Top

BMC Health Services Research

Published in:

Open Access 01-12-2020 | Research article

Medicine shortages and challenges with the procurement process among public sector hospitals in South Africa; findings and implications

Authors: Cynthia Modisakeng, Moliehi Matlala, Brian Godman, Johanna Catharina Meyer

Published in: BMC Health Services Research | Issue 1/2020

Abstract

Background

Medicine shortages are a complex global challenge affecting all countries. This includes South Africa where ongoing medicine shortages are a concern among public sector hospitals as South Africa strives for universal access to healthcare. The objectives of this research were to highlight challenges in the current pharmaceutical procurement process for public sector hospitals. Subsequently, suggest potential ways forward based on the findings as the authorities in South Africa seek to improve the procurement process.

Method

Qualitative in-depth interviews were conducted with 10 pharmacy managers in public sector hospitals in the Gauteng Province, South Africa. A thematic content analysis was performed, with transcripts coded by two of the authors. Coding was discussed until consensus was reached. Categories were developed and grouped into themes.

Results

The ‘Procurement process’ emerged from the data as the overarching theme, rooted in three main themes: (i) The buy-out process that was used to procure medicines from suppliers other than the contracted ones; (ii) Suppliers not performing thereby contributing to medicine shortages in the hospitals; and (iii) Challenges such as the inaccuracy of the electronic inventory management system used in the hospitals.

Conclusions

Effective management of contracts of suppliers by the Provincial Department of Health is crucial to ensure accessibility and availability of essential medicines to all citizens of South Africa. Ongoing monitoring and support for the future use of computerised inventory management systems is important to reduce medicine shortages, and this is being followed up.

Available only for authorised users

De Weerdt E, Simoens S, Casteels M, Huys I. Clinical, economic and policy implications of drug shortages in the European Union. Appl Health Econ Health Policy. 2017;15(4):441–5.CrossRefPubMed

Heiskanen K, Ahonen R, Kanerva R, Karttunen P, Timonen J. The reasons behind medicine shortages from the perspective of pharmaceutical companies and pharmaceutical wholesalers in Finland. PloS One. 2017;12(6):e0179479-e.CrossRef

Yang C, Wu L, Cai W, Zhu W, Shen Q, Li Z, et al. Current Situation, Determinants, and Solutions to Drug Shortages in Shaanxi Province, China: A Qualitative Study. PloS One. 2016;11(10):e0165183–e.CrossRefPubMedPubMedCentral

Alsheikh M, Seoane-Vazquez E, Rittenhouse B, Fox ER, Fanikos J. A comparison of drug shortages in the hospital setting in the United States and Saudi Arabia: an exploratory analysis. Hosp Pharm. 2016;51(5):370–5.CrossRefPubMedPubMedCentral

Acosta A, Vanegas EP, Rovira J, Godman B, Bochenek T. Medicines shortages: gaps between countries and global perspectives. Accepted for publication Frontiers in Pharmacology. 2019;10:763. https://doi.org/10.3389/fphar.2019.00763.

Bochenek T, Abilova V, Alkan A, Asanin B, de Miguel BI, Besovic Z, et al. Systemic measures and legislative and organizational frameworks aimed at preventing or mitigating drug shortages in 28 European and Western Asian countries. Front Pharmacol. 2017;8:942.CrossRefPubMed

Fox ER, Birt A, James KB, Kokko H, Salverson S, Soflin DL. ASHP guidelines on Managing drug product shortages in hospitals and health systems. Am J Health Syst Pharm. 2009;66(15):1399–406.CrossRefPubMed

Morris S. Medicine shortages in Australia - what are we doing about them? Aust Prescr. 2018;41(5):136–7.CrossRefPubMedPubMedCentral

Walker J, Chaar BB, Vera N, Pillai AS, Lim JS, Bero L, et al. Medicine shortages in Fiji: a qualitative exploration of stakeholders' views. PLoS One. 2017;12(6):e0178429.CrossRefPubMedPubMedCentral

10.

Gray A, Manasse HR Jr. Shortages of medicines: a complex global challenge. Bull World Health Organ. 2012;90(3):158–A.CrossRefPubMedPubMedCentral

11.

McLaughlin M, Kotis D, Thomson K, Harrison M, Fennessy G, Postelnick M, et al. Effects on patient care caused by drug shortages: a survey. J Manag Care Pharm. 2013;19(9):783–8.PubMed

12.

WHO Department of Essential Medicines and Health Products. Medicines shortages -Global approaches to addressing shortages of essential medicines in health systems. WHO Drug Information. 2016; 30 (2): 180–5. Available at URL: https://apps.who.int/medicinedocs/documents/s22463en/s22463en.pdf.

13.

World Health Organization. Addressing the global shortage of, and access to, medicines and vaccines: Report by the Director-General. 2018. Available at http://apps.who.int/gb/ebwha/pdf_files/EB142/B142_13-en.pdf.

14.

Yadav P. Kenya Medical Supplies Authority (KEMSA): a case study of the ongoing transition from an ungainly bureaucracy to a competitive and customer focused medical logistics organization. World Bank. 2014. Available at URL: http://documents.worldbank.org/curated/en/876311468277741016/pdf/918640WP0P14870e0ongoing0Transition.pdf.

15.

Gray A. Medicines shortages-unpicking the evidence from a year in South Africa. Australas Med J. 2014;7(5):208–12.CrossRefPubMedPubMedCentral

16.

Goldsack JC, Reilly C, Bush C, McElligott S, Bristol MN, Motanya UN, et al. Impact of shortages of injectable oncology drugs on patient care. Am J Health Syst Pharm. 2014;71(7):571–8.CrossRefPubMed

17.

EAHP. EAHP’s 2018 Survey on Medicines Shortages to improve patient outcomes. November 2018. Available at URL: http://www.eahp.eu/practice-and-policy/medicines-shortages/2018-medicines-shortage-survey.

18.

FIP. Report of the International Summit on Medicine shortage. 2013 Available at: https://www.fip.org/files/fip/publications/FIP_Summit_on_Medicines_Shortage.pdf.

19.

Collins M. Managing Drug Shortages: A Buyer's Perspective. 2013. Available at URL: https://www.pppmag.com/article/1336.

20.

Dill S, Ahn J. Drug shortages in developed countries--reasons, therapeutic consequences, and handling. Eur J Clin Pharmacol. 2014;70(12):1405–12.CrossRefPubMed

21.

Greene JA. When did medicines become essential? Bull World Health Organ. 2010;88(7):483.CrossRefPubMedPubMedCentral

22.

Meyer JC, Schellack N, Stokes J, Lancaster R, Zeeman H, Defty D, et al. Ongoing initiatives to improve the quality and efficiency of medicine use within the public healthcare system in South Africa; A Preliminary Study. Front Pharmacol. 2017;8:751.CrossRefPubMedPubMedCentral

23.

Muhia J, Waithera L, Songole R. Factors affecting the procurement of pharmaceutical drugs: a case study of Narok County referral hospital. Kenya Med Clin Rev. 2017;3(4):20.

24.

Barraclough A, Clark M. Managing Procurement. Chapter 12 in Managing Access to Medicines and Health Technologies. In: Management Sciences for Health; 2012. https://apps.who.int/medicinedocs/documents/s19577en/s19577en.pdf.

25.

Magadzire BP, Ward K, Leng HMJ, Sanders D. Inefficient procurement processes undermine access to medicines in the Western Cape Province of South Africa. S Afr Med J. 2017;107(7):581–4.CrossRefPubMed

26.

Department of Health, Republic of South Africa. Policy for classifying medicines into therapeutic classes for purposes of therapeutic intercharge. 2017. Available at URL: https://www.bing.com/search?q=POLICY+FOR+CLASSIFYING+MEDICINES+INTO+THERAPEUTIC+CLASSES+FOR+PURPOSES+OF+THERAPEUTIC+INTERCHANGE+&form=EDGSPH&mkt=en-gb&httpsmsn=1&refig=0aadfcc948584b8bbe9f9b35d30041e1&sp=-1&pq=policy+for+classifying+medicines+into+therapeutic+classes+for+purposes+of+therapeutic+interchange+&sc=0-98&qs=n&sk=&cvid=0aadfcc948584b8bbe9f9b35d30041e1.

27.

Tyler LS, Cole SW, May JR, Millares M, Valentino MA, Vermeulen LC Jr, et al. ASHP guidelines on the pharmacy and therapeutics committee and the formulary system. Am J Health Syst Pharm. 2008;65(13):1272–83.CrossRefPubMed

28.

Griffith MM, Pentoney Z, Scheetz MH. Antimicrobial drug shortages: a crisis amidst the epidemic and the need for antimicrobial stewardship efforts to lessen the effects. Pharmacotherapy. 2012;32(8):665–7.CrossRefPubMed

29.

Berger J, Hofmeester N, Makhado M, Miot J, Moller H, Pharasi B et al. Challenges and opportunities for improvement of medicines procurement in South Africa’s public sector. Available at URL: http://ipasa.co.za/Downloads/Policy%20and%20Reports%20-%20Medicines/procurement/Medicines%20Procurement%20Task%20Team%20Report-%20Final%2029%2004%202010.pdf.

30.

Gray A, Riddin J, Jugathpal J. Health care and pharmacy practice in South Africa. Can J Hosp Pharm. 2016;69(1):36–41.PubMedPubMedCentral

31.

Conmy A. South African health care system analysis. Public Health Review. 2018;1(1):1–8 URL: file:///C:/Users/mail/Downloads/1568-Article%20Text-4255-1-10-20181130.pdf.

32.

Gray A, Vawda Y. Health Policy and Legislation. SAHR 2016; 3–15. Available at URL: http://www.hst.org.za/publications/South%20African%20Health%20Reviews/1%20Health%20Policy%20and%20Legislation.pdf.

33.

Gray A, Suleman F, Pharasi B. South Africa’s National Drug Policy: 20 years and still going. South African Health Rev. 2017;2017(1):49–58 https://www.hst.org.za/publications/South%20African%20Health%20Reviews/HST%20SAHR%202017%20Web%20Version.pdf.

34.

Pharasi B, Miot J. Medicines selection and procurement in South Africa: medicines, vaccines and technology. South African Health Rev. 2012;2012(2012/2013):177–85.

35.

Babar ZUD. Pharmaceutical policy in countries with developing healthcare systems: Springer International Publishing AG; 2017. https://doi.org/10.1007/978-3-319-51673-8 (Accessed 20200106).

36.

Treasury Department, Government of South Africa. PUBLIC FINANCE MANAGEMENT ACT 1999. Available at URL: http://www.treasury.gov.za/legislation/pfma/act.pdf.

37.

McKenzie A, McCann T. EVALUATION OF THE STOP STOCK OUTS PROJECT (SSP), SOUTH AFRICA. 2016. Available at URL: https://lakareutangranser106.sharepoint.com/Departments/OE/Documents/Evaluation%20Unit/02.%20Evaluations/SEU%20Dossiers%202016/14.%20SSOSA_Stop%20Stock%20Outs%20South%20Africa%20COMPLETE/1.%20Final%20Report/Final%20Version%20(pdf%2026%20doc)/SEU_Evaluation_SSP_Final_2016_SHORT%20VERSION.pdf.

38.

Christopher E. Essential Medication Stock Outs Persist in South Africa. 2016. Available at URL: https://africahealthnews.com/essential-medication-stock-outs-persist-south-africa/.

39.

Jobstown South Africa. Assistant Manager Pharmaceutical Services - PROVINCIAL ADMINISTRATION: GAUTENG DEPARTMENT. 2017. Available at URL:.

40.

Perumal-Pillay VA, Suleman F. Selection of essential medicines for South Africa - an analysis of in-depth interviews with national essential medicines list committee members. BMC Health Serv Res. 2017;17:17.CrossRefPubMedPubMedCentral

41.

Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15(3):398–405.CrossRefPubMed

42.

Chimberengwa PT, Masuka N, Gombe NT, Tshimanga M, Bangure D. Procurement processes at Gwanda provincial hospital, Matebeleland South Province, Zimbabwe, 2012; a descriptive cross sectional study. Austin J Public Health Epidemiol. 2015;2(1):1018.

43.

Schwartzberg E, Ainbinder D, Vishkauzan A, Gamzu R. Drug shortages in Israel: regulatory perspectives, challenges and solutions. Isr J Health Policy Res. 2017;6:17.CrossRefPubMedPubMedCentral

44.

Mathieu-Mendes A. Responses to the Questionnaire on the Measures implemented in the MS territories in the context of Article 81 of Directive 2001/83/EC. 2018. Available at URL: https://ec.europa.eu/health/sites/health/files/files/committee/ev_20180525_rd03_en.pdf.

45.

African Union. PHARMACEUTICAL MANUFACTURING PLAN FOR AFRICA - Business Plan. 2012. Available at URL: https://au.int/sites/default/files/pages/32895-file-pmpa_business_plan.pdf.

46.

WHO. Local production and access to medicines in Low- and middle-income countries - A literature review and critical analysis. 2011. Available at URL: https://www.who.int/phi/publications/Local_Production_Literature_Review.pdf.

47.

Campell K. Active pharmaceutical ingredients pilot plant marks important step for SA industry. Engineering news 2017. Available at: http://www.engineeringnews.co.za/print-version/new-pilot-plant-marks-important-step-for-local-pharmaceutical-industry-2017-11-24.

48.

Kershaw A. Transforming the Brazilian domestic pharma industry through PDPs. 2015. Available at URL: https://ihsmarkit.com/research-analysis/transforming-the-brazilian-domestic-pharma-industry-through-pdps.html.

49.

ChePa N, Jasin NM, Bakar NAA. How change management can prevent the failure of information systems implementation among Malaysian government hospitals? The 2nd International Conference on Applied Science and Technology 2017. Available at URL: https://aip.scitation.org/doi/pdf/10.1063/1.5005370?class=pdf.

50.

Ntege C, Mabirizi D, Kakungulu S, Madende S, Muchadeyi E, Kangudie M. Enhancing efficiency in pharmacy and patient management: The RxSolution experience at the Intermediate Hospital. 2012. Available at URL: http://apps.who.int/medicinedocs/documents/s21030en/s21030en.pdf.

51.

Wouters OJ, Sandberg DM, Pillay A, Kanavos PG. The impact of pharmaceutical tendering on prices and market concentration in South Africa over a 14-year period. Soc Sci Med. 2019;220:362–70.CrossRefPubMed

Title: Medicine shortages and challenges with the procurement process among public sector hospitals in South Africa; findings and implications
Authors: Cynthia Modisakeng
Moliehi Matlala
Brian Godman
Johanna Catharina Meyer
Publication date: 01-12-2020
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2020
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-020-05080-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Medicine shortages and challenges with the procurement process among public sector hospitals in South Africa; findings and implications

Abstract

Background

Method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Efficiency and efficacy of planning and care on a post-anesthesia care unit: a retrospective cohort study

Professional advice for primary healthcare workers in Ethiopia: a social network analysis

Workplace interventions that support older employees’ health and work ability - a scoping review

Combining patient, clinical and system perspectives in assessing performance in healthcare: an integrated measurement framework

Time trends in the regional distribution of physicians, nurses and midwives in Europe

The impact of tumor board on cancer care: evidence from an umbrella review