The lack of medications in public healthcare facilities has prompted calls for urgent national intervention. Western Cape reports the distribution of medicines among both patients and the institutions themselves.
For individuals dependent on vital drugs to treat chronic diseases, the shortage can lead to therapy interruptions, dosage reductions, or substitution of medications with alternatives. This potentially can cause serious health problems such as epilepsy, stroke, or more severe conditions. Among the drugs experiencing scarcity are those for hypertension, cholesterol, diabetes, and mental disorders.
The National Department of Health (NDoH) informed The National publication about supply issues in certain areas and facilities, but did not provide data on the number of affected patients or specific missing medications.
An NDoH representative, Foster Mohale, noted that it is difficult to accurately count the number of affected patients because alternative drugs exist for those suffering from supply problems. The department stated that it is working to find medication replacements, and some patients may temporarily switch to other treatments until supply issues are resolved.
Supply chain disruptions exacerbate the shortage
The causes of the current supply problems stem from a combination of factors, including geopolitical tension in the Middle East, as well as instances of non-compliance with regulatory requirements by local manufacturers under the South African Health Products Regulatory Authority (SAHPRA). The department is actively engaging with suppliers and procuring alternative medicines from other sources to minimize the negative impact on patients. During this transition period, some patients may be temporarily prescribed clinically appropriate substitutes for the same conditions until supply restrictions are lifted.
NDoH emphasized its commitment to ensuring continuity of care and will continue to monitor the situation closely, collaborating with all stakeholders to restore normal supply levels as quickly as possible.
Dr. Edward Ngwenya, chairman of the South African Medical Association (SAMA), pointed out that drug supply limitations are not uniform across all facilities and provinces, and availability varies significantly. He specifically highlighted concern over the shortage of treatments for chronic diseases, including cardiovascular and other non-communicable diseases, as well as specialized drugs. In Ngwenya's view, the clinical significance of the shortage depends on the drug itself and the availability of a suitable substitute.
He explained that a shortage of a drug with a safe and readily available equivalent can be managed, whereas a shortage of a critical drug without therapeutic alternatives poses a significantly greater risk to patient safety. For patients with chronic illnesses, interrupting treatment can lead to poorer disease control, symptom exacerbation, or complications requiring hospitalization.
Doctors urge caution when substituting medications
Although SAMA supports the use of clinically sound alternatives to maintain continuity of care, Ngwenya insisted on the necessity of thorough clinical assessment when making such substitutions. Doctors must consider the active ingredient, dosage, strength, therapeutic equivalence, potential contraindications, and drug interactions, as well as the patient's other medical conditions and previous response to treatment. He also warned that changing the brand or packaging should not be assumed to mean a change in treatment if an equivalent product with the same active ingredient and strength is available from another approved manufacturer.
SAMA reported that it does not possess sufficient consolidated clinical data to quantitatively assess the degree of patient deterioration or attribute individual adverse outcomes solely to drug shortages. However, according to Ngwenya, it is clinically arguable that interruptions in vital treatment create a real and preventable risk, especially for patients dependent on uninterrupted intake of chronic or specialized medications.
The association called for enhanced national and provincial real-time monitoring of drug availability, earlier notification of supply delays, improved procurement planning, and accelerated redistribution of existing stocks among facilities. Clearer communication with doctors, pharmacists, and patients regarding expected shortages, their anticipated duration, and approved alternatives was also requested.
The City of Health and Wellness of the Western Cape, Mireille Wenger, appealed to the Minister of Health, Dr. Aaron Motsoaledi, to present a clear plan and timeline for restoring stocks and protecting patient access to necessary treatment. Her representative, Robin Thomson, confirmed that distribution is already taking place between patients and facilities. She added that the list of affected medications is constantly changing as new batches arrive and shortages occur, but if a specific drug is unavailable, a suitable alternative or a smaller quantity can be provided until supplies are secured. Teams are working on the fair distribution of available medicines and finding alternatives wherever possible.
In a parliamentary response in June, Motsoaledi named several medications affected by supply disruptions. These include antibiotics such as ciprofloxacin, flucytosine, fosfomycin, and mebendazole; anti-tuberculosis drugs containing rifampicin; oncology drugs including bleomycin, carboplatin, docetaxel, and filgrastim; insulin; and some pediatric antiretroviral drugs such as nevirapine and lamivudine. However, it was not possible to determine whether all these medications are currently facing shortages, as NDoH did not provide this information.
Opposition parties demand answers from the Ministry of Health. A DA party representative on health matters, Michelle Clark, stated that her party believes up to 50 critical medications are missing in the country. The party submitted a request under the Promotion of Access to Information Act for departmental stock reports from April to October 2026 and plans to raise this issue through parliamentary questions.
Stavros Nicolaou, chairman of the Pharmaceutical Task Team, recently pointed out several contributing factors to the shortage. He referred to global supply chain disruptions linked to the oil crisis in the Persian Gulf, noting that some pharmaceutical ingredients and excipients used in production are derived from oil. He also pointed to rising production costs that are not keeping pace with regulated drug prices, as well as the suspension of production capacity by regulators. Nicolaou called for greater certainty regarding procurement rules, local manufacturing policy, and drug pricing. The shortage also triggered warnings against purchasing medicines from street vendors, which followed the arrest of a man in Gugulethu who allegedly sold expired drugs.
