Stop Stock Outs Project (SSP) established in 2013
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3 Stop Stock Outs Project (SSP) established in 2013 Consortium of 6 civil society organisations 1 2 Patients and healthcare workers have a system to identify and report essential medicine stock outs and shortages 3 key objectives Monitor, analyse and track essential medicine needs 3 Engage Department of Health (DoH) and other key stakeholders to resolve stock outs.
4 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
5 2015 INTERIM SURVEY RESULTS
6 2015 Survey Participation Facilities Province Identified Number of Facilities Contactable by phone % (Number) Willing to provide information % (Number) Eastern Cape % (501) 94% (469) Free State % (193) 70% (135) Gauteng % (334) 83% (277) KwaZulu-Natal % (508) 87% (443) Limpopo % (290) 86% (248) Mpumalanga % (240) 92% (220) Northern Cape % (123) 0% (123) North West % (243) 91% (222) Western Cape % (372) 88% (326) 79% 88% National (Total) 3547 (2804/3547) (2463/2804)
7 PERCENTAGE Facilities in South Africa participating by province
8 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) 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%) 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.
9 Key Findings - ARV/TB Medicines Most common out of stock items and contributing factors to stock outs vary: st 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) Urgent need for plans developed by all stakeholders, addressing multiple contributing factors to stock outs, to reduce occurrence and mitigate impact.
10 PERCENTAGE Facilities in South Africa reporting ARV/TB medicine stock outs by province (day of call) 2013 (n=242) 2014 (n=4) 2015 (n=480)
11 PERCENTAGE Facilities in South Africa reporting ARV/TB medicine stock outs (3 months prior to call) 2014 (n=614) 2013 (n=459) 2015 (n=585)
12 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%
13 Facilities in South Africa reporting Paediatric ARV, PMTCT and TB-related medicine stock outs by province PERCENTAGE 12 PMTCT for children (n=15) Paediatric ARV's (n=116) TB related medicines (n=42)
14 PERCENTAGE Facilities in South Africa reporting Adult ARV stock outs by province Adult ARV's (n=472) 2nd line adult HIV (264 facilities) 53 1st line adult HIV (122 facilities) Adult exceptional HIV cases (170 facilities)
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16 PERCENTAGE Duration of ARV/TB medicines stock out (by province) Less than 1 week 1-4 Weeks More than 1 month [VALUE]
17 Impact of ARV/TB medicine stock outs on patients (n=702) Medium Impact (259 stock outs) 37% High Impact (186 stock outs) 27% HIGH Turned away AND No medication MEDIUM Referred or turned away patients/ pill burden increased/borrow AND a smaller supply Low Impact (249 stock outs) 36% High Impact Low Impact Medium Impact LOW Switched to appropriate alternative / borrowed AND full supply
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19 PERCENTAGE Essential medicines stock outs (by province) 50 Ferrous sulphate tablets (n=261) Furosemide tablets (n=89) Haloperidol tablets (n=325)
20 Engagement with Department of Health Interim results of survey shared with all provincial departments EC, NC, NW and GP responsive SSP Collaboration with Department of Health SSP not yet invited to NDoH Ministerial Task Team on nonavailability 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
21 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
22 Thank you
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