MONROVIA, Montserrado – After The Bush Chicken reported on the current stockout of antiretroviral drugs at treatment facilities in the country, efforts have been announced to remedy the situation.

The new managing director of the Central Medicine Store, Boakai Boley, announced in a Bush Chicken interview last Tuesday that distributions of the HIV drugs are currently ongoing and would be completed this week.

Boakai said saving lives is a top priority of the agency, formerly known as National Drugs Service, and he would therefore ensure that people living with HIV have access to treatment.

“We want to make sure that medication gets to the users as soon as possible,” he noted.

During the interview, he said that Redemption Hospital on Bushrod Island had already received supplies, and other facilities in the country would follow soon.

The head pharmacist of Redemption Hospital, Abdullah Kanneh, confirmed receipt of the supply and said patients had started receiving their medication in line with their schedules.

Kanneh said the hospital had earlier sent in a requisition but supply was delayed because the Central Medicine Store warehouse at the Freeport of Monrovia was undergoing inventory check.

Stephen McGill, the executive director of Stop AIDS in Liberia, who is directly affected by the stockout as a person living with HIV and receiving treatment at Redemption Hospital, had reported that he was unable to get his treatment since January, this year.

Kanneh termed the claim as untrue, noting that the stockout did not last for more than a week.

“Immediately when the inventory was completed, Redemption was supplied on emergency request,” he said. When asked about the consumption rate and the number of patients registered for HIV at the hospital, the pharmacist declined to release any figure, saying he did not have the records with him.

Records from the Central Medicine Store provided to The Bush Chicken show that Redemption Hospital was supplied with antiretroviral drugs on March 9, this year.

The records also showed that Home of Dignity, a private chronic treatment facility for HIV, cancer and tuberculosis in Brewerville, was last supplied HIV drugs was on April 17, this year. The facility had reported stockout of HIV treatment drugs since December, last year.

Chinnie Sieh, who runs the center, confirmed that 200 cans of Nevirapine was supplied to them. Sieh, however, told The Bush Chicken that the drug was not served to the patients because it did not make a complete dosage. According to her, the Nevirapine is served along with Zidovudine and Lamivudine for the treatment to be effective.

“We can’t use the Nevirapine because you cannot give a patient one drug,” she said.

She said serving a single type of the antiretroviral will build the patient’s resistance to the drug, which may require changing the patient’s entire treatment. Currently, she said adult patients are still out of HIV medications, while supplement for children affected by the virus were also unavailable.

S.D. Cooper and ELWA and S.D. Cooper Hospitals are also reported to have also been supplied antiretroviral drugs on March 27 and April 10, respectively.

Boley, who took over the management of the Central Medicine Store less than a month ago, said he inherited a systemic issue with getting drugs delivered throughout the country on time. While acknowledging that his agency was partly at fault, Boley also said facilities requesting fewer drugs than necessary was a contributing factor to the reported stockout of the HIV drugs.

The Central Medicine Store’s managing director, Boakai Boley. Photo: Gbatemah Senah

“We want to make sure that when people are making requisitions, the numbers are accurate,” he said. This, he said, would ensure that supplies are adequate, and facilities do not run out of drugs.

He said as part of his administration’s efforts to remedy the problems at the Central Medicine Store, he plans to work with the county health teams and health facilities to ensure that medication supplied are accessed by end users.

“It’s our responsibility not just to provide those medication, but to also ensure that they reach the end users,” he noted.

He acknowledged that the history of his agency is characterized by theft and misappropriation, which has complicated efforts to regain the public’s trust, something he also promised to change.

“I inherited this, and I am intending to fix it,” he said.

In May last year, fire gutted the building that hosted the agency’s laboratory and medical supplies warehouse, destroying huge quantity of essential drugs.

A burglary was also reported at the warehouse on August 16, when dozens of cartons of drugs were taken away by criminals. Police charged guards assigned at the warehouse in connection to the crime; those guards are still awaiting trial and the private security firm is expected to share the cost of the stolen drugs with the Ministry of Health.

Meanwhile, a source at the Ministry of Health spoke anonymously to The Bush Chicken in order to disclose specific information about the stockout of drugs. The source said although a previous grant from Global Funds, which is the lone source of funding to procure tuberculosis and HIV drugs in the country, ended last December, full procurement of treatment drugs for 2018 were completed and are available in the country. The source added that a new grant that would cover the costs of the drugs up to 2020 has also been approved, and another consignment of essential drugs are expected in June.

However, the refusal of county health teams to provide the Ministry of Health with updated consumption data has been a major contributing factor to the stockout of HIV drugs, the source said.

The source maintained that the ministry has been regular with its quarterly distribution, but on low quantity because distributions were being done using historical data which did not represent the current number of patients on treatment.

“In February, we distributed, but because we did not get adequate consumption data from the counties, we just used historical data and then sent the supply. At the same time, our actual HIV data has increased,” the source disclosed.

Last year for example, the source said about 9,000 patients were being served antiretroviral drugs, but the number currently has increased to 14,000.

“So, if you use the previous data to give the next quarter commodity, there would always be stockout,” the source added.

Our source also revealed that the unconsolidated warehouse management at the ministry also a major caused to the stockout situation.

The source said since last year, the ministry has operated three unconsolidated warehouses that operated on manual inventory recording system, which made it almost impossible to have stock on the total quantity of drugs in stock.

“For the Supply Chain Management unit to approve anything that goes to the counties, they have to know what is available in the warehouse,” the source further noted, adding that although the issue of an inventory management software is yet to be completely addressed, the ministry has recently completed a full inventory to establish the quantity of drugs on in stock, the first time in more than 12 months.

The Supply Chain Management unit at the ministry has also consolidated its warehouses to a centralized unit at the Freeport of Monrovia, to take advantage of the tighter security system at the Freeport and prevent theft.

According to the source, the ongoing distribution of antiretroviral drugs, especially in Montserrado, would be on emergency because most facilities in the county were not supplied during the ministry’s eighth quarterly integrated distribution in February because the county’s health authorities were unable to take delivery of their consignment.

Unlike Montserrado, where supplies are taken from the warehouse directly to the facilities, distributions in the other counties are done through their depot management by the health teams for last mile delivery to the facilities.

Additionally, instead of the three-month quarterly distribution of the antiretroviral drugs, the source said the ministry and coordinating partners have now decided to carry out two distributions per annum, to help address shortage and avoid the drugs getting expired in stock.

Featured photo by NIAIDS