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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,

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Presentation on theme: "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,"— Presentation transcript:

1 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

2 Contents History of the survey Why a national stockout survey Methods Results The media response What now

3 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

4 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

5 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, deaths “I am afraid to die, every time they tell me there is no treatment I think of dying,”

6 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

7 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

8 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

9 Results Of 3827 facilities, 61% contactable, of which 91% participated

10 Results - geographic distribution

11 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%

12 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

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14 Mobilization of activists

15 The government response “Government denies shortage of TB, HIV/Aids treatments” eNCA “We do not believe the results of this survey”

16 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

17 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

18 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


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