Systematic Problems in Drug Supply Have to be Addressed Now to Avert Future Crisis
MSF winds up temporary support from Eastern Cape medical depot; MSF and TAC call on health authorities to better train staff, provide emergency response
28 January 2013.
MTHATHA / CAPE TOWN / JOHANNESBURG – After responding to a drug distribution crisis at Mthatha medical depot between 7 December and 24 January, the medical humanitarian organisation Médecins Sans Frontières /Doctors Without Borders (MSF) is handing all activities back to Eastern Cape health authorities. The Treatment Action Campaign (TAC) will mobilize 25 volunteers to assist in the handover. During this period, the intervention mitigated widespread and dangerous regional drug stock ruptures which impacted thousands of patients. To avoid repeating crises MSF and TAC warn that the Eastern Cape and national Department of Health need to implement urgent remedial steps to strengthen national and local drug supply processes and monitoring.
In early December, the Mthatha medical depot – serving more than 300 medical facilities in the North-eastern region of the Eastern Cape for medical supply needs – faced severe supply and delivery disruptions of life-saving HIV and tuberculosis [TB] treatment for over 100,000 patients. Stripped of 70% of its workforce due to suspensions in a labour dispute, the faltering management of the depot collapsed and critically compounded existing stock shortages at the depot, hospitals and clinics in the area. Orders had not been processed, supplies not received and, ultimately, drugs not dispensed to patients most in need. As a result, the danger of treatment interruption for HIV and TB patients was a perilous reality.
After Section27 and the Rural Health Advocacy Project (RHAP) received pleas for help from distressed health care workers on the ground and with the consent of the responsible health authorities, MSF and TAC started a coordinated response. MSF hired a temporary workforce and cleared the backlog of drug orders by coordinating stock reception, order processing and deliveries to affected facilities. TAC set up and maintained a drug stock-out hotline and monitoring network to help prioritise essential drug delivery to clinics. The Department of Health complemented the MSF/TAC intervention by sending three experienced pharmacists to assist at the Mthatha depot.
“A rapid MSF survey showed the depot crisis’ direct impact on thousands of regular patients who couldn’t get their drugs. Several hundred people now potentially face a lifetime of drug-resistance to first line treatment, while scores of unnecessary deaths potentially resulted from the acute break in service delivery,” says Andrew Mews, country coordinator for MSF in South Africa. “The erratic drug supply also affected patients newly eligible for ART or TB treatment. This is especially severe for HIV/TB co-infected children. As paediatric TB drugs were widely out of stock, children could not be treated for TB and consequently could not start on ARVs either.”
For patients dependent on the HIV and TB drug supply, the stock rupture also brought severe emotional and financial distress to those who can least afford it. “I am afraid to die. Every time they tell me there is no treatment, I think of dying,” an affected 36 year-old HIV patient explained. Another patient, a 31 year-old unemployed woman from Goso Forest said: “In November I went to the clinic and they gave me just one ARV tablet. For the next two days I had nothing. I had to travel all the way back to the clinic again. It’s painful to spend my money on this.”
“We need the capacity to monitor treatment ruptures like these at local, provincial and national level. The Mthatha depot for one, but also the national health system as a whole, must be more accountable to the patients they serve. A monitoring system will help us achieve that,” said Vuyiseka Dubula, TAC General Secretary.
To improve essential drug supply monitoring the RHAP, the Southern African HIV Clinicians’ Society, SECTION27, TAC and MSF plan to set up a drug stock-out monitoring system. The aim is to centralise reporting on supply ruptures from patients and health staff into a national database, to identify clinics requiring emergency supplies.
Even with the MSF and TAC intervention, some key supplies of ARVs are yet to be delivered to the Mthatha depot, with national supplies of Tenofovir, an essential first line treatment of HIV, still not delivered. As a result, the potential for future stock-outs in the medical facilities remain high. It is therefore imperative that the national Department of Health expedites delivery to the provinces immediately.
MSF and TAC also call on the national Department of Health to prevent a repeat of avoidable drug supply crises by training depot and health staff in drug ordering processes and proper stock-keeping, as well as by assembling an emergency response team, consisting of experienced staff able to react rapidly in crisis situations like the one in Mthatha.