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.

1

2

3

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 INTERIM SURVEY RESULTS

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

Thank you…