Stock Outs in SA

A country wide surveyResponse to a national

crisisPresenter: Amir Shroufi

Bella Hwang, Amir Shroufi, Tom Ellman, Gilles Van Cutsem, Monique Lines, Mwenya Mubanga, Andrew Mews

Contents• History of the survey• Why a national stockout survey• Methods • Results• The media response• What now

Why ARV & TB stockouts so important

• Increased risk of drug resistance• Increased risk of sickness• Eventually illness over time leading to death• Patient distress and increased expenses• Increased risk loss to follow up

MSF responds to depot crisis - Mthatha• October 2012, staff strike, • Subsequent service disruption• Called in by civil society• Supplies not received in warehouse • Items not issued to medical facilities • Drugs not dispensed to patients• MSF & TAC support December

2012

The situation in Mthatha - January 2013

• Worked with TAC in depot • Notification & resolution stockouts• Wanted info for wider advocacy • Systematically called all clinics• Depot serves > 100,000 on ARVs • 24% had to send patients away

> 700 resistance, 20-80 deaths “I am afraid to die, every time they tell me there is no treatment I think

of dying,”

Media interest

Provincial denial

National acceptance

MSF is “distorting the facts” ..report is a…“a clear

mischievous attempt to mislead the world”

“Shut it down, bring in the army”

“ we know exactly what’s short, but we have no way of knowing what’s happening at

facilities”

A provocative report

Why do a national survey?• Reports from other provinces

• No good national info – No transparency

• Officially ‘not a problem’ – No accountability

• We knew it was feasible

• We knew it was affordable

• Clear national importance

Eastern Cape Depot – December 2012

Methods• Sept - Oct 2013 (8 weeks)

• 2.5 trained survey assistants

• 11 Questions

• 5 follow-up attempts

• ART/TB Sister or Pharmacist

• 371 person hours to complete

• Total Cost: $3,180 USD

Results• Of 3827 facilities, 61% contactable, of which 91% participated

Results - geographic distribution

Impact on ART patients

Sent home w/no drugs OR Referred elsewhere w/no drugs

Shortened supply given

Borrowed supply

Change dose/regimen given

20%

Media & Advocacy strategy

• August 2013: NDOH informed & engaged

• October 2013: survey complete

• Released 26 November 2013 (AIDS Day)

• Factual and objective report

• Patient and professional testimony

• Acted as a civil society coalition

• Called for acknowledgement & actions

Mobilization of activists

The government response

“Government denies

shortage of TB, HIV/Aids treatments”

eNCA

“We do not believe the results of this survey”

The following 7 months• Government re-engaged with us• Consulted on plans to re-engineer supply chain• Hundreds of facility level stokouts resolved• Stop stockouts has grown as a watchdog• The issue has continued to energize activists

Stop Stockouts Project-Ongoing

Stock out Reporting

SMS, Please Call Me, Web and Mobile

Stock out verification

Lay cadre & pharmacist managed

Stock out Resolution

NDOH informed, action fed back

Reporter informed & cases mapped

Conclusions• Telephone survey allowed for rapid and cheap assessment of stock outs• Cheap yet high impact on a national level• Stock outs in SA more widespread than suspected• Assessment can lead to action• Local action gave us legitimacy nationally