HIV struggle in South Africa undermined by medicine stockouts and mismanagement
Treatment Action Campaign
On World AIDS Day, 1st December 2013, the Treatment Action Campaign (TAC) will not be celebrating.
We recognise that we have made very significant progress in the fight against HIV. But medicines stock-outs, corruption, mismanagement and an apparent lack of political will to deal with these problems are undermining our struggle against HIV.
The official World AIDS day event, hosted by the South African National AIDS Council (SANAC), will take place in Piet Retief in Mpumalanga. At this event, hundreds of TAC members will conduct a silent and respectful protest while government relaunches the HIV Counselling and Testing Campaign (HCT) in the same area. While we support the HIV Counselling and Testing (HCT) campaign, we feel attention must be drawn to the serious problems in the health system in Gert Sibande. It will not help people to know their status if they cannot get access to ARV treatment, counseling or quality health care. We cannot celebrate while clinics do not have stock of essential HIV and TB medicines, while hospitals run out of food and important equipment, and in a district where there is a death causing shortage of health workers.
We acknowledge the positive leadership that continues to be shown by Health Minister, Dr Aaron Motsoaledi. Over two million people are receiving antiretroviral treatment in South Africa and all indications are that the rate of new infections is on the decline – although it remains shockingly high at around 1,000 new infections per day.
However, we cannot turn a blind eye to the crumbling public health systems in most of our provinces.
The following issues are of particular concern across provinces.
1. Medicine stock-outs
Between September and October 2013, the Stop Stock-outs Project (SSP) undertook a national telephone survey to quantify the extent of ARV, TB and vaccine stock-outs.
More than one in five facilities reported a stock out or shortage of ARV and/or TB medicines in the last three months. Six out of the nine South African provinces had more than 17% of their facilities reporting shortages. Mpumalanga, Limpopo and the Free State fared the worst with an unacceptable 25.9%, 40.8% and 53.8% respectively. This report is now published online. [1, 2]
Medicine stock outs and shortages lead to patients taking partial doses of their treatment, interrupting it or defaulting treatment altogether. Medical consequences and costs to the health system and patients can be grave, including drug resistance, decreasing immunity, increased risk of opportunistic infections and transmission of HIV and TB, ultimately leading to more illness and death. In 20% of affected facilities patients were sent home or referred elsewhere without medicines, adding to travel costs for already deprived people.
2. Crumbling health systems
In many provinces, the public health system is plagued by corruption and mismanagement. Doctors and nurses have to work under extremely difficult conditions. Often, essential equipment is not available and buildings are insufficient. Many health workers are paid months late. Many posts remain vacant.
TAC and SECTION27 have recorded the unacceptable state of the Eastern Cape health system in our recently published report ‘Death and Dying in the Eastern Cape’. 
However, the Eastern Cape is not the only province that is struggling and similarly shocking reports could be written about Limpopo, Mpumalanga and Gauteng.
3. Civil society sidelined in NHI discussions
The introduction of National Health Insurance has the potential to be a massive step forward for the provision of quality healthcare for all in South Africa. However, we are deeply concerned with the many delays in publishing further policy documents that would explain how NHI is to be funded.
We are also deeply concerned with the lack of consultation with civil society – in general, but more particularly in the areas where NHI is being piloted. Meaningful community engagement will be essential to the success of NHI.
4. TB prevention and integration still not addressed
The purchase of Gene Xpert machines to speed up the diagnosis of TB has been a significant step forward in our struggle to bring the TB epidemic under control. Alone, however, it will not be enough. More than two years after a policy document on the decentralisation of MDR-TB was published, provinces are struggling to implement this policy. This means that many MDR-TB patients are not diagnosed, and not optimally treated once diagnosed. The laxness from provinces in implementing this policy is unacceptable.
Furthermore, very little progress has been made on the health emergency that is TB in prisons. It is almost exactly one year since the Constitutional Court stated categorically that the government has a duty to take concrete measures to prevent TB in our prisons. But while new TB guidelines for diagnosing and treating TB in prisons have been published, these guidelines do not go nearly far enough. Our prisons are overcrowded and therefor an ideal setting for the spread of TB. We need aggressive measures to ensure that overcrowding in prisons is reduced and that sufficient infection control measures are implemented in all correctional facilities.
For all these reasons TAC says that World AIDS day 2013 does not give us reason to celebrate. It is a time to step up our commitment, not pat our backs. If we do not address urgent measures to solve these problems, then the success of South Africa’s precious National Strategic Plan on HIV, STIs and TB will be threatened.
This article was edited from the Treatment Action Campaign electronic newsletter. (29 November 2013).
- Treatment Action Campaign. Independent national survey reveals extents of ARV and TB medicine stock outs. (28 November 2013).
- SSP Stockouts National Survey. November 2013.
- Death and dying in the Eastern Cape: an investigation into the collapse of a health system.