Free State Health System in Collapse – Lives are Being Lost
Urgent & Immediate Intervention from Minister of Health needed
JOHANNESBURG – The Free State health system is collapsing with stock outs of more than 200 essential drugs and supplies at the provincial depot, desperate health workers begging for help and stock outs of supplies needed for critical investigations such as electrocardiographies (ECGs).
ECGs monitor heart activity for various medical procedures. Out of stock drugs at the depot include antiretrovirals, antibiotics, pain killers, meningitis treatment, anti-psychotic medication, anti-rabies drugs, high blood pressure medication and epilepsy medicine. Supplies include anti-TB masks for health workers and solution to sterilise theatre equipment. The depot also has no HIV tests.
A doctor working at the hospital in Bloemfontein reported to SECTION27 that they are increasingly running out of essential devices which they need for lifesaving procedures. These devices include infusion sets (connects the infusion bag to the venous catheter), central venous lines (a catheter placed into a large vein in the neck, chest or groin to administer medication or fluids, especially in emergency situations and in critically ill patients) and spinal needles (used for spinal anaesthesia and lumbar punctures to test for among others meningitis).
“Many day and district hospitals are unable to write ECGs due to lack of paper or electrodes (the stickers placed on the chest), but you cannot diagnose a myocardial infarction (heart attack caused by poor blood flow to the heart) or arrhythmias (problems with the rate or rhythm of the heart beat) in severely ill patients, or start an extensively drug resistant TB patient on Bedaquiline, without writing an ECG,” a doctor said.
Last week doctors were told that the medical depot supplying the department of health pharmacies in the district that includes Bloemfontein, had no antibiotics left and almost no antihypertensives or antidiabetics. This would translate into doctors being unable to treat acute infections (such as pneumonia) or to control high blood pressure or blood sugars in chronically ill patients. These patients will sustain complications and damages to their health. While some facilities may still have drug supplies, they will not be able to restock from the depot once they run out.
Last week the South African Medical Association (SAMA) issued a statement drawing attention to the financial crisis and its impact on health services. TAC and SECTION27 have been told that on the human resources front recent medical graduates (both from the under and post graduate streams) have not been appointed, resulting in them sitting at home or searching for work in other provinces. “My main concern is the health and life of our patients, but I am also worried about the human resource problems that we are accumulating by burning out personnel and losing them to other provinces and countries,” said a specialist doctor.
A paediatrician said it was becoming increasingly difficult to look after their patients in the current situation.
In the eastern Free State, one hospital stopped performing elective surgical procedures, and non-emergency patients are being turned away because of the lack of funds. And even at the tertiary hospitals in Bloemfontein, elective (non-emergency) operations are cancelled due to a lack of resources, to the detriment of both the patients and the young clinicians who work at the academic centre to be trained in such procedures.
Documents in the possession of TAC and SECTION27 reveal that on 11 June 2014 the provincial depot was out of at least 11 antiretrovirals, paracetamol, surgical gloves and masks, surgical blades, needles, surgical gauze swabs, viral load and CD4 test kits and antibiotics. One list had 23 items out of stock and the other 182. (SEE APPENDIX ATTACHED)
The above picture is that of a system which has collapsed.
While we are shocked by all these revelations, we are sadly not surprised. The health system crisis in the Free State dates back at least to 2008/09 when financial mismanagement led to a moratorium on ARV treatment that cost hundreds of lives.
For over a year the TAC and SECTION27 have tried to engage the Premier Ace Magashule and his health MEC Dr Benny Malakoane. Instead of meeting with the TAC they have chosen to launch a witch hunt against activists who speak out and deny that there are problems. Doctors, nurses, activists and other roleplayers have been too fearful to speak out. In December last year, the Stop Stockouts Project (SSP) reported that the Free State had recorded “alarmingly high” levels of drug stockouts and shortages, specifically TB and HIV medication. The SSP found that one in two facilities in the Free State had been affected by ARV and/or TB drug stockouts and/or shortages. The SSP warned that the time that a failure to institute emergency joint action by provincial and national departments had the potential to cause unnecessary suffering and death.
The TAC and SECTION27 have reported these issues to the National Department of Health, including the health minister Dr Aaron Motsoaledi, but their response is that the NDoH does not have the capacity or power to intervene.
In the face of today’s crisis and because people are being harmed NOW we call on the Minister of Health, the Minister of Finance and the Minister of Co-operative Governmence and Traditional Affairs to IMMEDIATELY:
- Form a crisis task team and urgently deploy it to the province to assess the scale of the problem and implement solutions.
- Rapidly identify drug, medical supply and equipment shortages and take steps to ensure their rapid and ongoing supply to facilities.
- Address the human resource crisis with an audit of essentail personnel, including the crisis being caused by non payment of community haelth workers.
We ask for a plan of action and timeframes. We call on the national and provincial health departments to co-operate with civil society and health workers.
Every hour that passes translates into the lost lives of patients, including children. This is not the first time that the Free State has faced such a crisis. We want this to be the last.
For comment contact:
Anele Yawa Mark Heywood Sello Mokhalipi
0793281215 0836348806 0789272369
TAC General Secretary SECTION27 Director TAC Free State Chairperson
A selection of the drugs and supplies out of stock at the provincial depot as of 11 June 2014 and its use.
- BUPIVACAINE HYDROCHLORIDE AND DEXTROSE ANHYDROUS – Critical for spinal procedures
- EFAVIRENZA TABLETS– Antiretroviral for people living with HIV
- FLUCONAZOLE TABLETS– Very important for treatment of cryptococcal meningitis, which currently has a high mortality rate.
- MASK, SURGICAL FLUID RESISTANT TYPE N95 – Used by healthcare workers in tuberculosis wards to prevent inhalation of the TB bacteria and resultant infection.
- STAVUDINE CAPSULES – Specifically for paediatric HIV.
- TEST KIT, HUMAN IMMUNODEFICIENCY VIRUS DETECTION FIRST RESPONSE HIV 1 - 2.0 CARD TEST – No HIV tests can be conducted.
- Antiretrovirals out of stock including Abacvir, Efavirenz, Lopinavir, Stavudine, Tenofovir and Zidovudine. Unless patients are being switched to the new Fixed Dose Combination antiretrovirals these stockouts are lifethreatening for HIV patients.
- AMOXYCILLIN - All possible amoxycillin antibiotic powder for suspension for paediatrics is out of stock. All antibiotics tablets for adults out of stock.
- AZITHROMYCIN - No macrolide antibiotic available, which means no alternative for penicillin allergic patients.
- CEFIXIME, CEFOTAXIME, CEFTRIAXONE SODIUM FOR INJECTION, CEFUROXIME SODIUM INJECTION – Critical intravenous antibiotics.
- CIPROFLOXACIN HYDROCHLORIDE TABLETS – Critical antibiotics.
- DOXYCYCLINE – Critical antibiotic for treatment of sexually transmitted infections.
- FLUCLOXACILLIN – An antibiotic.
- FLUPHENAZINE DECANOATE INJECTION – Anti-psychotic medication.
- GLUTERALDEHYDE SOLUTION – Essential for sterilizing theatre/surgery trays.
- IMMUNOGLOBULIN HUMAN INJECTION ANTI-RABIES – Important anti-rabies medication.
- NIFEDIPINE TABLETS – Anti-hypertensive.
- NYSTATIN SUSPENSION – Only treatment for oral thrush.
- MIFEPRISTONE TABLETS – Essential in maternity wards.
- PHENYTOIN – Critical for epilepsy.
- BLOOD GLUCOSE AND URINE DIPSTIX – Essential for monitoring patients and diabetics.