Provinces face drug stock outs due to overspending

Massive provincial overspends have seen health facilities across South Africa running out of lifesaving drugs for anything from hypertension pills and paediatric vaccinations to tuberculosis and HIV treatment.

New budgets were expected to kick in on April 1, but the situation is dire at many hospitals and clinics, especially those in rural areas. Health-e has received stock-out reports from doctors, nurses and pharmacists in all provinces except the Northern Cape and NorthWest (although this does not mean there are no shortages).

There was only one report of a looming stock out in the Western Cape when details surfaced of a pending shortage of dialysis tubes and filters at Groote Schuur Hospital’€™s kidney dialysis unit.

It was thought to be due to budget constraints however, it is understood that the problem was resolved before the stock ran out and was due to an administrative problem.

Provincial media representatives in the Eastern Cape, Free State, KwaZulu-Natal and Gauteng denied that there were any stock outs.

Reports from the Eastern Cape detailed stock outs at Thafalofefe, Mthatha General, Cecilia Makiwane, Zithulele and Madwaleni hospitals.

Speaking shortly after a visit to Thafalofefe hospital near Lusikisiki last week, Thandeka Vinjwa of the Treatment Action Campaign confirmed that the hospital had run out of the antiretroviral tenofovir.

She said the provincial depot had failed to process the order placed three weeks ago as they ‘€œwere busy with stocktaking’€.

After the TAC intervened an emergency order was placed and the drugs were dispatched to the hospital.

A health worker posted at Mthatha General Hospital and surrounding health centres said the depot stock out list was long with drugs out of stock for long periods.

He said health workers had to refer patients to other health facilities when stocks ran out, at great expense to the patient. ‘€œOften we have to improvise and miraculously we have had very few adverse clinical events’€.

One patient’€™s record revealed that she had elevated blood pressure and despite her punctual follow ups had not received her hypertension medication since September last year. Some patients resorted to buying their medication from private pharmacies.

More serious stock outs in Mthatha involve psychiatric medications, blood pressure drugs for pregnant women, oral polio vaccines and a cream put in babies’€™ eyes at birth to prevent eye infections (there is no substitute). One doctor reported seeing a baby with permanent damage to one eye, suspected to be linked to the stock out of the cream.

Doctors at Mthatha also reported out of date and broken anaesthetic equipment, at times no Plaster of Paris at the orthopaedic hospital and an x-ray machine at the peripheral centre non-functioning due to delayed repairs for over two years.

There are currently only two ambulances serving the health district which covers three hospitals, six health centres, many clinics and 500 hospital deliveries every month.

The district has been out of paper towel for a month.

The drug situation at Cecilia Makiwane, a referral hospital to many of the district clinics, was even more dire according to a report received two weeks ago. Health workers reported stock outs of most drugs used for hypertension management as well as paracetamol (Panado), Amoxicillin (antibiotic) and Erythromycin (antibiotic ). Carvedilol, a critical alpha and beta blocking agent prescribed for chronic heart failure is also often out of stock.

‘€œThe ward matrons had to borrow medication from each other on a constant basis, they become like traders,’€ said a doctor.

‘€œI know of stories where pregnant ladies have been referred to the obstetric department from peripheral hospitals with a pair of gloves accompanying them, because there are none in the obstetrics ward. Sisters wash their gloves between patients because there are none,’€ he said.

The hospital ran out of syringes several times.

Zithulele and Madwaleni hospitals in rural Eastern Cape reported long lists of stock outs including antibiotics, pain medication, diabetes medication, treatment for measles, surgical gloves, gauze and crepe bandages.

Eastern Cape health department spokesperson Sizwe Kupelo said according to his information they had only experienced a shortage of the BCG vaccine, but that this had been due to a problem with the supplier. He said that the shortages experienced in the province were due to poor stock management rather than financial issues.

Gauteng clinics, including Hillbrow clinic reported a range of stock-outs, especially the critical paediatric vaccines at those facilities that are part of the Expanded Programme on Immunisation.

A source said that the problem at the Gauteng clinics stemmed from unpaid bills. Other reported stock outs included co-trimoxazole (a prophylaxis critical for HIV positive children and adults in preventing pneumonia) and HIV rapid test kits.

The Mopani district in the Limpopo lowveld also reported vaccine shortages. Clinics reported stock-outs of vaccines, Panado and Allergex syrup, TB treatment, female condoms, sexually transmitted infection drugs, hypertension medication and treatment for diabetes.

Middelburg Hospital depot in Mpumalanga reported drug stock outs across the board including pain medication, eye ointment, antibiotics, polio vaccine and TB medication.

Piet Retief Hospital has also previously reported stock outs of several antiretrovirals.

The Free State was in the spotlight in 2008 and 2009 when it announced a moratorium on HIV treatment. Despite an improvement Bloemfontein has experienced a stock-out of paediatric tenofovir as well paediatric TB treatment.

Brandfort clinic had no power due to unpaid bills and there was no running water due to infrastructure problems. They were also virtually out of stock of all medication.

Theunissen clinic, an antiretroviral site, had no electricity and no other medication other than ARVs.

Welkom clinic also reported a good supply of ARVs, but a long list of stock outs of other medication including TB drugs, various vaccines, oxygen masks and insulin syringes.

KwaZulu-Natal, which has the highest rate of TB infection in the country has no stock of the TB drugs Rifinah and Rifampicin. This is the case at all community pharmacies, private hospital pharmacies and wholesalers. The same drugs are out of stock in most of the provinces forcing doctors to manage patients on generic combinations.

King Edward VIII Hospital was also out of stock of some paediatric TB drugs.

An Eastern Cape doctor remarked wryly:’€œUnless sustainable budgeting measures are put in place, the reality is that long before the end of the next financial year we will be in the same place again.’€

 TAC Comments on drug stock outs

The Treatment Action Campaign (TAC) confirmed that it had witnessed stock-outs of antiretroviral therapy and other essential medicines over the past year.

‘€œThe upcoming (ARV) tender is an opportunity for government to end the stock-outs by ensuring that
sufficient quantities of drugs are purchased. Government should also purchase fixed-dose combinations and co-packages to simplify procurement and supply chains ‘€“ this will also simplify regimens for
patients and healthcare workers,’€ said Catherine Tomlinson, senior researchers at the TAC.

Marije Versteeg, Project Manager of the Rural Health Advocacy Project said they continued to receive reports of stock outs in rural areas.

‘€œNon-pharmaceutical stock-outs  are a huge problem too,  eg. syringes, needles, spinal needles and gloves.  Health professionals  try to do with what is available, but this often means using unnecessarily expensive drugs and change of treatment courses. It is a huge cause of frustration,’€ she said.

‘€œThe situation is quite ludicrous regarding drug supply. There has been no HCTZ in clinics for many months – patients are told by nurses to go and buy their own. Recently has appeared the combination drug of HCTZ and perindopril (prexum plus) and some patients previously controlled on a cheap thiazide could be put on this. Today all antacids were out of stock and patients put on cimetidine instead. Ceftriaxone is available for a few days, then out of stock for the rest of the week, so that critcially ill patientrs interrupt treatment.   It seems to be a very common thing in Mpumalanga that the cheap drugs go out of stock and expensive alternatives have to get used instead. There seem to be chronic shortages of paracetamol. This situation has been going on for so long that the prevailing attitude, of nurses, doctors, pharmacists and managers, seems to be one of accepting this as the norm and that to challenge it woud be futile,’€ said a Mpumalanga doctor.

National health department spokesperson Fidel Habede failed to comment at the time of going to press.

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