Kopano Klaas, Project Coordinator from Stop Stockouts Project (SSP) says that the North West province is currently experiencing a stockout of tuberculosis (TB) medication. Primary healthcare facilities have mostly reported a stockout of Isoniazid and Isoniazid 300 mg.
“The hospitals are hoarding the stock. They don’t dispense medication to smaller clinics, they keep the stock to themselves. When the stock is about to expire, then they dispense the stock to the facilities – only to find that it’s late. The stock has expired and clinics cannot use them. Delaying the delivery of medication.”
Klaas says that hospitals have the opportunity to hoard medication because the primary healthcare facilities order from the district hospitals, they don’t order directly from the medical depot.
“We are still trying to investigate because it’s not easy to find the root causes of these problems. Sometimes we blame manufacturers, only to find that it’s just internal issues in facilities with unsigned contracts and order forms that impact the medication availability.”
The North West has experienced stockouts of essential medicines for years, including antiretroviral therapy (ART) for people who are living with HIV. In 2021, Ritshidze released a report on the state of health in the province, which shone the light on the reality of patients being turned away from the pharmacy and leaving empty-handed because the facility was out of stock.
Nqabutho Mpofu, Policy, Communications and Research Manager from the Treatment Action Campaign (TAC), presented research at the State of TB Report launch, showing the low administering of the TB preventive treatment (TPT) and Multidrug-resistant TB (MDR-TB) treatment in facilities.
According to the data, over their last two quarters (October – December 2022 and January – March 2023) their surveys show that only 35% of patients received MDR-TB treatment within a year and 39% received TPT in the monitored facilities across the country.
A devastating problem for patients
Klaas directly experienced a stockout of the 300 mg Rifafour medication for TB, at his local clinic in Soweto, in December 2022.
“It was a big challenge for me because I really needed the medication.”
Klaas was on his fourth week out of eight of treatment when he was forced to find alternative medicine. He says he was told the facility was waiting for more medicine.
“The clinic was turning people away because they didn’t have medication. At times, if someone was moving from the intense eight-week treatment to the first-line of treatment then they would add the leftover pills that someone was drinking to the next patient who was starting their intense treatment.”
Klaas says the situation improved after three weeks. He says the availability of this medication began to stabilise in February.
Monitoring in facilities continues
Klaas says that they currently do not have recorded data on the observed TB medication stockouts, as the project is ongoing and the report has not yet been concluded. However, reports on the stockout of TB medication in public healthcare facilities date back to 2019.
The COVID-19 pandemic worsened the stockouts of TB medication.
“The production of TB medication was affected because the suppliers and manufacturers were also impacted by the pandemic. At the end of the day, the medication is not produced, affecting the supply chain and they’re not going to be available in facilities. As a result, we’re seeing pop-ups of medication stockouts there and there.”
Klaas says that the organisation is currently observing a stockout of morphine. They intend to continue investigations to identify the root causes of these problems.
Research shows that the first report of morphine stockouts in the country was first reported in July 2022. This is still an ongoing problem.
“The only challenge that we have is that the money that we used to have for our annual surveys is not there. And so we’re looking for finances to do this,” says Klaas.
The SSP plans to conduct separate community-led monitoring surveys in primary healthcare facilities to specifically look into TB testing, treatment, and follow-ups.
“We don’t have x-rays that can perform tests in primary healthcare facilities, they can only be found in hospitals. This is one of the barriers to TB diagnostics – we will be searching around these issues.”
Department says issues resolved
However, Dr Norbit Njeka, from the National Department of Health, says that the targets regarding MDR-TB patients’ diagnostics and treatment initiation were all exceeded.
“We have heard reports of imminent stockouts and stockouts of items in the longer MDR-TB regimens and paediatric formulations from different facilities. These were resolved in the shortest period of time by requesting centres with drugs to help those running short and urgent orders made.”
Njeka claims that patients have not had to go without medicines. He says that drug substitutions were made for MDR-TB patients in the longer regimen. – Health-e News