Inadequate Budgeting, Financial and Monitoring Systems Result in Formula Shortages for PMTCT Programmes

According to a report in The Times (on 26 May 2009), the MEC for Health in Gauteng, Qedani Mahlangu, issued an apology to mothers in Soweto who have been unable to access formula for their babies as a result of an unacceptable 10 day delay in delivering infant formula to hospitals and clinics across Gauteng.

The MEC's statement is a welcome acknowledgement of the problem, but does not adequately take responsibility for, or appreciate the dire consequences of, the shortage. Access to formula milk for infants of HIV positive mothers is important because of the risk of transmitting HIV to babies through breastfeeding. Women with HIV who are enrolled in the PMTCT programme are, according to government policy, entitled to receive infant formula if they are unable to afford it privately.

Tragically, the problems in Gauteng are not new. The seriousness of formula shortages was drawn to the attention of the provinces by the ALP in August 2008 as a result of shortages experienced in Mpumalanga and elsewhere. That shortages continue is a failure of the provincial health departments to urgently address the situation. This is grossly negligent. Women and children who are harmed as a result have a claim against the government for damages.

There are a number of grave risks that arise from this:

• For those women who chose not to breastfeed – a decision that is irreversible after a few days - the shortages put parents in a desperate situation of trying to find alternative sources of nutrition for their babies.
• Those who were forced to breastfeed due to the lack of availability of formula milk risked transmitting HIV to their infants.
• Scientific studies have shown that the risk of transmitting HIV is greatest when mixed feeding is used. This occurs when parents use both formula and breast milk in an attempt to make a limited supply of formula milk last longer.

This current shortage, as indicated by the MEC, stems from the failure of all provinces to institute adequate budgeting and financial systems. At a meeting of the Programme Implementation Committee of SANAC on 12 May, the Deputy Director General of Health, Dr Yogan Pillay, indicated that the default in payments amongst all nine provinces to Nestle alone amounted to R15 million.

The consequences of this situation is no different from the moratorium on ARV initiation that began in the Free State in November last year. Without proper budgeting, financial and monitoring systems – including early warning systems for drug and formula shortages, procurement and supply systems, and standards compliance mechanisms – these shortages are inevitable.

We call on the Minister of Health, Dr Aaron Motsoaledi, to take urgent action to resolve these failures. We also call for the immediate publication of reports written by the Integrated Support Teams established by the former Minister of Health, Barbara Hogan, in collaboration with the MECs for Health, to investigate financial management across provincial departments.

For further comment contact: Mark Heywood 083 634 8806