Statement by Stop Stock Outs Project in response to today's press briefing by Health Minister Mostoaledi on medicine stock outs in SA
The Stop Stock Outs Project (SSP) welcomes Health Minister Aaron Motsoaledi’s public commitment to reducing stock outs of HIV, TB, maternal health, vaccines, antibiotics and other essential medicines (see BDLive report here).
The Minister noted that drug stock outs across South Africa are often caused by manufacturing challenges. However, of the daily reports from patients and health workers of drug shortages received by the SSP, only 20% of reported cases are found to be caused by manufacturing issues.
Instead, the SSP has found that the remaining 80% of cases are caused by management and logistical challenges between the medicine depot and clinics at provincial and district levels. These include incorrect quantities of drugs being ordered by clinics, inaccurate forecasting of drugs per population, and poor stock management at facility level.
”The National Department of Health commitment to solving the problem is key to reducing stock outs, but it requires implementation and commitment at province, district and facility level if we are to see bold changes that ensure medicine is always available in every clinic. The problem goes well beyond the sole responsibility of the minister, and 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 witness to the Stop Stock Outs project hotline (084 855 7867).” – Bella Hwang, Stop Stock Outs Project
“Supply of medicine to clinics and hospitals are the basic pillar to any public health system and stock outs of medicines are indicative of a bigger problem related to the management and accountability in a health system.” – Karl Le Roux, Doctor, Stop Stock Outs Project
To date, the Stop Stock Outs Project (SSP) has undertaken two national stock outs survey in 2013 and 2014. Over 2500 clinics and hospitals across the country have participated out of a total of 3732 health facilities contacted nationwide. In 2013, one in four clinics reported at least one stock out of any ARV or TB medicine nationwide. This picture has persisted over time where in the 2014 National Stock Outs Survey, one in five clinics reported at least one stock out of any ARV or TB medicine. Encouragingly, only 20% of these cases patients are turned away without any of the medicine, and are instead either given a small supply of the drug and asked to return for the reminder, or clinics borrow from another clinic and patients are able to leave with their full supply.
In the 2014 SSP National Stock Outs Survey (report to be released on 11 June, 2015), seven districts require urgent attention and were most severely impacted by stock outs. In each district, over 40% of clinics and hospitals reported ARV/TB medicine stock outs when surveyed - Joe Gqabi 46% (16/35), Eastern Cape; Alfred Nzo 50% (28/56), Eastern Cape; Bojanala 44% (34/77), North West; Nkangala 44% (25/57), Mpumalanga; Gert Sibande 41% (23/56), Mpumalanga; Lejweleputswa 42% (13/31), Free State; Fezile Dabi 42% (11/26), Free State.
“Stock outs of HIV, TB, maternal health, antibiotics and other essential medicines are disastrous to a patient’s health. Stock outs undermine adherence and lead to costly resistance. Patients have to travel long distances to their clinic only to be turned away. Health care workers are left without the basic tools they need and everyone loses confidence in the health system.” – Dr. Prinitha Pillay, Stop Stock outs Project
The SSP welcomes seen constructive engagement and a commitment to mitigating the problem by national and Limpopo, Gauteng, North West and Northern Cape provinces, who provided action plans on their mitigation strategies in April 2015 to civil society. We applaud their commitment.
These action plans along with the full results of the 2014 National Stop Stock Outs Survey will be released on 11 June in Durban at the SA AIDS Conference.
Note for editors
About the Stop Stock Outs Project
The Stop Stock Outs Project (SSP), a civil society coalition, seeks to ensure that all people have access to the medicines they require and to which they have a right. The SSP does so by monitoring and communicating about shortages and stock outs of medication, and ensuring that transparency and accountability exists along the supply chain. With its free hotline (084 855 7867), the SSP ensures that patients and health care workers can ring the alarm when stock outs occur anywhere in the country. Rapid communication to public health authorities aims to speed up resolution of stock outs so that every patient and every health care worker has the medicine they need.
The project represents the Treatment Action Campaign, Doctors Without Borders/ Medecins Sans Frontieres/, Rural Health Advocacy Project, Rural Doctors Association of Southern Africa, SECTION27, 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.
FOR A DOWNLOADABLE LIST OF ALL STOCK OUTS REPORTED TO THE PROJECT VISIT
Statement issued by Stop Stock Outs Project (SSP), May 24 2015
BACKGROUND:
Text of the earlier Stop Stock Outs Project statement, May 18 2015:
The Stop Stock Outs Project (SSP) is an independent civil society coalition that ensures that patients and healthcare workers have the medicines they need at public clinics and hospitals. Every day project receives reports of essential medicine stock outs from patients and health care workers through a confidential hotline.
Over the past three months the project has received reports of medicines not being available at 80 different clinics, the majority from the Eastern Cape, Free State and Mpumalanga. While 25% of cases of stock outs reported can be attributed to supply constraints from manufacturers, 75% of stock outs result due to logistical challenges between clinics and depots.
A recent national survey from the Stop Stock Outs project showed that, on average, one in four clinics are out of at least one HIV or TB medicine. Facing stock outs, many patients are at risk of interrupting and even defaulting on their treatment, ultimately increased risk of illness. National, provincial and local health authorities have widely acknowledged the problem, and committed themselves to mitigating the problem to protect patients’ health and improve the outcomes of SA’s scaled-up ART programme.
To date, the National Department of Health (NDoH) has committed to taking steps to minimising the length and frequency of stock outs. Some of these steps initiated in 2014, include a programme which allows for patients to pick up their medicines at alternative locations besides their clinic and a mobile application used to monitor stock outs at clinics. Additionally, last month, the health departments of Gauteng, Limpopo, North West, Northern Cape and Western Cape have provided narratives and action plans to the Stop Stock Outs Project, all aimed at resolving the issue of stock outs in their hospitals and clinics. The next step is to translate these plans into action.
These action plans will be released on 11 June 2015, along with the results of the 2014 National Stock Outs survey. The issue of stock outs can also be alleviated by the participation of patients and health workers, who can report them to the Stop Stock Outs Project helpline (085 855 7867), from where it will be escalated confidentially and anonymously to relevant stakeholders.
Background:
What is SSP? The SSP uses reports received from patients and health care workers to liaise with the Department of Health (DoH) along different levels of the supply chain – to independently facilitate and monitor the resolution of each case. Additionally, the SSP aims to engage with government to improve procurement, distribution and management of essential medicine stocks in the longer-term.
In 2014, the SSP received 614 reports of essential medicine stock outs from the general public through the hotline. To systematically assess and quantify the extent of medicine stock outs in public health facilities across South Africa, the SSP also undertakes annual national surveys. Thus far, two surveys have been conducted, in the fourth quarters of 2013 and 2014. The aim of our surveys and reports is to act as a constructive dialogue between civil society, the Department of Health and its partners.
Together, all these actors are looking for ways to reach their common goal: improving the health of people in this country. Our forthcoming report will assist in identifying gaps in healthcare delivery and, as a result, help investigators from the Department of Health to diagnose causes and implement solutions.
Statement issued by Stop Stock Outs Project, May 18 2015
