Essential medicines not available in Gauteng South Africa

Categories: Policy.

The SSP has claimed that at least 53 different medications were out of stock with only 15 of those cases being resolved. The vast majority of the drugs, 38 different medications necessary to treat HIV, TB and mental and maternal health issues, still remain unavailable in clinics and hospitals across the province.

Doctors and healthcare workers have raised the alarm of the critical situation, warning that the stock outs will likely to lead to unnecessary suffering and death.

The civil society watchdog that aims to bring transparency to medicine supply challenges facing patients and a struggling health care system
claimed that one of the affected drugs, Amphotericin B, was not available across the province’s major hospitals during last month. Amphotericin B is a critical medication required to manage cryptococcal meningitis, an extremely serious disease that is fatal without timely treatment.

“Patients with severe cryptococcal meningitis are now being given [other drugs]. I expect one of them will die today,” a Medical Officer at Leratong Hospital outside Krugersdorp told the SSP. The Amphotericin shortage was reported and the problem escalated to provincial levels. However, stock returned only in 2 to 3 weeks, an unacceptable length of time unnecessarily risking patient’s lives.  “This is such a fundamental drug, it staggers me that running out of it is regarded so casually. The number of fatalities that could result is both unacceptable and unnecessary,” a Gauteng doctor told SSP. 

Other medications among the 38 that remained out of stock include a number of anti-retrovirals – including those used in infants and children; antidepressant and antipsychotic drugs; TB medication; treatments for asthma; and warfarin, which is used to prevent strokes and is a critically important drug for patients with cardiac valve replacements.

Since its inception in 2013 the SSP has received reports of stock outs from networks of patients and healthcare workers. SSP team members then follow a standardized response procedure to alert the affected facility first and if the issue is not resolved the report is escalated to the district, provincial and national Department of Health.

“During November all of the cases reported have followed this protocol and the Department of Health in Gauteng has been alerted to the persistent problems. There is little evidence of action in the face of this crisis with 72% of the affected drugs still out of stock. People who depend on these drugs for their survival and health deserve better. The Gauteng Health Department must announce and implement a short-term remedy and a long-term strategy to prevent crises like this,” said Bella Hwang, of the SSP said. 

Drug stock outs affect both patients and healthcare workers at hospitals and clinics. People who are ill are sent home without treatment, which means they also waste time off work and incur a loss of income. Healthcare workers are left feeling disempowered and frustrated as they know the trust in them is eroded and undermined.

“The causes of drug stock outs are varied, resulting from multiple factors but generally they are caused by human error. Regardless of the cause, accountable and informed people within the Department of Health’s supply chain management have an obligation to investigate and resolve the cause. They also have to inform frontline healthcare workers of what specific medications are unavailable, and provide guidance about interim alternative treatments when possible,” said Hwang. 

The SSP represents Treatment Action Campaign, Doctors Without Borders (MSF), SECTION27, Rural Health Advocacy Project, Rural Doctors Association of South Africa, and the Southern African HIV Clinician’s Society.

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