We have all seen the stories on the TV news – long queues of patients at clinics, waiting for medicines that may not be available while over-stretched health workers try to juggle competing demands. An innovative programme by the National Department of Health, supported by HST, is changing all that.
The past decade has seen a sharp – and unpredicted – rise in the number of patients needing chronic medication for a range of conditions, including a growing number of non-communicable diseases. While South Africa provides universal access to Antiretroviral Therapy (ART) for patients living with HIV and AIDS, the country is also facing an uptick in non-communicable diseases such as diabetes and hypertension.
This unexpected shift has put public health workers and facilities under a great deal of pressure and has led to medicine shortages and concerns about quality of professional care for patients. Patients often have to wait a long time in queues, spend money they can ill-afford on transport and even lose a day’s wages due to absence from work. This makes it more likely that patients will default on their treatment, which can lead to drug resistance or deterioration of their condition.
The CCMDD programme improves access to chronic mediation for patients in a stable condition, by allowing them to collect repeat medication from a convenient pick-up point near their home or work, including from some big retail outlets such as Clicks and Dischem. This also means that patients can collect their medicines from certain pick up points after hours and on weekends.
The programme uses a centralised dispensing operation that obtains prescriptions for stable chronic patients from health facilities and dispenses a package of medicines for each patient, which they can collect from a health facility (using an express queue) or another convenient pick up point. Patients are also able to nominate two other persons such as a family member to collect their repeat medicine parcels.
By the end of September 2016 more than 735 080 patients in 37 Districts and 1672 health facilities were participating in this scheme.
Feedback from healthcare workers shows that this programme reduced their workload, giving them time for longer consultations with patients.
HST is the primary support partner for CCMDD at a national level, provides technical support in seven districts regarding CCMDD policy implementation and plays an important role in the developing of standard operating procedures. Provincial support is provided in seven provinces (excluding Western Cape and Northern Cape), in terms of orientation and training to other support partners and assistance to provinces and districts on scale-up of the programme.
Batha Msweli (33) is a practice manager for a private GP’s surgery in the township and says this collaboration between the public and private health care systems is heartening.
"This programme really helps, because if patients go the polyclinic they have to be there as early as 5a.m to get in the queue. Now they are happy because when they pick up here they usually don’t wait more than 5 minutes," says Msweli. The Kwa-Mashu polyclinic now refers patients to this private pick-up point.
Msweli adds that patients who are new to the programme are sometimes surprised at how straightforward the process is.
"The meds are pre-packaged, so when I am handing over the packages the patients from this community know that the contents are confidential. We also set follow-up dates and remind them when it’s time for a review, such as when they are due for more blood tests."
In the pipeline
HST developed a web-based system for the CCMDD programme which has been piloted successfully. The electronic system will enable online patient registration at facility, electronic submission of prescriptions to dispensing service providers, scanning capability for medicine parcels received at pick-up points as well as the issuing of parcels to patients. Automated reporting is also catered for, including notification to facilities regarding patients who failed to collect their medicines in order to activate patient tracing processes Implementation will take place in three districts in KwaZulu-Natal during 2017.
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