One of the biggest frustrations faced by rural clinicians at the coalface of healthcare delivery in clinics and district hospitals is that short, yet devastating sentence: “Sorry, it’s out of stock”. It is hard to describe the helplessness and anger one feels when cheap, yet important medications such as anti-hypertensives, anti-epileptics, ARV’s, antibiotics and even simple analgesics are not available.
I do not know a single healthcare provider working in a government hospital, rural or urban, who has not often heard and does not always dread that sentence uttered; sometimes several times a week, potentially signalling death for the people we serve.
When medication is not available, it means that trained health professionals are practicing without some of the most important tools at their disposal. And of course, medicine stock outs are worse in rural areas, where pharmacists and pharmacy assistants are scarce, and the supply chain is long and weak.
Such shortages are hugely demotivating for healthcare workers – doctors, nurses and therapists alike. Yet, much more significant is the suffering it engenders for the many South Africans reliant on the public health system. The absence of medication causes people to suffer unnecessary pain. Babies who should be protected during delivery acquire HIV, grannies to be laid low by an avoidable stroke and uncomplicated TB infections turn into resistant ones.
Each time a medication is out of stock, there is a measurable human impact, in terms of hours wasted, hard-saved money spent on taxi fare to no avail, diseases left untreated, and confidence lost in our public health system. Stock outs of medications on the essential drugs list are never acceptable.
Every stock out is a dire emergency and should be treated as such. This survey quantifies the level of stock outs of a few basic, essential medications in the government sector and aims to help start a conversation to identify causes and find solutions to an unacceptable situation. If we are to ensure a reliable supply of medicines to all South Africans, regardless of where they live, every level of the healthcare system will need to tackle this problem and work together from districts, to province and to the National Department of Health.
Dr. Karl le Roux, Rural Doctors Association of Southern Africa
(RUDASA)