister on June 3. We welcome the Ministers willingness to engage with the SSP. We also welcome the National Department of Health’s statement released on June 9. The statement reported back from a meeting that the Minister of Health had on June 5 with representatives of pharmaceutical companies regarding supply shortages.
While we welcome the Minister’s positive interventions on ensuring a more reliable medicines supply from pharmaceutical companies, we stress that this only addresses a limited part of the problem. As indicated by the new SSP report and as evidenced by our experience responding to stockouts at local, district and provincial level, most facility level stockouts are not a result of supply shortages, but of poor management of the distribution of medicines. Only 20% of the stockout reports received by the SSP so far in 2015 are related to manufacturer issues – the remaining 80% are due to distribution problems in the healthcare system.
“Most of the time when a person can’t get a medicine at their local clinic, that medicine is collecting dust somewhere in a depot,” says Amukelani Maluleke, of TAC Limpopo. “We don’t like how the minister is shifting the blame to suppliers, when most of the blame should be placed on our dysfunctional provincial healthcare systems.”
TAC considers the ongoing problem of medicine stockouts to be a symptom of the wider dysfunction in our provincial healthcare systems. This dysfunction is partly due to the appointment of uncommitted and/or unqualified MECs for health in many provinces and the appointment of uncommitted and/or unqualified heads of provincial and district health departments.
At the opening of the South African AIDS Conference on Tuesday TAC called on the ruling party to drop its policy of cadre deployment. We repeat that call. The needs of the people require that we appoint only capable and committed people to run our public healthcare system. We cannot allow politics to stand in the way of improving the quality of healthcare service delivery to our people.
The full 2014 National Stock Outs Survey can be found at
To arrange interviews pleae contact Lotti Rutter on 081 818 8493
We also include today’s press statement from the Stop Stockouts Project below.
Stop Stock Outs Project releases second annual survey indicating persistent medicine shortages in majority of provinces and calls for an emergency response
DURBAN – Chronic shortages of essential medicines, including antiretroviral (ARVs), tuberculosis, vaccines and other medicines, in health facilities across South Africa require urgent, sustained and co-ordinated action from provincial and national health authorities, according to the 2014 Stop Stock Outs Project (SSP) Survey, which is being released today at the 7th South African Aids Conference in Durban.
"We want to see all levels of government, especially Provincial Health MECs and Heads of Health Departments, take bold and decisive action to create a system that is responsive to the needs of patients," says Anele Yawa, General-Secretary of the Treatment Action Campaign, which is a member of the Stop Stockouts Project consortium. "We urgently need to develop a culture of accountability in our health system."
The  second annual national stock outs survey, conducted over the fourth quarter of 2014, comprises of the most comprehensive data on the frequency, prevalence and impact of stock outs to date, found that five of the nine provinces (Mpumalanga, North West, Limpopo, Free State and Eastern Cape) were severely affected, with more than one in three health facilities reporting a stock out of at least one ARV or TB medicine during the three month survey period. 
In Gauteng, Northern Cape and Kwazulu-Natal provinces, drug supply remains erratic, with more than one in five clinics reporting at least one ARV or TB medicine stock out.  32% of reported ARV or TB stock outs lasted for more than one month; 43% lasted between one and four weeks; and 25% lasted less than one week nationwide.
 Across the country, at least one childhood vaccine, including Measles, Pentaxim and Rotavirus were also reported out of stock in 12% (249/2157) of facilities.
These results show that most medicines are available in South Africa’s medicine depots, but patients are unable to get their prescriptions fully filled in health facilities because of downstream logistical and management problems. These problems range from inaccurate forecasting to storage or transport issues.
In 22% of reported ARV and TB stock outs, patients were sent home with no medication.  In 35% of cases the patient was given a smaller supply, switched to an alternative which increased the number of pills they needed to take, or a less than optimal regimen was given.
“This situation is unacceptable because patients are the ones paying the cost of a dysfunctional system,” says Dr. Indira Govender of the Rural Doctors Association of Southern Africa. “They miss out on work or school to queue at a health facility, only to be told there is no medication or they need to come back again. Then they have to live with the stress of an untreated disease that puts them at risk of further illness or death. Patients are expected to remain adherent to treatment and are labelled "defaulters" when they don't. But is this fair, when our health departments are defaulting on their medicine supply?”
While the survey found improved availability of the most commonly prescribed Fixed Dosed Combination (FDC - Tenofovir, Emtricitabine and Efavirenz) for patients on first line HIV medicine, there were frequent stock outs of other first line HIV medicine, second line HIV medicine, paediatric HIV medicine, isoniazid preventive treatment (IPT) for TB, and medicine for complicated TB. This puts HIV patients unable to take standard FDCs due to clinical complications and co-existing conditions, as well as HIV-infected children at risk of treatment interruption.
“The basic pillar of any public health system is the supply of medicine to clinics and hospitals, and stock outs are indicative of a bigger problem related to management and accountability,” says Karl le Roux, a doctor working in the rural Eastern Cape.
The survey’s findings have been presented to the National Department of Health (NDoH) and the Provincial Departments of Health (DoH) in the Free State, Eastern Cape, Gauteng, Limpopo, North West, Northern Cape and Western Cape who acknowledge the extent of the problem.
As the result of constructive engagement between the SSP and provincial health authorities (with the exception of KwaZulu Natal), five provinces (Gauteng, North West, Northern Cape, Limpopo and Western Cape) have for the first time produced action plans. The remaining provinces have acknowledged the extent of the problem, have not yet committed any action plans.
The Department of Health’s commitment is key to reducing stock outs. The problem requires actions from all across the supply chain, from the Ministry to local clinic managers and all the way to patients who can help by reporting stock outs they experience to the Stop Stock Outs project hotline – 084 855 7867.
The full 2014 National Stock Outs Survey can be found at
For a summary of the results please turn to the Executive Summary on page 6.
Mpumalanga reported the largest proportion of facilities with stock outs:  40% (82/205) of facilities experiencing a shortage of at least one ARV/TB medication in the preceding three months, and 30% (62/205) of facilities in Mpumalanga reporting a stock out on the day of the survey call.
North West province had the most significant increase from 4% (8/182) in 2013 to 39% (86/222) in 2014 in facilities reporting stock outs.
South Africa’s three worst affected provinces for HIV and TB medicine stock outs/shortages:
-    40% of its 205 responding facilities reported a stock out or shortage
-    33% of reported stock outs lasted more than 1 month 
-    39% of its 222 responding facilities reported a stock out or shortage
-    31% of reported stock outs lasted more than 1 month 
-    29% of its 266 responding facilities reported a stock out or shortage
-    46% of reported stock outs lasted more than 1 month 
South Africa’s 7 worst affected districts for HIV and TB medicine stock outs/shortages: ((%) Proportion of health facilities reporting at least one ARV or TB medicine during the survey period)
1.Nkangala 44% (25/53 facilities)
2.Gert Sibande 41% (23/56 facilities)
3.Bojanala 44% (34/77 facilities)
4.Joe Gqabi 46% (16/35 facilities)
5.Alfred Nzo 50% (28/58 facilities)
6.Lejweleputswa 42% (13/23 facilities)
7.Fezile Dabi 42% (11/26 facilities)  
About the Stop Stock Outs Project:
The Stop Stock Outs Project (SSP) is an independent civil society consortium that monitors and speaks out about medicine stock outs and shortages, with the aim of achieving a stock out free health system. The SSP consortium consists of the Treatment Action Campaign, the Rural Doctors Association of South Africa, the South African HIV Clinicians’ Society, Rural Health Advocacy Project, SECTION27 and Doctors Without Borders (MSF).  The SSP raises awareness and brings transparency to medicine supply problems facing patients during medicine stock outs as they occur, to highlight problem areas in the supply chain that need urgent attention. The project seeks to empower the tens of thousands of patients and clinicians.
The SSP operates a NATIONAL HOTLINE to ensure accountability and transparency to patients, while creating a network of proactive monitors to build on the success of resolving stock outs by working with the Department of Health.
Report medicine stock outs & shortages: -   Send a Please Call Me, SMS, WhatsApp message or Call: 084 855 7867  
• Ryan Fortune, MSF Field Communications Officer: 072-350-0851 |
• Kate Ribet, MSF SA Media Liaison Officer: 079 87 229 50 |