A shortage of an essential AIDS drug this week has revealed shortcomings in the Department of Health’s medicines supply chain management, casting the spotlight on one of the many service delivery problems the pilot sites for National Health Insurance will have to tackle.
Public health facilities frequently run short of even the most basic medical supplies. In January, Chris Hani Baragwanath ran out of Panado and some antibiotics.
Vital stocks of tenofovir have run dangerously low at clinics and hospitals in Gauteng, Mpumalanga and North West, according to the Southern African HIV Clinicians Society, putting patients at risk of drug resistance.
Gauteng’s Helen Joseph Hospital usually receives 10000 packs a month, but by Tuesday had received only 300, according to the society’s president, Francesca Conradie.
Tenofovir is the backbone of HIV treatment, and is used by most of SA’s 1,6-million patients. The alternative is stavudine, but it has occasionally dangerous side-effects.
The shortage of tenofovir has prompted finger-pointing on all sides, with the department’s deputy director-general for health regulation and compliance, Anban Pillay, saying pharmaceutical companies were struggling to meet demand, and drug makers insisting provincial health departments failed to order stock early enough, after donor-funded supplies ran out at the end of last year.
SA secured funding from the US government in 2009 after several provinces ran out of money for AIDS drugs. The government’s two-year tender to supply tenofovir was split between Pharmacare (70%) and Sonke Pharmaceuticals (30%).
"They (the pharmaceutical companies) obviously have a supply problem," said Dr Pillay.
"Gauteng ordered 152270 packs in November and 140000 packs in December. Aspen delivered 91000 packs in February and 40000 packs in March," he said.
"Sonke also has a problem. They are not supplying anything close to what they promised. Somehow they thought the figures we gave them were inflated. They have told us they are not able to cope with demand."
Both companies challenged Dr Pillay’s version of events, saying they were more than capable of meeting their contractual obligations.
They said the provincial health departments placed their orders late, and ordered much larger quantities than the government had called for in its tender.
"We have met the upsurge. The issue is demand management," said Aspen’s head of strategic trade development, Stavros Nicolaou.
The tender required Aspen to provide about 420000 packs a month, but larger orders had been placed after the donor stock was exhausted. "We’ve had orders of 780000 packs, which makes us look like we are undersupplying. We are not," he said.
Sonke CEO Sotse Segoneco said the department did not appreciate the lead-time required to scale up production. "We are like the fashion industry, we plan a season ahead. It takes three months to increase production. They did not order for 10 or 11 months, and now they are flooding us with orders. They are asking us to do the supernatural," she said.
Both companies said they had continued to supply Gauteng, despite its outstanding debts.