Good afternoon ladies and gentlemen.
Thank you for responding to our invitation to this media briefing. I apologise for calling you to a media briefing on a Sunday! This is because the past week has been extremely traumatic for me as well as the senior management of the department. We were at the World Health Assembly in Geneva, myself, the Deputy Minister, the DG and a few DDGs in line with this international obligation of each Ministry of Health in the world.
We then received messages about the general unavailability of medicines in the country which it is alleged have reached crisis proportions. I cut my trip short and arrived in the country on Thursday, 21 May morning and left the Deputy Minister and DG to represent us for the remainder of the meeting.
I spent the whole day in the office investigating these widespread reports. I also fielded many phone calls from worried South Africans, stakeholders like doctors association, patient groups, etc. Most of whom were confused and wanted to understand what was going on because some said that what they were reading in the media was not what they were experiencing in their facilities.
From the information that we could piece together the whole saga started early last week with a national paper’s headline about extreme drug shortages in the country. This was then followed by a widely reported ENCA report on Tuesday, 19 May where a patient from Esigodeni Clinic in Umgungundlovu district in KwaZulu-Natal (KZN) was being interviewed and reported that she did not receive her antiretroviral medicines and that many people were being turned away because of widespread shortage of medicines in public health facilities.
It will be important to deal with this specific report first.
Obviously, as the Minister, what is reported on this clip is extremely worrying and it needed urgently intervention from me as the Minister because it is said that lots and lots of patients are suffering and this particular patient has one of the most worrying symptoms, a rash which usually indicates serious side effects that would necessitate a change in her treatment.
It was more for this latter reason that we needed to find the patient and help her. We requested the KZN Department of Health to locate the patient for us. The information we received was even more worrying that the story itself. Firstly, the clinic denied vehemently that there was ever such a patient at Esigodeni Clinic. As you can see from the clip we were not provided with the name of the patient.
This is the report that we received from KZN (Minister reads from the letter received from KZN).
Our own findings are that there were more than adequate Fixed Dose Combination (FDC) available in the facility, district, and indeed in the whole country.
Ladies and gentlemen it must be noted that the FDCs is our flagship programme and we do everything in our power to protect it. When we launched the FDCs in 2012 we did not want to take clinical judgment away from doctors and we allowed them to switch patients over at their discretion but we note with regret that some of them seem to be resisting even though the FDCs have very clear advantages, clinically, logistically and in terms of affordability for a country that is running the biggest ARV programme in the world.
To make sure that there are not problems in this very importance programme we even implemented the practice of a national buffer stock whereby 10% of all the FDCs provided are strategically stockpiled with a service provider in a warehouse. This is done in case there are unforeseen emergencies which may arise locally, nationally and even internationally. We also made sure that we have differently suppliers of the FDCs for strategic reasons. So we can assure you that at no stage did we have a shortage of the FDC in the country.
Let’s go back to the particular areas of alleged shortages that have been mentioned in the clip. As the information from the district manager suggests they do not have any shortage of all adult treatment regimens, fixed dose or even single doses.
The shortage that the country has definitely experienced is that of Abacavir used to treat children. When a shortage occurs it is very easy to fiercely attack government for a “non-caring attitude, incompetence, cadre deployment and corruption” as claimed by the Treatment Action Campaign. I must inform you that this shortage is a result of circumstances beyond our control.
In this whole problem of drug supply all over the world is that we source these medicines from companies that are in business and their actions and decisions are not always based on the needs of patients but on what makes business sense. There are lots of essential medicines (those that appear on our essential medicine list) which are always in short supply. Last week in Geneva we noted the global shortage of routine vaccines like BCG and measles because companies are shutting down their plants as it does not make business sense.
Despite having three suppliers of Abacavir we experience a severe shortage because companies informed us that they had difficulty in sourcing sufficient active pharmaceutical ingredients (API) sourced internationally to produce sufficient quantities of both the syrup and the tablets. In addition to the problem of API availability, one supplier also suffered three batch failures which they had to investigate before the stock could be released and this took a long time!
At no stage did any company report that the shortages were related to non-payment of ARVs despite us asking them directly.
The latest information from our suppliers suggests that supplies of Abacavir should normalise by the middle of June, with all outstanding orders fulfilled by the end of June. It must be noted however, that suppliers are continuously releasing stock on a weekly basis.
Mention is always made of a long list of drugs that are out of stock which emerged from the department itself. That list was released on our website as an early warning system to solve particular problems. Firstly, we do not order drugs but provinces and facilities do so. In order to save time and cut down on problems it will be important for people who place orders to have knowledge of which companies currently have problems supplying specific drugs.
This avoids the problem of placing orders and only to discover after 14 to 42 days that the company is unable to supply because none of the companies inform us up front that they don’t have stock. This in business parlance, we are told is to protect their brand. The second reason for the list is that in areas where there are shortages, people should seek alternative therapeutic options.
There is a belief that the fastest solution to these problems is to change suppliers and move to the next one. Yes, we do have a policy that if a supplier fails to supply they are written a letter and given two days to respond to the letter and seven days to supply the product, suitable alternative or we move to another supplier.
This is part of the contract that we sign with each supplier but practically and in quite a number of instances this does not solve the problem as the new supplier would want a lead time of 6 weeks to three months to produce stock to supply – which may be longer than the time the original supplier would have taken to solve the problem. So we are often forced to stick with the original supplier with the hope that they will soon solve the problem as you can see is the situation with Abacavir which they started delivering on Friday, 22 May. If we contracted a new supplier, they would still be preparing to supply in 6 weeks at the earliest.
In conclusion, ladies and gentlemen, as a country with a huge burden of disease and running the biggest ARV programme in the world (30% of those on treatment globally are in South Africa), we are very vulnerable to all these production and logistical challenges as well as business decisions that may even be made outside the borders of the country.
Hence we need to work with each other, whether you are in government, suppliers, patients, and the media rather than trying to outclass each other. What will not help us is to hide behind non-disclosure of sources so that instead of solving the problem we are forced to go on a wild goose chase.
The claim that we victimize patients who complain is unfounded. It is not in our interest to do so because we want our programme to be successful. For instance in Momconnect we have already registered more than 400 000 pregnant women who have lodged a total of 300 complaints and of course more than 1500 compliments.
These complaints are about specific districts, clinics and even individual health professionals and we are able to attend to them rapidly. There has never been any report of victimization of a patient because they lodged a complaint!
It is quite unfortunate that this whole sage emerged from KZN. Because this is one of two provinces where we are piloting and KZN in particular is fully covered by the new cell phone technology that traces drug stock outs right up to facility level. (Minister explains how this system works). Because of this system we can tell you what is happening in every clinic in KZN, which is why the story on the clip came as a complete surprise to us!
Finally, we will issue a report on the international summit on medicines shortages held in Toronto Canada on 20-21 June 2013. This report shows that we are not the only country that has shortages. This international conference develop recommendations all of which we are busy implementing as reflected in the handout that we have given you.
Thank you very much for your attention.