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Contraceptives have been the most common medicines that are out of stock at public facilities this year.
This is according to a report by the Stop Stockouts Project, an organisation that assesses the extent and impact of stock shortages at public sector clinics nationwide.
The report says that 6.9% of patients who were surveyed at 380 health facilities across seven provinces over three months reported that they, or someone they knew, had left a public health facility without the medicine, contraceptives, vaccine, dry stock or tests they needed.
Of the group of patients, 40% reported a shortage in contraceptives, while 19% said they could not get other medicines or tests; 17% did not get vaccines; and 16% reported HIV medicine as being in short supply or out of stock on the day of the survey.
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The data were collected by Ritshidze, a community-led monitoring project aimed at improving the quality of HIV and tuberculosis service delivery for people living with HIV in South Africa, between April and June.
A total of 15 750 patients took part in the survey, from health facilities in the Eastern Cape, the Free State, Gauteng, KwaZulu-Natal, Limpopo, Mpumalanga and North West.
Dr Indira Govender of the Rural Doctors Association of Southern Africa said that contraceptive stock-outs exclusively and negatively affect women and girls.
Govender said:
The most commonly reported shortages were of injectable and oral contraceptives.
Xabisa Qwabe, spokesperson for the Treatment Action Campaign, said that, as a young woman, having access to a variety of contraceptive methods allowed her space to be independent and equal in society by giving her choice and control over her body.
“Not having the [contraceptive] option I prefer for months at a time has not been ideal,” she said.
Section27 legal researcher Baone Twala said failure to prioritise access to contraceptives was a failure by government to prioritise the lives of women and girls across the country.
“Women and girls are bearing the burden of the unavailability of contraceptives in South Africa, despite a clear constitutional right to access healthcare services, including reproductive healthcare services. Inability to access contraceptives when needed can lead to unwanted pregnancies, which in turn can directly affect their physical and mental health, financial security and ability to continue education or working,” Twala said.
The report said that:
The report went on to say that the stock-outs affected women’s ability to plan their pregnancies, leading to their need to terminate unplanned pregnancies, a service they may struggle to access at public healthcare facilities.
“Often, it is poor women who are most affected by the impact of stock-outs of contraceptives and a lack of access to abortions. When women who cannot afford to have more children are denied services that enable them to plan or prevent their pregnancies or exercise their choice to terminate, they are forced to increase the number of children in their care. This forced child-rearing increases the burden not only on the individuals, but also on government programmes including social security, and education and health programmes. Adolescents who are unable to access contraceptives or are unable to terminate pregnancy will experience obstacles to completing school. This has life-long and generational impacts on the girl child’s ability to provide for herself and her children, and to improve her socioeconomic circumstance.”
The survey, however, indicated that healthcare workers did their best to ensure that patients did not leave clinics empty-handed.
While workers from 367 health facilities reported that patients had left the facilities without the medicine they needed due to a stock-out or shortage, some staff members said they resorted to giving patients alternative medications and others said they gave patients less medicine than was needed.
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Of the healthcare workers surveyed who worked in facilities that experienced stock-outs of contraceptives, 58.3% recommended switching to an alternative.
The report said this solution was not sustainable and could have detrimental effects on the lives of women and girls through side-effects such as hormonal changes and the inconvenience of making such significant, and sometimes risky, changes to their lives.
The Stop Stockouts Project said it had shared the full survey report with the national and provincial health departments.
The organisation urged government to develop a plan that addressed medicine stock-outs at public healthcare facilities so that women and girls would be able to access their preferred contraceptives, and to develop guidelines for managing the effects of contraceptive stock-outs.
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