Tunisians struggle as life-saving medicine shortage hits country

For more than a year, pharmacies and health centres in Tunisia have been facing a critical depletion of stock for a large number of medicine and it has become an ongoing crisis despite a cash injection by the government to reduce the Central Pharmacy deficit.

Since the start of this year, at least 300 different drugs are either unavailable or becoming scarcer in Tunisia's pharmacies and hospitals as the country's strategic stock of medicine shrinks.                         

In November, the Tunisian association of pharmacists released a list of 303 medicine out of stock including contraceptive pills, antiseptics, anxiolytics, antidepressants, and immunosuppressant drugs.

To raise public awareness on the crisis, the association launched the hashtag  #Libérezlesmédicaments… Il est de mon droit de vivre! (#Freethemedicine… I have a right to live!)                                                           

The new health minister, Abderraouf Cherif, acknowledged that 20 percent of medication is not available on the Tunisian market, promising that the situation will be back to normal within two months.

Earlier in July, the Tunisian Medical Board criticised the slow crisis response from authorities.

"These supply cuts, especially of vital medicines could lead to particularly harmful effects on the quality of healthcare," it warned.

These supply cuts, especially of vital medicines could lead to particularly harmful effects on the quality of healthcare

"The Central Pharmacy doesn't pay any more!" one Tunisian pharmacist spoke up on a French radio, while another chemist added that, "It's not the first time the country faces a penury of medicine stock, but this time the situation is unprecedented." 

Holding a monopoly on medicine imports, Tunisia's Central Pharmacy – which distributes medicines in the local market to the country's pharmacies – is confronting financial difficulties including outstanding debts to foreign suppliers, resulting in a halt in supply from several drug companies.

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The factors lying behind the shortage are well known.

Chedly Fendri, head of the Council of the Order of the Pharmacists of Tunisia (CNOPT) pointed to "shortfalls" in the National Social Security Fund, and the National Health Insurance Fund (CNAM) in particular, stating that the CNAM is currently unable to finance the healthcare benefits given in health providers supplied by the Central Pharmacy, which in turn cannot pay the supplying pharmaceutical companies abroad.

The rising debt is reportedly caused by increased financial benefits for pharmacies in the local market and social fund offices, affecting the availability of medicine in the market. It is also due to the significant devaluation of the local currency versus the increase in prices of imported drugs.

As for local medicine manufacturing, the CNOPT's president continued, prices of raw materials have increased by 40 percent in just three years since the value of the Tunisian dinar has dropped steadily.

"With sale prices of drugs unchanged, due to rigid price review procedures, the local pharmaceutical industry has been exposed to financial problems," he said. This has negatively affected the Tunisian medicine production.

"There is bad management within the CNAM, the Central Pharmacy and hospitals, and there is widespread corruption in all these institutions," voiced Tunisian popular cyber-activist and blogger Lina Ben Mhenni, who denounced the scarce availability of medicine in dispensaries and hospitals.

She pointed out that the lack of computerised systematisation in most healthcare structures makes it difficult to manage and track stocks of pharmaceutical products, leading to supplies going missing and losses worth "hundreds of thousands dinars".

The lack of computerised systematisation in most healthcare structures makes it difficult to manage and track stocks of pharmaceutical products, leading to supplies going missing and losses worth 'hundreds of thousands dinars'

Suspicions of corruption have grown since the Tunisian prime minister conducted an inspection visit at the headquarters of the Central Pharmacy in January this year. Three investigations were opened against some of the staff suspected of corruption in the purchase operations of medicines from suppliers.

Theft of drugs inside the Central Pharmacy and hospitals and drugs smuggling into neighbouring countries, toward Libya in particular, are another two issues contributing to the depletion of supplies.

Known for being an outspoken cyber-activist criticising Ben Ali's dictatorship during the 2011 revolution, Ben Mhenni is today speaking out against the medicine crisis in her country.

She is a sufferer of an autoimmune disease (lupus) since the age of 11, when she started observing the reality of Tunisian healthcare and received a kidney transplant in 2007. Her life depends on immunosuppressants and corticosteroids.

"My illness opened my eyes on the deplorable conditions of hospitals, the penury of drugs, the lack of medical equipment, and the negligence by medical staff," Ben Mhenni, also the author of A Tunisian Girl, told The New Arab.

After realising over time that, like her, many other Tunisians were struggling to find their pharmaceutical supplies, she created a Facebook group named Médicaments Pour Tous (Medicines For All) two years ago.

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Last March, the activist experienced an acute transplant rejection and her health state deteriorated. Rushed back to hospital for treatment, she became more aware of how serious the drugs shortage was getting by the time she was prescribed new medication which she could not find.

She made a distress call on Facebook, after which some Tunisians brought the medicine she required from abroad. It was after this that people started contacting her to help them find drugs for their relatives.

That's when the blogger decided to launch a Facebook page Winou_eddewe (Where is the medicine?) now counting around 7,000 members, as a communication tool to enable people to contact each other, ask for help, find information or reply to urgent requests.

"One of the reasons I became a human rights defender is my disease," emphasised the young woman who is fighting her battle for access to healthcare in her homeland.

Suspicions of corruption have grown since the Tunisian prime minister conducted an inspection visit at the headquarters of the Central Pharmacy in January this year. Three investigations were opened against some of the staff suspected of corruption in the purchase operations of medicines from suppliers

With other activists, she has been putting pressure on the ministry of health.

Fendri insisted arguing for a need for reforms. The CNOPT and all the parties concerned are planning to work on the dossier and formulate recommendations to address the grave penury.

At the end of June, the Tunisian government allocated 500 million Tunisian dinars ($190 million) to reform the Central Pharmacy and reduce its fiscal deficit.

The CNAM and hospital structures owe the Central Pharmacy more than 820 million dinars ($278 million) according to health labour unions. The Central Pharmacy, for its part, is believed to have a debt of over 500 million dinars toward its foreign suppliers.

Despite promises that the crisis would be soon resolved, problems with stocks remain.

Noor, a chemist working at a pharmacy in Tunis, showed a list of about 100 drugs that they have not had in stock in the last three months. They include anticoagulants, corticosteroids, medication for thyroid and cardiovascular diseases, which are on high demand.

"We have people complaining as they can't find their medication anywhere," the pharmacist said. "If we're out of stock, we advise a substitute if we have it available, otherwise we redirect our clients to other pharmacies."

Several chemists have long demanded authorisation to sell generic medicines or substitutes made in Tunisia that should replace those products out of stock. However, in some cases drugs and chronic disease remedies as well as their substitutes are hard to find.

Little to no availability of certain drugs, especially vital ones, poses a risk to the treatment of patients eventually leading to health complications, including death.

Citing examples of individuals with cancer or mental diseases, Ben Mhenni explained that some could resort to desperate acts when they run out of their medicines. Among them, a girl with schizophrenia who threatened to commit suicide the day she could not find her sedatives in stock, and a group of patients who turned violent and assaulted health staff at a psychiatric hospital after their medication became unavailable.

"On several occasions, I've seen people dying in front of my eyes because of the drug shortage," she recalled.

For emergencies, some choose to share their medicine stocks with others who are in urgent need at very short notice.

"I save what I can in times of crisis, it's my duty," she uttered.
 

Alessandra Bajec is a freelance journalist currently based in Tunis. 

Follow her on Twitter: @AlessandraBajec