Questions & Replies: Questions & Replies No 151 to 200
2010-01-25
[PMG note: Any gaps in numbering are due to replies not yet received]
NATIONAL ASSEMBLY
FOR ORAL REPLY
QUESTION NO. 166 (written 1042 transferred)
DATE OF PUBLICATION IN INTERNAL QUESTION PAPER: 04 SEPTEMBER 2009
(INTERNAL QUESTION PAPER NO. 14)
Questions Day: 21 October 2009
Mr M Waters (DA) to ask the Minister of Health:
Whether any medicines were destroyed in the past three years up to the latest specified date for which information is available; if so, (a)(i) in which provinces and (ii) at which hospitals and (b) in each case, (i) what type of medicine was destroyed, (ii) what were the quantities destroyed, (iii) what was the monetary value and (iv) what were the reasons for the medicines being destroyed?
NW1209EREPLY:
EASTERN CAPE
Yes
(a) (i) and (ii) In the Eastern Cape, at both the pharmaceutical depots and at all facilities
(b) (i) and (ii) All expired medicines are destroyed as per medicines controls regulations. This is across the full range of medicines. In addition, the following items were destroyed during this period due to changes in policy: Tetanus-Diphtheria vaccine (full strength) was replaced by Tetanus-Diphtheria (½ st) – the immunisation schedule had been changed and all available supplies of the former needed to be removed in order to avoid (dangerous) incorrect dosing. A total of 6,025 vials to a value of R137, 129-00 were destroyed.
(iii) the following table reflects the monetary value
| 2006/7 | R 572,669.18 |
| 2007/8 | R 837,010.93 |
| 2008/9 | R 425,598.13 |
| 2009 to date | R 214,089.87 |
| R 2,049,368.10 |
(iv) As above – mostly date-expiry.
FREE STATE
(a) Yes, there was medication destroyed/disposed in the past 3 years in the Free State Province.
(i) and (ii) The following table reflects the situation
| INSTITUTION / OFFICE | 2004/05 | 2006/07 | 2008/09 | |
| Boitumelo Hosp | - | 2,648.53 | 36,618.81 | |
| Botshabelo Hosp | 115,173.81 | |||
| Bongani Hospital | 23,821.17 | 121,027.09 | 1,114,835.03 | |
| Diamant Hosp | 8,273.69 | 23,192.31 | 55,861.84 | |
| Dihlabeng Hosp | - | 509.44 | 357,401.95 | |
| Elizabeth Ross Hosp | - | 70,446.23 | 24,245.16 | |
| Embekweni Hospital | 258.30 | 7,834.06 | 39,411.03 | |
| Harrismith Clinics | - | 64,428.17 | ||
| Itemoheng Hosp | - | 30,547.12 | 89,631.14 | |
| Jd Newsberry Hosp | - | 31,100.74 | 66,698.22 | |
| Katleho Hospital | - | 22,208.19 | 120,378.45 | |
| Lejweleputswa District Office | - | - | 5,870,737.28 | |
| Mafube Hospital | - | 880.40 | 5,165.64 | |
| Mantsopa Hosp | - | 13,401.99 | 43,042.96 | |
| Medical Depot | - | 285,391.94 | 3,909,090.94 | |
| Metsimaholo | - | 47,846.08 | 270,263.73 | |
| Mmm | 541,200.92 | |||
| Mohau Hosp | - | 419,382.30 | ||
| Moroka Hosp | - | 62,975.29 | 66,296.37 | |
| Motheo District Office | - | - | 1,923,822.63 | |
| Nala Hosp | - | 114,121.23 | ||
| National Hosp | - | 2,978.86 | ||
| Northern Fs (Fezile Dabi) | 158,276.79 | 133,588.55 | 229,700.69 | |
| Parys Hosp | 200,766.44 | 305,846.64 | 165,350.88 | |
| Pelonomi Hosp | - | R 305,846.64 | 1,253,361.62 | |
| Phekolong Hospital | 10,645.64 | 25,107.23 | ||
| Phumelela Hospital (Cold Chain Broken) | 14,805.77 | R 10,645.64 | ||
| Phumelela Hospital (Expired) | - | R 20,871.12 | 70,606.28 | |
| - | 41,633.37 | 311,493.24 | |
| Psychiatric Complex | 16,683.67 | 5,300.95 | 39,571.30 | |
| Stoffel Coetzee Hospital | 82,086.65 | 180,764.60 | 14,806.47 | |
| Thabo Mofutsanyana District | - | R 64,428.17 | 4,233,926.05 | |
| Thebe Hospital | R 180,764.60 | 148,768.25 | ||
| Thusanong Hosp | - | 11,317.12 | 44,001.12 | |
| Tokollo Hospital | - | 131,141.04 | 17,025.11 | |
| Universitas Hosp | R 131,141.04 | 38,493.73 | 2,171,119.93 | |
| Winburg Hosp | 5,104.80 | R 38,493.73 | ||
| Xhariep District Office | R 5,104.80 | R - | 463,828.79 | |
| 641,218.32 | 2,800,701.51 | 23,838,542.87 | ||
| 2004/05 | 2006/07 | 2008/09 | ||
| District Offices | R 163,381.59 | R 198,016.72 | R 12,722,015.44 | |
| Regional Hospitals | R 171,645.88 | R 473,826.38 | R 5,514,109.56 | |
| District Hospitals | R 311,295.65 | R 1,913,195.59 | R 1,693,326.93 | |
| Medical Depot | R - | R 285,391.94 | R 3,909,090.94 | |
| R 646,323.12 | R 2,870,430.63 | R 23,838,542.87 | ||
| | ||||
| 2004/05 | 2006/07 | 2008/09 | |
| District Offices | R 163,381.59 | R 198,016.72 | R 12,722,015.44 |
| Regional Hospitals | R 171,645.88 | R 473,826.38 | R 5,514,109.56 |
| District Hospitals | R 311,295.65 | R 1,913,195.59 | R 1,693,326.93 |
| Medical Depot | R - | R 285,391.94 | R 3,909,090.94 |
| R 646,323.12 | R 2,870,430.63 | R 23,838,542.87 |
Summary
| Name Of District Office / Hospitals | Value Of Exp Medication | |
| District Offices | ||
| Thabo Mofutsanyana District | R 4,233,926.05 | |
| Motheo District | R 1,923,822.63 | |
| Fezile Dabi District | R 229,700.69 | |
| Lejweleputswa District | R 687,709.78 | |
| Xhariep District | To Be Confirmed | |
| Total District Offices | R 7,075,159.15 | |
| Regional Hospitals | ||
| Dihlabeng Regional Hosp | R 357,401.95 | |
| Mmm | R 541,200.92 | |
| Bongani Hospital | R 1,114,835.03 | |
| Boitumelo Hosp | R 36,618.81 | |
| Psychiatric Hosp - Not Done | ||
| Total Regional Hospitals | R 2,050,056.71 | |
| District Hospitals | ||
| Name Of Hospital | Total Value | |
| Newsberry Hospital | R 66,698.22 | |
| Phuthuloha Hosp | R 311,493.24 | |
| Itemoheng Hospital | R 89,631.14 | |
| Phekolong District Hosp | R 10,353.69 | |
| Phekolong Art | R 14,753.54 | |
| Thebe Hospital | R 148,768.25 | |
| Phumelela Hosp | R 70,606.28 | |
District Hospitals
| Elizabeth Ross Hosp | R24,245.16 | |
| Mantsopa Hospital | R43,042.96 | |
| Botshabelo Hospital | R115,173.81 | |
| Dr J.S. Moroka Hospital | R66,296.37 | |
| Nala/Mohau/Thusanong | R44,001.12 | |
| Katleho /Winburg | R120,378.45 | |
| Metsimaholo Hospital | R270,263.73 | |
| Mafube Hosp | R5,165.64 | |
| Tokollo Hosp | R17,025.11 | |
| Parys District Hospital | R165,350.88 | |
| Total District Hospitals | R1,583,247.59 | |
| Total Exp Medication To Date | R 10,708,463.45 | |
Thabo Mofutsanyana
| Expired Medication Disposed 08/09 Fin Year | |||
| Thabo Mofutsanyana District | |||
| Name Of Clinic | Total | ||
| Bluegumbush | R 47,763.22 | ||
| Boiketlo | R 41,370.30 | ||
| Bolata | R 34,830.21 | ||
| Dinkweng | R 11,522.43 | ||
| Eva Mota | R 63,060.94 | ||
| Kopanong | R 83,135.63 | ||
| Makhalaneng | R 62,640.82 | ||
| Mahaig | R 54,555.14 | ||
| Makeneng | R 36,263.67 | ||
| Makoane | R - | ||
| Malesoane | R 61,432.63 | ||
| Marakong | R 55,677.17 | ||
| Matsieng | R 34,670.00 | ||
| Monontsha | R 34,618.37 | ||
| Mphalatsane | R 21,493.88 | ||
| Namahadi | R 39,760.15 | ||
| Nthabiseng | R 7,865.10 | ||
| Paballong | R 3,528.83 | ||
| Phutaditjaba | R 4,841.67 | ||
| Qholaqwe | R 44,015.49 | ||
| Riverside | R 15,889.18 | ||
| Seka Mota | R 30,678.90 | ||
| Tebang | R 15,061.25 | ||
| Thabo Mofutsanyana District | |||
| Name Of Clinic | Total | ||
| Thaba Bosiu | R 19,259.73 | ||
| Thabang | R 7,078.08 | ||
| Tina Moloi | R 13,795.09 | ||
| Tseki | R 59,087.17 | ||
| Tshirela | R 45,410.83 | ||
| Senekal Clinic | R 36,861.26 | ||
| Soetwater Clinic | R 26,676.89 | ||
| Marquard Mamelo Clinic | R 246,703.93 | ||
| Masebabatso Clinic | R 248,393.51 | ||
| Boitumelo Clinic | R 32,850.62 | ||
| Hlohlowane Clinic | R 8,593.10 | ||
| Meqheleng Clinic | R 1,881,874.01 | ||
| Ficksburg Store | R 36,067.38 | ||
| Phomolong Clinic | R 4,116.33 | ||
| Mphohadi Clinic | R 645.17 | ||
| Petsana Clinic | R 8,223.77 | ||
| Lindley | R 306.15 | ||
| Bakenpark | R 7,736.39 | ||
| Dihlabeng Local Area | R 9,117.71 | ||
| Nketoana Hosp | R 26,040.40 | ||
| Rearabetswe Clinic | R 28.18 | ||
| Rosendal Clinic | R 15,770.48 | ||
| Bethlehem Clinic | R 50,377.89 | ||
| Arlington Clinic | R 61,217.83 | ||
| Clarens Clinic | R 5,173.16 | ||
| Bohlokong Clinic | R 7,811.57 | ||
| Reitumetse Clinic | R 6,982.40 | ||
| Bophelong Clinic | R 130,564.07 | ||
| Lesedi Clinic | R 77,026.66 | ||
| Warden Clinic | R 32,806.82 | ||
| Memel Clinic | R 11,132.25 | ||
| Vrede Clinic | R 207,589.80 | ||
| Vrede Ems | R 1,953.68 | ||
| Tsiame Clinic | R 26,472.85 | ||
| Manapo Mohau Clinic | R 37,010.94 | ||
| Harrismith Clinic | R 38,494.97 | ||
| Total Of Clinics Thabo Mofutsanyana District | R 4,233,926.05 | ||
| Regional Hospitals | |||
| Name Of Hospital | Total Value | ||
| Dihlabeng Regional Hosp | R 357,401.95 | ||
| Mmm | R 541,200.92 | ||
| Totals | R 898,602.87 | ||
| District Hospitals | |||
| Name Of Hospital | Total Value | ||
| Newsberry Hospital | R 66,698.22 | ||
| Phuthuloha Hosp | R 311,493.24 | ||
| Itemoheng Hospital | R 89,631.14 | ||
| Phekolong District Hosp | R 10,353.69 | ||
| Phekolong Art | R 14,753.54 | ||
| Thebe Hospital | R 148,768.25 | ||
| Phumelela Hosp | R 70,606.28 | ||
| Elizabeth Ross Hosp | R 24,245.16 | ||
| Totals | R 736,549.52 | ||
| Grand Total | R 5,869,078.44 | ||
Motheo
| Motheo District | ||
| Mantsopa Phc | R 1,934.82 | |
| Mauersnek Clinic | R 771.62 | |
| Boroa Clinic | R 101,641.03 | |
| Manyatseng Clinic | R 26,891.48 | |
| Houbhouse Clinic | R 4,050.64 | |
| Ikaheng Clinic | R 41,575.10 | |
| Excelsior Clinic | R 31,968.70 | |
| Thaba Patswa Clinic | R 14,655.51 | |
| Dewetsdorp | 2,265.38 | |
| Qibing Clinic | 2,515.25 | |
| Mafane Clinic | R 22,325.27 | |
| Sediba Clinic | R 555.57 | |
| Seadimo Clinic | R 4,953.56 | |
| T/N Primary Health | R 92,874.41 | |
| T/N Clinic | R 20,302.40 | |
| Motheo District | ||
| Kgalala Clinic | R 1,450.70 | |
| Tigeriver Clinic | R 29,955.78 | |
| Tweefontein Clinic | R 21,786.37 | |
| Gaongalelwe Clinic | R 108,179.08 | |
| Phetogo Clinic | R 6,292.97 | |
| Botshabelo Clinics | R 1,154,469.87 | |
| Gateway Clinic | R 11,967.70 | |
| Poly Clinic | R 128,825.77 | |
| Linolia Old Age Home | R 99.71 | |
| Kagisanong Clinic | R 3,383.39 | |
| Langenhovenpark | R 11,412.92 | |
| Bloemspruit | R 3,038.02 | |
| Batho Clinic | R 4,936.12 | |
| Freedom Square | R 9,531.62 | |
| Tlc | R 944.50 | |
| Opkoms Clinic | R 3,774.79 | |
| Bainsvlei Clinic | R 3,785.09 | |
| Thusong Clinic | R 29,869.18 | |
| Mmabana Clinic | R 809.49 | |
| Bayswater Clinic | R 2,598.95 | |
| Chris De Wet Clinic | R 5,088.32 | |
| Westden Clinic | R 7,783.38 | |
| Fichartpark Clinic | R 2,575.79 | |
| Mcdc | R 1,982.38 | |
| Total | R 1,923,822.63 | |
| Mantsopa Hospital | R 43,042.96 | |
| Botshabelo Hospital | R115,173.81 | |
| Dr J.S. Moroka Hospital | R 66,296.37 | |
| Total | R224,513.14 | |
| Universitas | Not Done | |
| Peolonom | Not Done | |
| Psychiatric | Not Done | |
| Total | R 2,148,335.77 | |
Fezile Dabi
| Name Of Clinic | R-Value Of Expired Medication Clinics –Ombudsman | |
| Pax Chc Viljoenskroon | R 64,911.19 | |
| Kananelo Chc | R 7,788.78 | |
| Tumahole Clinic | R 4,924.41 | |
| Najaasrus Oah | R 88.92 | |
| Kroonstad Laundry Clinic | R 627.84 | |
| Parys Town Clinic | R 2,336.73 | |
| Lesedi Clinic | R 104,781.22 | |
| Fezile Dabi D/Office | R 22,244.44 | |
| Kganya Clinic | R 3,551.22 | |
| Saundersville Clinic | R 180.00 | |
| Sizabanthu Clinic | R 553.90 | |
| Philane Clinic | R 17,712.04 | |
| Total | R 229,700.69 | |
| Metsimaholo Hospital | R 270,263.73 | |
| Boitumelo Hosp | R36618.81 | |
| Mafube Hosp | R5165.64 | |
| Tokollo Hosp | R17025.11 | |
| Parys District Hospital | R 165,350.88 | |
| Total | R 494,424.17 | |
| Total | R 724,124.86 | |
Lejweleputswa
| Name Of Clinic | R-Value Of Expired Medication Clinics -Ombudsman | ||
| Bongani Hospital | R1114835.03 | ||
| Nala/Mohau/Thusanong | R44001.12 | ||
| Total | R1158836.15 | ||
| Kopano Building (District Office) | R687709.78 | A Lot To Be Finalized In New Fin Year | |
KWAZULU/NATAL
A survey was carried out in October 2008 to try to get a picture of what was happening. It was merely a snapshot, but with sufficient responders to get a fairly good idea of the situation. The answers below are taken from the survey.
Yes, Medicines Are Destroyed From Time To Time In Most Institutions In The Province.
(a) (i) In KwaZulu/Natal
(ii) From a total of 31 of the 44 institutions from which a response was obtained in the survey.
(b) No detail is available, but from past experience, it covers a wide range of medicines and is not limited to any specific type of medicine.
These are mainly items that have past their expiry date
A portion of the items are those returned by patients/families of deceased patients – none of this can be re-used.
Occasionally Thermo Labile items will be exposed to high temperature, example if a refrigerator fails or there is a prolonged power outage.
(ii) details of the quantities destroyed is not readily available.
(iii) the monetary value is R 1 249 581.54 (Over 12 Months) – this equates to 0.27% of the annual medicine expenditure for the institutions involved.
(iv) the reasons for destroying the medicines include the following:
· Poor Stock Management, usually due to:
- Inadequately Trained Staff Especially Where There Is A High Staff Turnover (Especially At Phc Clinics)
- Inadequate Supervision Mainly Due To Severe Staff Shortages And Inexperienced Supervisors
· Low use of vital items that have to be kept for emergencies. These are often expensive but rarely get used
NORTHERN CAPE
Yes
(a) (i) and (ii) In the Northern Cape, at all health facilities
(b) (i) and (ii) All expired medicines are destroyed as per Medicines Controls Regulations. This is across the full range of medicines.
(iii) The following table reflects the monetary Value
| 2007/8 | R120 482.27 |
| 2008/9 | R201 022.31 |
| 2009 To Date | R 85 929.44 |
| R407 434.02 |
(iv) As above – mostly date-expiry.
WESTERN CAPE
(a) (i) Western Cape
1. Only values captured on Sinjani (Provincial Information Management System) are reported on. Monetary values below does not Include:
· City of Cape Town Municipality Clinics and
· Cape Medical Depot
2. Sinjani was introduced in 2006 and is still being rolled out to all facilities.
(ii) A list of Hospitals where medicines were written off is available on Sinjani. All hospitals have expired medicines or medicines returned by patients.
(b) (i) The medicines destroyed are usually expired medicines. This may include any type of medicines. Usually medicines provided with short-dated expiry dates; or medicines not frequently used, but essential to keep stock.
(ii) Quantities and cost per item may vary significantly from hospital to hospital. hospitals are supposed to record all medicine and quantities for audit purposes, as well as for destruction purposes.
(iii) See tables below. Central hospitals stock more expensive medicines that may expire e.g. Immuno-Suppressants or Oncology medicines. Certain hospitals also carry very expensive life saving medicines that are used seldomly and often expire e.g.
· dantrolene injection (r1700 per vial. minimum stock is 5 to 10 vials – most vials usually expire);
· snake antivenom: require 10 vials;
· poison antidotes
(iv) Main reasons for destroying medicines:
· Expired medicines
· Damaged medicines / containers
· Medicines that may have been damaged due to malfunctioning equipment e.g. refrigerators.
· medicines brought back by patients or returned from wards are destroyed by the hospital (this is not included in the monetary value).
· Redundant medicines e.g. flu vaccine
· National / provincial policy changes (e.g. new evidence suggests a medicine may be unsuitable)
| Financial Year | Value In Rands | Comment |
| 2006/2007 | R 474 712 | 2006 / 2007 = implementation of electronic system for capturing of data |
| 2007/2008 | R 4 182 409 | More than R3 million of this value was due to malfunctioning of refrigerator at Tygerberg Hospital bulk store. More sophisticated equipment has been installed. |
| 2008/2009 | R 587 160 | |
| Level Of Hospital | Value In Rands Per Financial Year | Comment | ||
| 2006/2007 | 2007/2008 | 2008/2009 | ||
| Central Hospitals (L3) Gsh, Tbh & Rxh | 201 945 | 4 036 401* | 331 397 | * malfunctioning of tbh refrigerator in bulk store |
| Secondary Level Hospitals (L2) | 20 468 | 70 488 | 51 144 | |
| District Hospitals (L1) | 30 687 | 40 481 | 93 238 | |
| Specialised Hospitals | 1 657 | 5 045 | 3 298 | |
| Community Health Centres | --------- | 5 739 | 67 120 *** | ***Improved reporting |
| Community Day Centres | 12 306 | 553** | 24 462 | **Restructuring of chc's to cdc's |
| Clinics | 4 738 | 5 396 | 12 558*** | ***Improved reporting |
| Provincial Chronic Dispensing Unit | 202 910 | 18 306 | 3 943 | Includes uplifted stock from hospitals |