Nationwide ARV shortages: Is South Africa heading for disaster?

Stocks of second- and third-line antiretroviral drugs (ARVs) and contraceptives are rapidly running out across the country, and some provinces have already run out, a crisis that has been developing over the past two months, according to The Stop Stockouts Project (SSP).

The organisation, which aims to monitor and report on shortages and stockouts of vaccines, essential and chronic medicines, has been speaking to the Department of Health (DoH) about the issue, but there is no plan to address the shortages – only a way to identify and report the shortages.

Lauren Jankelowitz, acting manager for the organisation and the CEO for the Southern African HIV Clinicians Society (SAHCS), said that coupled with this, there is a shortage of Active Pharmaceutical Ingredients (API).

In a statement, Jankelowitz said, "Responsibility for this monumental crisis lies at the door of the affected provincial and national departments of health. The SSP hotline for any party to report stockouts nationally has been inundated with calls and requests for assistance."

Following the shortages earlier this year in mainly the North West Province when industrial action led to stockouts of essential medicines, the latest stockouts represent a national crisis.

According to SSP information, Mpumalanga is the worst hit, followed by the North West, Gauteng, Limpopo, Eastern Cape, Free State and KwaZulu-Natal.

No response

There has been no response to a request by SSP in April this year, during the North West strike, urging the DoH to investigate why supplies were not being delivered, where bottlenecks were and why there was a backlog in the first place — although it was officially blamed on industrial action over unrelated employment issues by staff at distribution points in the province.

"If there is indeed no budget as indicated by NDoH, we need to get to the bottom of why this is the case and what will be done about it.

"A robust supply chain and uninterrupted access to medication is crucial in ending HIV. Stockouts of ARVs interrupt treatment, increasing the risk of opportunistic infections, treatment failure, ARV drug resistance and ultimately death," said Jankelowitz.

She added that we need to call on all parties – government suppliers and healthcare workers – to work together to resolve this disaster and are considering asking countries with surplus supply to help fill the gap temporarily, while we wait for South Africa's suppliers to step up production.

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