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Stock Outs in SA A country wide survey Response to a national crisis

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

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Stock Outs in SA A country wide survey Response to a national crisis

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  1. Stock Outs in SA A country wide surveyResponse 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, 20-80 deaths “I am afraid to die, every time they tell me there is no treatment I think of dying,”

  6. A provocative report Media interestProvincial denial National acceptance “Shut it down, bring in the army” MSF is “distorting the facts” ..report is a…“a clear mischievous attempt to mislead the world” “ we know exactly what’s short, but we have no way of knowing what’s happening at facilities”

  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 Shortened supply given Sent home w/no drugs OR Referred elsewhere w/no drugs 20% Borrowed supply Change dose/regimen given

  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

  13. Mobilization of activists

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

  15. 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

  16. 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

  17. 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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