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
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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
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Contents• History of the survey• Why a national stockout survey• Methods • Results• The media response• What now
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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
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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
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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,”
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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
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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
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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
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Results• Of 3827 facilities, 61% contactable, of which 91% participated
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Results - geographic distribution
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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%
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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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Mobilization of activists
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The government response
“Government denies
shortage of TB, HIV/Aids treatments”
eNCA
“We do not believe the results of this survey”
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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
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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
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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