Over the past few months there have been numerous medicine stockouts across the South African public healthcare sector. The National Department of Health’s (NDoH) response has been to blame external factors such as a global drug supply shortage and suppliers not delivering on time. However, according to a special report compiled by GroundUp, the reason for the stockout crisis has more to do with failures within the state system.
In a statement issued by Minister of Health, Dr Aaron Motsoaledi, in May 2015, suppliers were blamed for the stockouts because SA sources medicines from “companies that are in business and their actions and decisions are not always based on the needs of patients but on what makes business sense.”
Minister Motsoaledi also noted that the NDoH releases lists of drugs that are out of stock on their website “as an early warning system to solve particular problems.” He added that provinces and facilities are responsible for ordering drugs, not the NDoH.
However, according to the GroundUp report, the community news organisation received anonymous letters containing detailed and reliable reports of stockouts in healthcare facilities in KwaZulu-Natal (KZN). While the letters confirmed that some of the stockouts were due to supply issues from pharmaceutical companies, according to the letter, that reason is just “being used as a smokescreen to cover up the reason for the majority of stockouts. The [KZN medicine] depot is failing [clinics and hospitals] due to poor management and lack of knowledge of supply chain. Maintenance of stock levels at the depot, processing of orders, and distribution to its customers are the main reasons [for stockouts].”
The KZN stockouts crisis includes over-the-counter medicine such paracetamol, as well as various antibiotics, some antiretrovirals and some doses of fluconazole, an essential drug used to treat two potentially lethal opportunistic infections associated with HIV. Several products used for the management and treatment of TB are also reportedly out of stock across most KZN facilities.
A report issued by the Stop Stock Outs Project (SSP) backs up the anonymous allegations as it found that only “20% of reported cases are found to be caused by manufacturing issues. 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.”
“To motivate people to be responsible, the system needs to be completely transparent where stock levels are shared on a provincial and national level, with no political barriers,” said Project Manager at SSP, Monique Lines during an interview with eHealthNews.
Even though KZN is one of two provinces piloting a new mHealth pilot that traces drug stockouts right up to facility level, it’s evident that it’s not being used effectively. Perhaps a more robust, regional management system – such as the one used in the Western Cape which according to the SSP website has hardly had any stockouts – is needed to provide visibility of stock levels at facility level.
“I believe that any eHealth system that provides visibility of stock levels at facility level will improve stock management provided you have accountable individuals responding to the data provided,” said Lines.