A Tanzanian organization called Sikika (meaning noticeable or audible) has surveyed 30 health facilities and 71 districts (just over half of all districts) to assess the availability of medicines and medical supplies, concentrating on absorbant gauze, but also looking at supplies of surgical gloves, syringes, ALU (Artemether/Lumefantrine, for treating malaria), quinine injections and amoxicillin. The findings are very disturbing. Up to 50% or more of the facilities lacked supplies of at least one of the surveyed items. Up to 50% or more had no gauze, 40% had less than they needed and only 8% had sufficient supplies. Shortages could last for up to six months.
This can be compared to the work that Marc Koska did to demonstrate to health officials in Tanzania that there was a need to look at the role of injecting equipment reuse in transmitting HIV and other blood borne viruses, reviewed yesterday. These shortages are extremely unlikely to be confined to the five surveyed items, either. Representatives of the Ministry of Health and Social Welfare and of the Medical Stores Department did not respond to the survey.
The researchers do not appear to have asked what health professionals do when they have run out of such supplies. Do they treat fewer people, do they reuse supplies, with or without an attempt to sterilize them? Myself and a colleague have asked people working in healthcare that question; they appeared to think it obvious that they would reuse supplies. The report lists various contingency measures, such as borrowing from neighbouring hospitals, asking patients to supply, sending patients to other facilities, etc. But if most hospitals don’t have enough supplies these measures must be limited in effect. Some cancelled elective surgeries and others suggested that the numbers of cross infections and complications would increase as a result of shortages.
The study aimed to survey the extent of the problem, find out what was being done about it and how patients were affected by it. They also interviewed health officials from Uganda and Kenya to compare the three countries. Some of the shortages were due to lack of funds available to individual facilities. Orders were placed for lower levels of supplies than required and surgery had to be cancelled for all but emergency cases. But the entire procurement and distribution process was found to be in urgent need of revision.
The study also highlights a massive shortage of public pharmacies, even in areas which are not particularly isolated, such as Dodoma, the administrative capital of Tanania. There are only about 700 trained pharmacists in the whole country, which has a population of over 40 million, and pharmacies are concentrated in cities and big towns. Over 75% of tanzanians live in rural areas. Medicines and medical supplies are all procured through the Medical Stores Department, a centralized agency, and they are currently reforming their delivery system.
Shortages of supplies other than gauze were less severe, with shortages of syringes being least severe. But there were still 6% of facilities at district level and another 10% of facilities interviewed that had no supplies. 50% of facilities were short of syringes. The figures for lacking surgical gloves were 28% and 17%, respectively, with 58% suffering from shortages.
Conflicting information was received from Kenya and none at all from Uganda. Kenya did experience shortages of gauze, said to be due to a global shortage of cotton. Africa, including East Africa, produces a lot of cotton. But that is unlikely to have much impact on medical supplies that mainly come from large pharmaceutical multinationals, rather than from non-Western manufacturers.
I can certainly see why UNAIDS would recommend to its employees that they avoid health facilities that are not approved by the UN when working in African countries. But I don’t understand why UNAIDS don’t think that Africans themselves are in any danger. Are Africans not entitled to the same warnings about unsafe healthcare as UN employees?