A recent report by Ritshidze, a community monitoring project started by organisations representing people living with HIV, paints a grim picture of public healthcare services in the North West. The report, titled North West: State of Health, asserts that the province’s public healthcare system has been in a state of crisis for many years.

“Of major concern is the persistent and widespread stockouts crisis across the province that causes people to be sent home from the clinic empty-handed, or with shorter supplies of essential medicines than they need,” the report reads. 

“We hear too many reports of people waiting long days at clinics only to be told there are no medicines when they finally get their turn at the pharmacy.”

Such reports are indeed not new.

In June 2020, Spotlight reported that the Stop Stockouts Project found that North West had the most stockouts of South Africa’s nine provinces during the country’s first Covid-19 lockdown. Shortly before that, doctors blew the whistle on severe stockouts of a long list of essential medicines in the province. The province’s health department has been under National Department of Health administration since April 2018. (In July last year Spotlight published an in-depth analysis asking how well administration had worked in the province and why stockouts were still occurring more than two years later.)

‘Empty-handed’

The new Ritshidze report, based on information from 56 healthcare facilities in the province, found that 23.5% of people surveyed reported that they or someone they knew had left a clinic without the medicines they needed. Medicines that were out of stock included medicines for HIV and tuberculosis, as well as contraceptives and childhood vaccines.

“Community members in the North West often tell us that they go to the clinic, only to be sent home empty-handed or with short supplies. Some only manage to stay on treatment by borrowing ARVs or other medicines from friends and neighbours. Others manage to scrape together some money to buy a few pills,” says Anele Yawa, general secretary of the Treatment Action Campaign (TAC), which is part of the Ritshidze project.

Yawa says for many it means going without their life-saving treatment. “This puts people with HIV or TB at risk of becoming resistant to their treatment and needing different regimens, often more costly to the government, and in the case of TB less effective at leading to a cure,” he says. “At times people can disengage from care altogether because they see no point in going to the clinic only to be sent home with nothing.”

Underlying causes

“According to recent reports, the North West Department of Health has attributed the shortages and stockouts to three issues: depot staff, clinics not ordering adequate stock, and budgetary issues,” says Yawa.

“Some of these don’t stand up to scrutiny. For example, depot staff were suspended over two-and-a-half years ago [February 2019], and blaming them for the access to medicines issues would be tantamount to flogging a dead horse.”

He says one of the issues they witnessed was the termination of pharmacist assistants’ contracts on 31 March, which has resulted in shortages of staff being amplified and some clinics unable to order on time.

In some cases people are doubling up, performing other roles besides that of pharmacy assistants, and facility managers have had to use their own vehicles to transport medicines.

Yawa does, however, concede that there are valid concerns about the budgetary constraints faced by the department.

In response to questions from Spotlight, the provincial department of health suggests that suppliers, stock management at facilities and communications shortcomings are to blame for the stockouts.

“Sometimes the department does not have certain items that run out due to a number of reasons. Amongst others, it could be that the suppliers have not delivered, or the item is in short supply in the market,” says Tebogo Lekgethwane, spokesperson for the North West Department of Health.

“In certain instances, facilities do not monitor their stock levels, resulting in shortages in a particular facility, whereas the stock is available in the province. If facilities indicate shortages of specific items on time, the management is able to intervene quickly,” he says.

Lekgethwane suggests that part of the solution is better communication.

“Patients and loved ones who might not be getting medicine are requested to interact with their governance structures, who can bring the matter to the attention of the department for intervention. 

“When certain items are running short, it is always allowed to check with other nearby facilities which might be having more than enough stock. Such items can therefore be taken from other facilities with a surplus,” he says.

Following the launch of their report, representatives from Ritshidze say they have met with the North West Department of Health to discuss their concerns.

“The outcome of the meeting involved an agreement for the parties to further meet and discuss in smaller, specialised teams. Importantly, the North West Department of Health also acknowledged the inimical effects of the lack of pharmacists’ assistants, pledging to have 140 additional staff by 1 September,” says Yawa. DM/MC

Note: A representative of the TAC is quoted in this article. Spotlight is published by Section27 and the TAC but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.

This article was produced by Spotlight – health journalism in the public interest.