stock outs in sa a country wide survey response to a national crisis
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Stock Outs in SA A country wide survey Response to a national crisis. Presenter: Amir Shroufi Bella Hwang, Amir Shroufi, Tom Ellman, Gilles Van Cutsem, Monique Lines, Mwenya Mubanga, Andrew Mews. Contents. History of the survey Why a national stockout survey Methods Results - PowerPoint PPT PresentationTRANSCRIPT
Stock Outs in SA
A country wide surveyResponse to a national
crisisPresenter: Amir Shroufi
Bella Hwang, Amir Shroufi, Tom Ellman, Gilles Van Cutsem, Monique Lines, Mwenya Mubanga, Andrew Mews
Contents• History of the survey• Why a national stockout survey• Methods • Results• The media response• What now
Why ARV & TB stockouts so important
• Increased risk of drug resistance• Increased risk of sickness• Eventually illness over time leading to death• Patient distress and increased expenses• Increased risk loss to follow up
MSF responds to depot crisis - Mthatha• October 2012, staff strike, • Subsequent service disruption• Called in by civil society• Supplies not received in warehouse • Items not issued to medical facilities • Drugs not dispensed to patients• MSF & TAC support December
2012
The situation in Mthatha - January 2013
• Worked with TAC in depot • Notification & resolution stockouts• Wanted info for wider advocacy • Systematically called all clinics• Depot serves > 100,000 on ARVs • 24% had to send patients away
> 700 resistance, 20-80 deaths “I am afraid to die, every time they tell me there is no treatment I think
of dying,”
Media interest
Provincial denial
National acceptance
MSF is “distorting the facts” ..report is a…“a clear
mischievous attempt to mislead the world”
“Shut it down, bring in the army”
“ we know exactly what’s short, but we have no way of knowing what’s happening at
facilities”
A provocative report
Why do a national survey?• Reports from other provinces
• No good national info – No transparency
• Officially ‘not a problem’ – No accountability
• We knew it was feasible
• We knew it was affordable
• Clear national importance
Eastern Cape Depot – December 2012
Methods• Sept - Oct 2013 (8 weeks)
• 2.5 trained survey assistants
• 11 Questions
• 5 follow-up attempts
• ART/TB Sister or Pharmacist
• 371 person hours to complete
• Total Cost: $3,180 USD
Results• Of 3827 facilities, 61% contactable, of which 91% participated
Results - geographic distribution
Impact on ART patients
Sent home w/no drugs OR Referred elsewhere w/no drugs
Shortened supply given
Borrowed supply
Change dose/regimen given
20%
Media & Advocacy strategy
• August 2013: NDOH informed & engaged
• October 2013: survey complete
• Released 26 November 2013 (AIDS Day)
• Factual and objective report
• Patient and professional testimony
• Acted as a civil society coalition
• Called for acknowledgement & actions
Mobilization of activists
The government response
“Government denies
shortage of TB, HIV/Aids treatments”
eNCA
“We do not believe the results of this survey”
The following 7 months• Government re-engaged with us• Consulted on plans to re-engineer supply chain• Hundreds of facility level stokouts resolved• Stop stockouts has grown as a watchdog• The issue has continued to energize activists
Stop Stockouts Project-Ongoing
Stock out Reporting
SMS, Please Call Me, Web and Mobile
Stock out verification
Lay cadre & pharmacist managed
Stock out Resolution
NDOH informed, action fed back
Reporter informed & cases mapped
Conclusions• Telephone survey allowed for rapid and cheap assessment of stock outs• Cheap yet high impact on a national level• Stock outs in SA more widespread than suspected• Assessment can lead to action• Local action gave us legitimacy nationally