Stop Stock Outs Project (SSP) established in 2013
Transcript of Stop Stock Outs Project (SSP) established in 2013
Stop Stock Outs Project (SSP) established in 2013
• Consortium of 6 civil society organisations
• 3 key objectives
Patients and healthcare workers have a system to identify and report essential medicine stock outs and shortages
Monitor, analyse and track essential medicine needs
Engage Department of Health (DoH) and other key stakeholders to resolve stock outs.
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Survey Overview
Third Annual National Stock Outs Survey • Telephonic survey
• 22 questions to public health facilities about:
i. Availability of ARV and TB medicine
ii. Duration and impact of ARV and TB medicine stock outs
iii. Availability of 3 vaccines and 7 essential medicines
• University of Cape Town – Ethics Approval
2015 Survey Participation
Province
Facilities
Identified Number of Facilities
Contactable by phone % (Number)
Willing to provide information % (Number)
Eastern Cape 669 75% (501) 94% (469)
Free State 226 85% (193) 70% (135)
Gauteng 363 92% (334) 83% (277)
KwaZulu-Natal 726 70% (508) 87% (443)
Limpopo 357 81% (290) 86% (248)
Mpumalanga 299 80% (240) 92% (220)
Northern Cape 163 75% (123) 100% (123)
North West 322 75% (243) 91% (222)
Western Cape 422 88% (372) 88% (326)
National (Total) 3547 79%
(2804/3547) 88%
(2463/2804)
Facilities in South Africa participating by province
96
87 90
84
96 96 95 95
87 91
98
63
84 83
94 92 96
84 87 87
94
70
83 87 86
92
100
91 88 88
PER
CEN
TAG
E
2013 2014 2015
Key Findings - General
88% facilities willing to participate
25% participating facilities experienced an ARV/TB medicine stock out (in 3 months prior)
11% participating facilities experienced vaccine stock outs (on day of survey call)
Wide variation across provinces and districts in proportion of facilities with stock outs, duration of stock outs and facility response to stock outs.
Percentage of facilities experiencing stock outs in 2015 has not changed dramatically
compared to 2014.
25% of ARV/TB medicine stock outs resulted in majority of patients leaving with no
medication or incomplete regimen (in 3 months prior)
.
4% participating facilities reported stock outs of adult fixed dose combination (FDC)--
reduction compared to 2014 (9%)
Key Findings - ARV/TB Medicines
Urgent need for plans developed by all stakeholders, addressing multiple contributing factors to stock outs, to
reduce occurrence and mitigate impact.
Most common out of stock items and contributing factors to stock outs vary:
2013 – 1st line FDC (inadequate planning for introduction of new regimens)
2014 – Wide variety of ARV/TB medicines (weaknesses in supply chain)
2015 – LPV/r and ABC (reliance on single suppliers; patent and registration
barriers, substitution for out-of-stock medicines)
Facilities in South Africa reporting ARV/TB medicine stock outs by province (day of call)
10
22
9 9
22 18
3 3 5
11
19
12
18
12
21
30
13
27
1
17 17
42 38
10
16
38
11
23
4
20
0
10
20
30
40
50
60
PER
CEN
TAG
E
2013 (n=242) 2014 (n=410) 2015 (n=480)
Facilities in South Africa reporting ARV/TB medicine stock outs (3 months prior to call)
20
54
20
14
41
26
18
4 5
21
28 28 25
19
29
40
21
39
4
25
19
36 39
20
12
59
14
31
9
25
0
10
20
30
40
50
60
PER
CEN
TAG
E
2014 (n=614) 2013 (n=459) 2015 (n=585)
2015: Districts with highest percentages of facilities reporting stock outs of ARV and TB medicines
(3 months prior to call)
District (Province)
Number of facilities with a
stock out % of participating facilities with a stock out
1. Nkangala DM (MP) 39 63%
2. Ehlanzeni DM (MP) 62 62%
3. Sedibeng DM (GP) 17 53%
4. Mangaung MM (FS) 8 50%
5. Xhariep DM (FS) 8 50%
6. Ekurhuleni MM (GP) 34 47%
7. G Sibande DM (MP) 24 45%
8. Bojanala Platinum DM (NW) 30 41%
Facilities in South Africa reporting Paediatric ARV, PMTCT and TB-related medicine stock outs by province
1 1.48
0 0 0
2
0.45 1 1 1
4
7
5 5
4
10
8
2 2
5
2
4
2
0.48 1 1
5
3
0
2
0
2
4
6
8
10
12
PER
CEN
TAG
E
PMTCT for children (n=15) Paediatric ARV's (n=116) TB related medicines (n=42)
Facilities in South Africa reporting Adult ARV stock outs by province
13
33 33
17
7
53
7
22
6
20
6 6 6 4
2
12
2
7
2 5 5
27
21
6 3
39
1
9
3
11
3
11 9 9
2
17
4
10
1
7
0
10
20
30
40
50
60
PER
CEN
TAG
E Adult ARV's (n=472) 1st line adult HIV (122 facilities)
2nd line adult HIV (264 facilities) Adult exceptional HIV cases (170 facilities)
Duration of ARV/TB medicines stock out (by province)
38
7 19
29
46
7 13
54 44
23
29
53 23
[VALUE]
38
35
52
38
33
36
33 40
58
34
15
58
35
8
22
41
0
10
20
30
40
50
60
70
80
90
100
PER
CEN
TAG
E
Less than 1 week 1-4 Weeks More than 1 month
Impact of ARV/TB medicine stock outs on patients (n=702)
High Impact (186 stock outs) 27%
Low Impact (249 stock outs) 36%
Medium Impact (259 stock outs)
37%
High Impact Low Impact Medium Impact
HIGH – Turned away AND No medication MEDIUM – Referred or turned away patients/ pill burden increased/borrow AND a smaller supply LOW – Switched to appropriate alternative / borrowed AND full supply
Essential medicines stock outs (by province)
10 10 11
21
9
4
10
16
2
11
3 5 4 4
6 5 5 4
1
4
11 10 9 10
33 33
5
10
3
13
0
5
10
15
20
25
30
35
40
45
50
PER
CEN
TAG
E
Ferrous sulphate tablets (n=261) Furosemide tablets (n=89) Haloperidol tablets (n=325)
SSP Collaboration with Department of Health
Interim results of survey shared with all provincial departments —
EC, NC, NW and GP responsive
SSP not yet invited to NDoH Ministerial Task Team on non-
availability of medicines
SSP requests all provinces and NDoH submit a plan for the final 2015
survey report or invite SSP to participate in the development of
plans to address stock outs
Engagement with Department of Health
Recommendations
• Urgent need for action plans developed by ALL stakeholders to address multiple contributing factors, reduce occurrence and mitigate impact
• Urgent focus on poorly performing districts and provinces
• Timing appropriate given 2016 discussions on new NSP; WHA and UN HLM
• LPV/r stock outs show timing is right to reform South Africa’s patent laws and revise regulations during MCC transition to SAHPRA
• South Africa should consider including ATV/r as preferred second-line option in light of unfavourable LPV/r market dynamics