---
title: "Medicine availability must be measured at the pharmacy window"
description: "Stock figures matter, but public accountability should extend to whether patients receive their full treatment when they need it."
type: "OpinionNewsArticle"
publisher: "Daily Maverick"
site: "https://www.dailymaverick.co.za"
section: "Opinionistas"
author: "Colleen Aldous"
author_url: "https://www.dailymaverick.co.za/author/colleen-aldous/"
canonical_url: "https://www.dailymaverick.co.za/opinionista/2026-10-06-medicine-availability-must-be-measured-at-the-pharmacy-window/"
published: "2026-10-06T22:01:39"
lang: "en-ZA"
word_count: 1119
---

# Medicine availability must be measured at the pharmacy window

> Stock figures matter, but public accountability should extend to whether patients receive their full treatment when they need it.

By Colleen Aldous · Published 7 October 2026, 00:01 SAST

## Content

For a patient at a clinic pharmacy, medicine availability has a practical meaning. They want to receive the treatment they need, in the quantity required, when it is due. South Africa should judge its medicine supply system against this end point, alongside the stock figures used to manage procurement and distribution.

On 1 September 2026, the National Department of Health sought to reassure the public about medicine supply, explaining why changes in a medicine’s appearance or packaging do not necessarily indicate a shortage. That clarification matters. Patients should not lose confidence in an appropriate treatment simply because the tablet or box looks different. A generic medicine contains the same active ingredient, in the same strength and dosage form, as its reference medicine and must meet regulatory requirements for quality, safety and effectiveness. Approved interchangeable products can allow treatment to continue when a particular supplier’s product is unavailable. A change of manufacturer is therefore not, by itself, evidence that a patient has been denied treatment. But it appears that the Department of Health may be sidestepping the issue.

The department’s reassurance leaves a further question. How often do the measures used to manage shortages protect the patient from disruption? A supplier may have stock. A provincial depot may have stock. A hospital may have an equivalent product. But a patient at another facility may nevertheless leave without the treatment prescribed. These circumstances can coexist, because availability at one point in the supply chain does not guarantee access at another.

### Redistribution and therapeutic alternatives

In July, KwaZulu-Natal provincial officials acknowledged supply constraints affecting phenobarbital, rifampicin and some contraceptive pills. These are not trivial medications. They described redistribution between facilities and provinces, alternative sourcing and the use of therapeutic alternatives. These were reports of specific constraints and responses at that time, not evidence that every affected medicine remains unavailable today. Redistribution and alternative procurement are necessary features of a functioning pharmaceutical system. Their success should be measured partly by what they achieve for patients. A shortage resolved before the next dose is due has different consequences from one that requires another journey, a shortened supply or a treatment interruption.

[READ MORE:

Denosa urges Gauteng health department to address mounting system failures

September 6, 2026 ![Image](https://cdn.dailymaverick.co.za/i/0eEevUCmeAXlQe5ek5evDNU1KAk=/450x0/smart/file/dailymaverick/wp-content/uploads/2025/07/fdclinic7.jpg)](https://www.dailymaverick.co.za/article/2026-09-06-denosa-urges-gauteng-health-department-to-address-mounting-system-failures/)

Dispensing an interchangeable generic also differs from changing treatment. A therapeutic alternative may involve a different active ingredient or regimen and requires clinical judgement about the individual patient. The patient needs an explanation of the change and clear instructions. Counting both situations simply as “medicine supplied” risks concealing the additional work and possible burden involved.

For someone with epilepsy, tuberculosis, cancer, diabetes or HIV, continuity is part of treatment. Consider what a request to return next week may mean. A patient with private transport might manage another visit. A pensioner or rural resident may have to find another taxi fare, arrange help at home or miss paid work. A service can remain free at the point of dispensing while becoming costly to reach.

### Tools to monitor medicine availability

The department’s September statement identifies the Stock Visibility System and National Surveillance Centre as tools for monitoring availability and providing early warning of supply problems. Such infrastructure is valuable. Knowing where medicines are is essential to moving them to where they are needed. Patient-access measures would help establish whether those responses reach their intended endpoint.

There is a historical reason to ask this question. A national telephone survey conducted in 2015 and published in 2019 included 2,370 public facilities providing antiretroviral or tuberculosis treatment. Thirty-six percent reported at least one relevant medicine stockout during the preceding three months. Of the stockout events with information on their impact, 25% involved patients leaving without medicine or receiving an incomplete regimen. That percentage describes reported stockout events, not the proportion of all patients who went without treatment. These findings cannot tell us how common shortages are in September 2026, but they do show why counting stockouts and recording their consequences are complementary tasks. Some disruptions can be absorbed without interrupting treatment while others reach the patient.

A second study, published in 2019, analysed district-level data from 2011–2013. Higher tuberculosis medicine stockout rates were associated with lower cure and treatment-success rates, with larger associations in poorer districts. The historical, observational analysis does not establish that stockouts alone caused those outcomes; it supports taking the distribution of the burden seriously when assessing medicine access.

### Pubic reporting of medicine availability

The next step should be a set of publicly reported patient-access indicators. The central question is straightforward. Of the patients presenting with a valid prescription for treatment due at that visit, how many receive the full clinically appropriate supply at the first visit? An approved interchangeable generic should count as successful dispensing. A clinically agreed change of regimen should be recorded separately, together with whether it was prompted by a supply constraint.

Where treatment cannot be supplied in full, facilities should record the reason, the quantity dispensed and the proposed resolution. A shorter supply for a clinical reason differs from one imposed by limited stock. A referral to another pharmacy should remain unresolved until receipt of the medicine is confirmed. Otherwise, the system risks recording an administrative action as successful access.

[READ MORE:

How a single administrative error sparked 10 months of critical medication shortages in Eswatini

April 8, 2026 ![Image](https://cdn.dailymaverick.co.za/i/ZlFJWMJ0SwI_1V5j_XQ04LkJhlk=/450x0/smart/file/dailymaverick/wp-content/uploads/2024/12/iStock-1043213290.jpg)](https://www.dailymaverick.co.za/article/2026-04-08-how-a-single-administrative-error-sparked-10-months-of-critical-medication-shortages-in-eswatini/)

A practical starting point would be a representative group of facilities and a defined basket of essential medicines, building on existing dispensing records wherever possible. Brief patient follow-up could establish whether people asked to return or go elsewhere actually obtained their treatment. This should be tested for feasibility before wider implementation, with staff time and data quality treated as real requirements.

Public reporting should show differences between districts, medicine groups and rural and urban facilities, alongside the proportion of facilities submitting usable data. Missing reports must remain visible. A national average can conceal repeated failures in a small number of communities, and incomplete reporting can make apparent performance difficult to interpret.

Measurement must also trigger action. Repeated shortages should prompt investigation of procurement, supplier performance, delivery, staffing or local stock management, as appropriate. Patients need a clear route to report an unfilled prescription and obtain help. Frontline staff who document problems accurately should be supported to resolve them.

If generics, redistribution and alternative procurement consistently protect patients, these measures would make that achievement visible. Where people still leave without treatment, they would identify the remaining work. The test of a stable medicine supply is whether the patient receives appropriate treatment on time. That is the assurance South Africans should be able to verify. **DM**

*Colleen Aldous is a healthcare scientist and professor at the University of KwaZulu-Natal, working across clinical research, researcher development and evidence-based medicine.*