Stephanie Nieuwoudt

CAPE TOWN, May 11 2010 (IPS) – South Africa is experiencing a shortage of over 80 different drugs in its public health sector, including flu vaccinations and medication for tuberculosis and high blood pressure. The severity of shortages varies from province to province and hospital to hospital, depending on the leadership and skills levels of management.
Experts blame the shortage on a number of factors, including a lack of trained pharmacists, an ineffective tendering process and the inability of some pharmaceutical companies to deliver drugs.

The distribution and consumption of medicine forms a chain with many links. Each link has to function optimally for a patient to eventually get her medication, says Dr Elma de Vries, a former chairperson of the Rural Doctors Association of Southern Africa (RuDasa). Unfortunately, some links are often missing or broken.

South Africa has about 9,000 working pharmacists, although 10,824 names appear on the register of pharmaceutical practitioners, according to Andy Gray, a senior lecturer in therapeutics and medicines management at the University of KwaZulu-Natal. Only 1,746 are working in the public sector. Pharmacists often leave for the private sector or positions overseas to earn better pay.

At some hospitals, nursing staff have to dispense medicine, mostly without the necessary qualifications. Also, some hospitals and public clinics do not have computerised systems in place, which means they cannot track demands or place orders quickly enough, says Gray.

In cases where there are no pharmacists, the onus is on the nursing staff to place orders. But if there is inadequate supervision, medicine can get lost.
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Insufficiently stocked depots are another weak link in the medicines supply chain. Hospitals order their stock from provincial depots. But there are a myriad of problems at some depots, where skills shortages lead to a lack of efficient stock management, says de Vries.

But, even if all the systems at the depot are functioning optimally, the national treasury limits the amount of stock they can hold, and they are dependent on the pharmaceutical companies as recipients of state tenders.

Gray points to a number of problems at some pharmaceutical companies. Tenders are awarded to one or two suppliers, but it often happens that those to whom the tenders are awarded, battle to get hold of raw supplies. There is also a lack of skilled personnel and other resources, which means manufacturers battle to supply the huge amounts of medication needed.

Manufacturers have to deal with erratic ordering processes. Some provinces might say they want one million units of a specific medicine but eventually end up buying three million, or they might put in a big order one month and order nothing for the next three months, Gray points out.

South Africa is currently experiencing a stock-out of the flu vaccine Trivalent, which provides protection against the H1N1 (swine flu) strain.

In a statement, the national institute for communicable diseases confirmed that the shortage occurred because the national department for health bought 1.3 million doses to vaccinate HIV-positive children under 15 and health workers and officials at airports, harbours and other ports of entry during the coming FIFA Soccer World Cup tournament in June.

This has resulted in pharmacies in the private and public sector running out of vaccinations countrywide. According to the statement, another reason for the shortage is production problems because one of the strains in the vaccine did not grow well .

Gray adds that, manufacturers are not keen to produce medicines which do not bring in huge profits. If there is a drop in the price of a certain medicine, the manufacturer will scale down production. They do not want to have money on the shelf in the form of low priced stock.

In April this year there reportedly was a shortage of the anti-retroviral Tenofovir at the Thafalofefe hospital in the Eastern Cape because of an administrative problem. However, the problem was quickly sorted out through the intervention of activists.

Vuyiseka Dubula, spokesperson for the Treatment Action Campaign, an organisation campaigning for the rights of HIV-positive people, told IPS the organisation was also concerned about the reported stock-out of TB medicine and antibiotics countrywide .

Marije Versteeg of the Rural Health Advocacy Project said that there are stock-outs of TB medications in certain areas of Mpumalanga. It is a huge concern because people need to continue taking their medications. If they stop, it can lead to drug resistance which makes it difficult to effectively treat the illness.

The problem can be addressed, says Gray, by training more pharmacists, better management at all levels and an overhaul of the tendering processes.