South Africa: Essential Medicines Monitoring Consortium

Stock Outs in SA
A country wide survey
Response to a national
Presenter: Amir Shroufi
Bella Hwang, Amir Shroufi, Tom Ellman,
Gilles Van Cutsem, Monique Lines,
Mwenya Mubanga, Andrew Mews
• History of the survey
• Why a national stockout survey
• Methods
• Results
• The media response
• What now
Why ARV & TB stockouts so important
• Increased risk of drug resistance
• Increased risk of sickness
• Eventually illness over time leading to death
• Patient distress and increased expenses
• Increased risk loss to follow up
MSF responds to depot crisis - Mthatha
• October 2012, staff strike,
• Subsequent service disruption
• Called in by civil society
• Supplies not received in warehouse
• Items not issued to medical facilities
• Drugs not dispensed to patients
• MSF & TAC support December 2012
The situation in Mthatha - January 2013
• Worked with TAC in depot
• Notification & resolution stockouts
• Wanted info for wider advocacy
• Systematically called all clinics
• Depot serves > 100,000 on ARVs
• 24% had to send patients away
> 700 resistance, 20-80 deaths
“I am afraid to die, every time they
tell me there is no treatment I think
of dying,”
A provocative report
“Shut it down, bring in the
Media interest
Provincial denial
National acceptance
MSF is “distorting the facts” is a…“a clear
mischievous attempt to
mislead the world”
“ we know exactly what’s
short, but we have no way of
knowing what’s happening at
Why do a national survey?
• Reports from other provinces
• No good national info – No transparency
• Officially ‘not a problem’ – No accountability
• We knew it was feasible
• We knew it was affordable
• Clear national importance
Eastern Cape Depot – December
• Sept - Oct 2013 (8 weeks)
• 2.5 trained survey assistants
• 11 Questions
• 5 follow-up attempts
• ART/TB Sister or Pharmacist
• 371 person hours to complete
• Total Cost: $3,180 USD
• Of 3827 facilities, 61% contactable, of which 91% participated
Results - geographic distribution
Impact on ART patients
Sent home w/no drugs OR
Referred elsewhere w/no
supply given
Change dose/regimen
Media & Advocacy strategy
• August 2013: NDOH informed & engaged
• October 2013: survey complete
• Released 26 November 2013 (AIDS Day)
• Factual and objective report
• Patient and professional testimony
• Acted as a civil society coalition
• Called for acknowledgement & actions
Mobilization of activists
The government response
“We do not believe the results
of this survey”
shortage of
TB, HIV/Aids
The following 7 months
• Government re-engaged with us
• Consulted on plans to re-engineer supply chain
• Hundreds of facility level stokouts resolved
• Stop stockouts has grown as a watchdog
• The issue has continued to energize activists
Stop Stockouts Project-Ongoing
Stock out Reporting
SMS, Please Call Me, Web and Mobile
Stock out verification
Lay cadre & pharmacist managed
Stock out Resolution
NDOH informed, action fed back
Reporter informed & cases mapped
• Telephone survey allowed for rapid and cheap assessment of stock outs
• Cheap yet high impact on a national level
• Stock outs in SA more widespread than suspected
• Assessment can lead to action
• Local action gave us legitimacy nationally

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