Health Minister Dr. Aaron Motsoaledi revealed that among the medications frequently facing supply disruptions are antibiotics, tuberculosis treatment drugs, oncology agents, insulin, and certain pediatric antiretroviral drugs.
Medication Stock Audit
During his response to parliament, Mariam Muhammad from the MK party commented on the department's audit of drug stocks in public hospitals and clinics over the past twelve months. The answer also contained information on the most frequently unavailable medications, the regions hardest hit, and measures taken to prevent future shortages.
Motsoaledi stated that a national audit of drug stocks in all public hospitals and clinics had not been conducted over the last year. Nevertheless, the availability and presence of medications are monitored and tracked through regular reporting systems, including RxSolution and the Supply Visibility System (SVS). These systems transmit data weekly to the National Surveillance Centre (NSC), providing sufficient information for current monitoring and medication stock management.
Control and Response Methods
Furthermore, scheduled semi-annual inventories are conducted at provincial warehouses, along with targeted assessments and supply visibility reporting at warehouses, hospitals, and clinics to identify, monitor, and address disruptions in the medication supply chain.
Motsoaledi noted that 'medications most frequently subject to supply interruptions included certain antibiotics, tuberculosis drugs, oncology products, insulin, and some pediatric antiretroviral drugs.'
Antibiotic Shortage Details
Specifically, there was a shortage of Ciprofloxacin 200mg/100ml (injection) due to increased demand, with Ciprofloxacin 400mg/200ml injection being used as an alternative. There was also a shortage of Fluconazole 500mg (tablets) in packs of 100 due to rising demand and production delays, which was replaced by Amphotericin B deoxycholate injection. The shortage of Fosfomycin granules (one sachet of 3g) was caused by increased demand, and oral Nitrofurantoin 100mg was used as a substitute. Regarding Mebendazole, six tablets of 100mg and one tablet of 500mg experienced a shortage of Active Pharmaceutical Ingredient (API); stock replenishment was expected by mid-June, and if necessary, Mebendazole suspension 100mg/5ml 30ml was used.
Tuberculosis and Oncology Drug Issues
The supply of tuberculosis drugs was disrupted mainly due to a global shortage of Rifampicin, as well as delays in provincial payments. In oncology, for example, Bleomycin 15IU injection could not be supplied due to production limitations, and the stock was obtained through Section 21 process. Carboplatin 450mg/45ml (injection) faced production delays, and the stock was sourced from an alternative supplier. Docetaxel 20mg/ml injection suffered from production constraints, and Paclitaxel 30mg/5ml (injection) and Paclitaxel 100mg/16.7ml (injection) were used as alternatives. Additionally, one syringe of Filgrastim 30MU (pre-filled) had no supply, and PEG-Filgrastim 30MU (pre-filled) analogue was recommended.
Motsoaledi emphasized that 'the supply of oncology drugs remains challenging due to dependence on a limited number of international manufacturers.'
Pediatric Antiretroviral Period
A shortage of Active Pharmaceutical Ingredients (API) led to a deficit of Nevirapine suspension 50mg/5ml 100ml. Furthermore, due to a lack of 100ml packaging, demand for Nevirapine suspension 50mg/5ml 240ml increased. The temporary surge in demand for Lamivudine solution 10mg/ml 240ml as an alternative to Nevirapine has since been resolved. According to the NSC, the provinces most affected by supply disruptions were Eastern Cape, Mpumalanga, and North West.
Measures Taken by the Department
The Minister listed several measures implemented by the department: continuous monitoring of medication availability through the NSC and other reporting systems such as SVS and RxSolution; engagement with suppliers to improve supply continuity and adherence to agreed delivery times; redistribution of stocks between provinces and facilities where possible; procurement from alternative suppliers and use of therapeutic substitutes; assistance in submitting Section 21 applications through the South African Health Products Regulatory Authority (SAHPRA) for unregistered medicines when necessary; strengthening communication and escalation processes between national, provincial, and facility levels; conducting visits to suppliers and reviewing their operations to enhance compliance with contractual obligations and supply planning; and collaborating with provincial departments to implement mitigation plans to minimize impact on patient care.