For patients at clinic pharmacies in South Africa, medicine availability has a practical meaning - receiving the treatment they need, in the required quantity, when it is due. The country's medicine supply system should be evaluated based on this endpoint, alongside stock figures used for procurement and distribution. This approach ensures that the focus is not only on the availability of medicines but also on the actual access patients have to their prescribed treatments.
On 1 September 2026, the National Department of Health reassured the public that changes in a medicine's appearance or packaging do not necessarily indicate a shortage. This clarification is crucial as patients should not lose confidence in a treatment simply because the tablet or box looks different. Generic medicines contain the same active ingredient, in the same strength and dosage form, as their reference medicine and must meet regulatory requirements for quality, safety, and effectiveness.
However, the Department of Health's reassurance raises further questions about the measures used to manage shortages and protect patients from disruption. A supplier may have stock, a provincial depot may have stock, and a hospital may have an equivalent product, but a patient at another facility may still leave without the prescribed treatment. This highlights the need for a more comprehensive approach to measuring medicine availability, one that takes into account the complexities of the supply chain.
In July, KwaZulu-Natal provincial officials acknowledged supply constraints affecting certain medications, including phenobarbital, rifampicin, and some contraceptive pills. They described redistribution between facilities and provinces, alternative sourcing, and the use of therapeutic alternatives. These measures are necessary features of a functioning pharmaceutical system, and their success should be measured by their impact on patients.
The use of interchangeable generic medicines and therapeutic alternatives requires careful consideration. Dispensing an interchangeable generic differs from changing treatment, and a therapeutic alternative may involve a different active ingredient or regimen, requiring clinical judgment about the individual patient. Patients need clear explanations and instructions about any changes to their treatment.
The National Department of Health has identified the Stock Visibility System and National Surveillance Centre as tools for monitoring medicine availability and providing early warnings of supply problems. Such infrastructure is valuable, but patient-access measures would help establish whether these responses reach their intended endpoint. Historical studies have shown that stockouts can have significant consequences for patients, including interrupted treatment and reduced treatment success rates.
To improve the measurement of medicine availability, a set of publicly reported patient-access indicators is needed. This would involve tracking the proportion of patients who receive their full clinically appropriate supply at the first visit, as well as recording the reasons for any shortages or treatment changes. A practical starting point could be a representative group of facilities and a defined basket of essential medicines, building on existing dispensing records.
Key points
- Medicine availability in South Africa should be measured by whether patients receive full treatment when needed, not just stock figures.
- The use of interchangeable generic medicines and therapeutic alternatives requires careful consideration and clear communication with patients.
- Publicly reported patient-access indicators are needed to track the success of medicine supply systems in meeting patients' needs.
