The Budget Expenditure Monitoring Forum (BEMF), the Rural Health Advocacy Project (RHAP), the Treatment Action Campaign (TAC), the Rural Doctors Association of Southern Africa (RuDASA), Médecins Sans Frontières’ (MSF) and the Southern African HIV Clinicians Society (The Society) are deeply concerned by widespread stock outs at health facilities in the Eastern Cape, which have been caused by the collapse of the medicines supply chain from the Mthatha Medical Depot.
We call on the National Department of Health, the Eastern Cape Department of Health and provincial leadership, including the MEC for Health and the Premier, to take urgent action to restore the supply of medicines to facilities served by the depot and to deal with rampant mismanagement and corruption at the facility. This will require bringing in essential medicines from other parts of the country with immediate effect.
The Mthatha Depot has been functioning sub-optimally for many years, but since the beginning of October 2012, the situation with the supply of medicines has been at crisis point and our organisations have been receiving regular reports of critical shortages of a broad range of medicines such as antibiotics and ARVs. Based on information available to us we estimate that at least 160 medicines are either in dire shortage or are unavailable at facilities served by this depot.
Critically, on this list are ARVs that form part of 1st and 2nd line HIV treatment regimens. These drugs include:
· Tenofovir tablets
· Lamivudine tablets
· Efavirenz tablets
· Alluvia tablets
· Lamivudine syrup
· Stavudine 30mg capsules
· Ritonovir syrup
The vast majority of patients receiving their ARVs through the public sector are taking a combination of these medicines. The unavailability of these medicines is having and will continue to have severe consequences for patients on ART and will result in many developing resistance to their current treatment and others becoming increasingly ill.
This will also have long-term consequences for the public health system in the province, as it will be required to provide expensive alternatives to drugs patients have developed resistance to. Facilities will also be forced to treat increasingly ill patients for opportunistic infections that could have been avoided had there been no interruption in treatment.
Based on our work in the province and information supplied to us by health care professionals, DoH officials and people who access treatment at affected facilities, the current crisis was and is entirely avoidable.
Since at least 2010, our organisations have regularly attempted to engage with the Department of Health on issues concerning the supply of drugs from this depot. We have not only drawn attention the intermittent drug stock outs at facilities served by the depot but also highlighted reports of endemic corruption at the facility.
Despite the fact that it is well known that the facility has been dysfunctional and corrupt for several years now, there has never been any indication that meaningful and long-term interventions are taking place to ensure the reliable distribution of medicines to facilities in some of the country’s most rural and deprived communities.
Recently, this problem has been exacerbated by the fact that since 10 October 2012, the distribution of medicines from the depot to facilities has been severely compromised by strike action and staff participating in go-slows.
It is our understanding that the National Department of Health has recently established a task team to investigate the human resource crisis at this depot. This should be welcomed but it is important that the terms and scope of the task team are made public. It is also vital that the task team make public what is being done to ensure that the supply of critical medicines to facilities in the province is restored.
That said, it is also important to recognise that supply chain management remains a provincial function and responsibility for resolving the impasse falls to the leadership within the Eastern Cape Department of Health, the provincial MEC for health, and the Premier. It is a matter of great urgency that the leadership in the province take action to resolve the staffing conflict at the facility. In the event that this crisis is not resolved immediately, reliable alternative arrangements must be made to restore the supply of basic medicines to facilities.
A failure to take action now will result in a deepening crisis that will undoubtedly lead to unacceptable and unnecessary compromises in patient care.
Issued by: The BEMF, RHAP, TAC, RuDASA, Southern African HIV Clinicians Society and MSF.