08 December 2014

Stop Stock Outs (SSP) activists at the Stop Stock Outs (SSP) activist meeting in Soshanguve, a township outside of Pretoria.
Photo:Stefan Heunis

Johannesburg – The Stop Stock Outs Project (SSP) calls for immediate action by Gauteng Health MEC Qedani Mahlangu to avert crisis for thousands of patients as a spike in unaddressed medicine stock outs at public healthcare facilities risks a severe health impact, with over 50 different vital drugs out of stock in the last month.

The SSP has independently verified 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.

The Stop Stock Outs Project is a coalition of civil society organisations in South Africa, including MSF that mobilizes activists and people living with HIV or TB.
Photo:Stefan Heunis

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.

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.

Anyone, patients and healthcare workers alike, can report medicine stock outs to the SSP.
Send an SMS or Please Call Me to 084 855 7867
Email report@stockouts.co.za.

Anonymity is guaranteed.

About the Stop Stock Outs Project
The Stop Stock Outs Project (SSP) is a civil society watchdog that aims to bring transparency to medicine supply challenges facing patients and a struggling health care system. The project represents the 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. 

The main goal of the SSP is to bring awareness to stock outs as they occur and highlight problem areas in the supply chain that need attention. Resolution is sought through the direct engagement of civil society with accountable government individuals and entities The project employs citizen-based reporting, crowd-sourced stock out reports from patients, healthcare workers and sentinel surveyors, which provides a platform to empower patients as well as health care workers. The Stop Stock Outs Project hopes that the data from the reports will provide essential information to identify and understand the root causes of stock outs and shortages ensuring their urgent resolution and future prevention.

Read the Stop Stock Outs Project’s first ever national report on stock outs in South Africa which detailed medicine stock outs and shortages at 2,139 health facilities across South Africa’s nine provinces. Find it here: http://bit.ly/ssp2013rprt
Appendix A: Outstanding Stock Outs

Alexandra CHC
• Abacavir 600mg/Lamivudine 300mg tablets (Dumiva)
• Abacavir tablets
• Nevirapine syrup
• Zidovudine 100mg capsules
• Zidovudine 300mg tablets
• Co-Trimoxazole IVI

• INH 300mg tablets
Mental Health
• Amitriptyline
Other Essential Medicines
• Beclomethasone nasal spray, asthma
• Cephalexin suspension, antibiotic
• Cimetidine IVI, gastrointestinal Tract
• Ipratropium Bromide solution, asthma
• Salbutamol solution, asthma
• Warfarin 5mg tablets, cardiac
• Acyclovir, antiviral

Dark City CHC
• Abacavir 300mg tablets

Other Essential Medicines:
• Atenolol 50/100mg, cardiac
• Simvastatin 20mg tablets, cholesterol 

Hillbrow CHC
Mental Health
• Citalopram hydrobromide 20mg tablets

Itireleng (Region B) Clinic
• Abacavir 300mg tablets

Other Essential medicines:
• Albendazole 20ml syrup, antiparasitic
• Alumnium hydroxide tablets, gastrointestinal tract
• Benzoic acid ointment, topical
• Cimetidine 200/400mg tablets, gastrointestinal tract
• Ferrous Sulphate, maternal health
• Folic Acid, maternal health
• Pyridoxine 25mg tablets, TB
• Rhesus test kit, maternal health
• Simvastatin 10/20mg tablets, cholesterol 

Odirileng Maponya Clinic
• Lopinavir/ritonavir syrup
• Ferrous Sulphate, maternal health
• Folic Acid, maternal health
• Simvastatin 20mg tablets, cholesterol 

Randburg Clinic
Mental Health:
• Quetiapine tablets

Find out more about MSF in South Africa