Drug shortages: The dynamics

In recent months, Zimbabwe has experienced a shortage of one of the most critical drugs for the management of tuberculosis (TB) in its first two months of diagnosis.

THIS tablet, a combination of rifampicin, isoniazid, pyrazinamide and ethambutol tablets, also known as FDC-RHZE is imported, costs of which are wholly supported by a development partner. Oxytocin is another tablet whose availability is also supported by development partners working with Government in reducing pregnancy related deaths.

It is used to control bleeding after birth, among other uses.

Of late, this drug has also been in short supply.

These two medicines are typical examples of supply of critical drugs in the public health sector, where sole responsibility to provide some essential services has been assumed by donors, posing not only repercussions on patients’ road to recovery, but also a serious security threat to the country.

“My sister was diagnosed of TB a month ago at Mufakose Clinic in Harare. I’ve been going with her to collect her drugs weekly until recently when we were told that the drugs were out of stock.

“We went to Kambuzuma, Glen View and Budiriro clinics and the story was the same. We also went as far as Domboshava, but still didn’t get anything,” said Pretty Mandaza from Mufakose who is taking care of her sister.

She said last Saturday they went back to Makumbe Hospital, where they were only given a week’s supply.

“If one skips treatment for three consecutive days, they have to restart the whole two months course for it to be effective. My sister skipped her medication for more than three days now, meaning she is supposed to restart the treatment again.

“We have however, resolved not to give her this one week’s supply until we get enough medication because if her course is further interrupted, she will need to restart again,” further explained Ms Mandaza.

She said her sister’s condition had also deteriorated in the past weeks and they were now afraid that the TB bacteria could easily be passed on to other family members since she is no longer on treatment.

Ms Mandaza said they also feared that her sister would develop the drug resistant strain of TB which is difficult, expensive and takes longer to treat.

Without medical intervention TB is highly contagious and interrupted uptake of medication increase one’s chances of developing resistance to medication.

Deputy director of the Aids and Tuberculosis Unit in the Ministry of Health and Child Care, Dr Charles Sandi said the country needed at least $1,5 million for medicines to respond to drug sensitive TB and an additional $1 million for drug resistant TB.

Sadly, these medicines are currently funded by donors.

“We continue advocating for allocation of resources towards TB programming from our local resources so that donors come in only to complement our efforts not the other way round,” said Dr Sandi.

He said the challenge with relying on donors was that they procure from pharmaceuticals who meet certain standards, which are guaranteed by World Health Organisation accreditation.

“While we have no problems with the insistence on good quality medicines, the implication of this practice is that when the accredited pharmaceuticals have issues with their suppliers,which might impact on production processes, it also affects the whole supply chain resulting in shortages of the medicines such as those that we were experiencing in the past weeks,” said Dr Sandi.

In response to the current shortages, Government has availed US$500 000 from the Health Levy as a mitigatory measure to procure the much needed TB drugs.

Acting Natpharm managing director Mr Newman Madzikwa also confirmed that oxytocin, which was reported to be in short supply countrywide, was also funded by development partners.

Although Mr Madzikwa said the national drug stocks were improving following the introduction of the Health Levy, he said of late foreign currency shortages remain an impediment to procurements.

Mr Madzikwa said Natpharm had not been getting any allocations in the last two months.

“Since the beginning of the year, we have received about $5,5 million and the last allocation was sometime between May and June.

Mr Madzikwa further explained delays experienced in availing medicines after a tender has been awarded saying pharmaceuticals only produce an order once it has been paid for.

He said in that respect, medicines that are beginning to trickle in the country now were actually procured around June.

He said in light of these challenges, Natpharm was now working on utilising the letter of credit facility from the bank to guarantee payment to suppliers, but the facility is also issued based on availability of foreign currency.

However, Community Working Group on Health executive director Mr Itai Rusike said Government should invest domestic resources into local pharmaceuticals.

“With the coming in of the Health Levy, it is also high time Government begins investing in local pharmaceutical companies not only to ensure availability of drugs at reasonable costs but also to boost their potential.

“While donors give us money, they also expect us to buy from their industries, a situation that further contributes to underdevelopment of not only our country, but Africa as a whole,” said Mr Rusike.

He said currently most WHO accredited pharmaceuticals are from India, China, USA and Europe, yet great need of these pharmaceutical products was in Africa.

Mr Rusike further said reliance on funding partners was also a security threat to the country.

“Imagine if these donors are to pull out completely maybe because of differences in political ideologies where would that leave us as a country. Will the country not be held at ransom using these donations,” said Mr Rusike.

HIV activist Ms Martha Tholanah said by failing to prioritise such critical medications in national budgets, Government was doing a de-service to its citizens.

“Our Government has sold citizens out by placing their health and lives in the hands of donors. Why is there no allocation specifically for essential medicines in the national budget? Why is the Reserve Bank of Zimbabwe not fulfilling its promise by releasing the amount of foreign currency that is needed,” she said.

Pan African Treatment Access Movement (PATAM) director, Mr Tapiwanashe Kujinga also expressed concern over continued shortages of critical medicines outlying its implications on efforts to curb drug resistance illnesses.

Mr Kujinga said some of these drug resistant strains, like TB had high mortality rates, hence should be avoided from the beginning.

He said while Zimbabwe has made great strides in coming up with alternative sources of domestic financing through the Health Levy and the National Aids Trust Fund, more needed to be done on transparency and accountability to ensure maximum and effective use of the domestic resources.

He said Government should not only put in place sustainable mechanisms of funding, but also put in place clear structures and budgets on utilisation of those funds.

“As it stand, we do not know what else the Health Levy is funding. “We have been told its now funding costs of blood, dialysis and also drugs but we do not know the actual budgets, its administrative structure or the priority list,” said Mr Kujinga.

Domestic funding has been topical at most international forums, with the donor community advocating for increased domestic funding towards health.

The donors argue that, countries should take charge and responsibility of their challenges with funding partners complementing these efforts.