The phone call that is a lifeline

There’s a Stop Stock Outs sticker on the back of the consulting-room door of a clinic outside of Giyani, in Limpopo.

The sticker is a sad validation when the nursing staff fling open two cupboards that serve as their dispensary. In places, there are just labels where there should be medicines. They reel off what they don’t have enough of, what supplies are running low, and what they worry won’t arrive on time as the next round of patients arrive later on in the week.
Sometimes it is antiretrovirals or chronic medicines they don’t have; more often, it is as simple as there not being painkillers or cough medicines. It’s also a case of sitting with a surplus of haemorrhoid creams when they need headache tablets. They can operate like this for weeks; things may run smoothly for a while, but all too often lapse back into a cycle of disruption and disorder.
The nurses shrug; they have cynical laughs when they talk about the conditions they work under. They don’t want to be named or for the clinic to be identified, because they fear speaking out openly. At the same time they feel their hands are tied, and they feel they aren’t taken seriously when they contact depots to find out about medicine deliveries that never reach them.
“What happens when we phone that Stop Stock Outs number, anyway?” a nurse asks, pointing to the sticker on the door. She disillusioned by so much, she doubts a phone call can change the fortunes of her patients or the clinic.
However, for many the Stop Stock Outs Project represents a lifeline. It was started back in 2013 by Médecins Sans Frontières (Doctors Without Borders), the Rural Health Advocacy Project, the Rural Doctors Association of Southern Africa, the SA HIV Clinician’s Society, SECTION27 and the TAC. The project deals primarily with shortages of ARVs and TB medication, but also monitors shortages of chronic medication. WHO 2013 estimates area that there are 450 000 cases of active TB in South Africa, making South Africa one of the countries with the highest TB burden in the world.
With the phone line, the idea is for patients and medical staff to phone, SMS, send a ‘Please call me’ or email a stock out problem to a national, centrally managed point. It means crowd-sourced information can be used to build a visual map of hotspots; and most importantly, to unblock bottlenecks to get medicines to patients.
Bella Hwang of the Stop Stock Outs Project says that even though the system needs constant improving, she maintains, it’s a critical tool, and should be supported and more widely used. She says: “Once a stock out problem is logged, the clinic or hospital has two days to respond, then it gets escalated to senior people at district or provincial level.
“The logged complaints allow us to escalate the problems, to follow-up and to approach the media if a stock out is not sorted out”.
In April, MSF and TAC worked on Stop Stock Outs training for community healthcare workers in Limpopo. Hwang says training is important to raise awareness about patients’ options when there are stock outs, to understand dosages if they are given different medication, and to empower them to ask doctors and nurses better questions when there are stock outs. She adds that the system has seen successes; most significantly, stock outs dropped from 50 percent in 2013 to 29 percent in 2014 in the province.
For Sphiwe Mthembu, a Stop Stock Outs branch chairman for the Mopani district, the project is critical. He says: “When patients go home without their medicine, it means other problems will come when they get sicker.
“People must phone the number, because then we know where the stock outs are. We work hand in hand with the department, so it means we can keep pushing. If we don’t know where the problems are, we can’t push.”

Report Stock Outs and Shortages:
Send a Please Call Me, SMS or Phone 084 855 STOP (7867)
Send an email to report@stockouts.co.za
Go to stockouts.co.za/report