The Stop Stock Outs Project (SSP) is an NGO that monitors and reports stock outs of essential medicines and surgical consumables as they happen.
According to Project Manager at SSP, Monique Lines, the ultimate goal of SSP is to ensure accountability along the supply chain and ensure the availability of essential medicines and supplies to deliver an improved healthcare service. “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 Lines.
“Healthcare workers have an ethical commitment to the wellbeing of their patients and should do everything within their power to improve the system. Therefore they have to speak out about problems they encounter and the circumstances they have to work under. As a pharmacist who has formerly worked in the public sector, I know how difficult it is to provide a quality service to your patients when you don’t even have the basics at your disposal – we have to identify these challenges and fix them,” continued Lines.
SSP has developed into a platform for patients or healthcare workers to anonymously report on stock outs via the SSP website, SMS, phone call, WhatsApp or even a Please Call Me.
“When a report is received there’s a turnaround within a day,” said mHealth Coordinator at SSP, Bella Hwang. In response to a report an SSP representative calls the person back to get more information about the stock out and then escalates the report to relevant people in the supply chain by contacting the healthcare facility. The provincial DoH is ultimately involved to resolve the issue. “The SSP also shares regular reports with the NDoH on a quarterly basis to identify and find solutions,” said Hwang.
During the process, stock outs are mapped on the SSP website to allow full transparency; “the public can see where individual cases are at, what steps have been taken and DoH involvement,” said Hwang.
According to SSP, to date there have been 255 cases of stock outs reported across the country; however, the organisation has acknowledged that the figure is a significant underrepresentation of actual national stock outs. “A major challenge is that each province has different systems and procedures in place; when it comes to medicines supply, nothing is standardised. The level of engagement with the SSP also differs remarkably between provinces, some facilities and DoH officials willingly share information while others, especially the Free State and Limpopo Province, tend to be a closed book,” said Lines.
Hwang added that: “In 2010 we surveyed all health facilities across South Africa to ask about stock outs. We were only able to reach 60% of facilities; of which 21% reported a stock out or shortage of ARV or TB medication in the previous three months. Free State was the province most in trouble with over 50% of clinics reporting stock out or shortages of ARV or TB medicines.”
According to Lines, the SSP has been referred to the province’s Communications Officer when trying to engage with the provincial departments a number of times. “Instead of engaging with civil society to improve service delivery, our efforts are often hampered by the bureaucracy within the health system. We often get a response to a stock out from a completely different person to who we escalated it to: so things are happening in the background that we aren’t always aware of.”
Despite stock outs being a national concern, according to the SSP website there have been no reported stock outs in the Western Cape (WC), which is the only province that has a regional management system.
Lines explained that: “The WC has good reporting structures in place and pharmaceutical services (both at provincial and district level) and are very responsive when it comes to reported stock outs. 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.”
Hwang added that: “The WC is responsive to its pharmacy supply chain and their chronic medicines unit relieves pharmacy pressure at the primary level. The WC depot also has various policies along their supply chain that help prevent stock outs, such as fining suppliers for non-delivery.”
Stock outs are detrimental to the health and well-being of patients and is negatively impacting health seeking behaviour. It’s therefore essential for the government to intervene and for different provinces to identify what works, and “to learn from each other – especially from the WC – instead of repeating a broken cycle in a broken system. We need to work on new innovative solutions, not reinvent the wheel,” said Lines.
Hwang believes that the NDoH not only needs to have an emergency team ready to quickly resolve stock outs, but also to enforce the uptake of eHealth systems to effectively forecast stock outs at a facility level. “By implementing and effectively using electronic systems, facilities would be able to forecast their stock levels, keep track of expired stock and ultimately order new stock in time,” said Hwang.
In support, Lines added: “It’s really important for the NDoH to seriously consider using eHealth systems to stop stock outs and improve healthcare delivery. Currently for most facilities everything is paper based and manual, which means a lot of information gets lost along the way. We can’t stick with a paper trail, it’s far too time consuming.”
Hwang added that: “Because of all the health data out there it’s also important to sync different eHealth systems, such as Tier.Net and pharmacy systems, to triangulate how many patients are on ARV treatment and quantify the spread of the disease more accurately. This data can also be instrumental in ensuring that there’s no interruption to an individual’s treatment. Sticking to a medication schedule is crucial, even more so with the rise of drug resistant strains of TB – paper-based supply chains and stock outs are simply not an option. ”