South Africa’s KwaZulu-Natal province has had a tough two years. On top of the effects of the COVID-19 pandemic, which resulted in various levels of lockdowns and was declared a state of national disaster, the province has had a spate of tragedies to deal with. In July 2021, violent riots broke out and continued for two weeks, leaving at least 337 people dead. In April and May 2022, areas of KwaZulu-Natal suffered devastating floods, displacing about 40,000 people and killing almost 500 people, as well as severely damaging infrastructure.

People living in affected areas have had their lives disrupted on every front. To ensure their access to life-saving medicines was not interrupted, the National Department of Health, supported by Project Last Mile, PEPFAR and USAID, sprang into action.

Pivoting CCMDD and developing new procedures

South Africa is home to 7.7 million people living with HIV, including 4.8 million on daily antiretroviral therapy. Noncommunicable diseases are also on the rise. This places a strain on limited resources and healthcare facilities. Previously, patients collected routine medication refills from primary care clinics, often traveling far distances and foregoing a day of work or school to pick-up these essential medicines.

In response, South Africa’s National Department of Health (NDoH) launched the Central Chronic Medicines Dispensing and Distribution (CCMDD) program to improve access to chronic medicines through convenient pick-up points, including independent pharmacies, supermarkets, and retail outlets. This accounts for numerous direct, financial and non-financial benefits to people managing chronic diseases. The program also provides benefits to the public health system at all levels, including direct benefits to facilities by reducing over-crowding.

Maggie Munsamy, Head of CCMDD at the NDoH says, “We have worked tirelessly with partners like Project Last Mile to achieve our goals of providing patients on chronic medication with easy, reliable access to medicines they need. Our efforts have been recognized by the Center for Public Service Innovations, which awarded CCMDD with the prestige of being the innovator of the year. This is a real feather in our cap. We will stay focused as we continue to innovate in the pursuit of patient service excellence.”

Throughout COVID-19, Project Last Mile supported the CCMDD program in identifying ways to enable more patients to access chronic medication to reduce the strain on overburdened health facilities. When the riots began in KwaZulu-Natal, the NDoH, supported by Project Last Mile, designed and executed a recovery plan built on its existing disaster recovery planning.

Building on prior learning

Merlin Pillay, CCMDD Coordinator at Project Last Mile, explains that Project Last Mile had previously mapped all the province’s CCMDD pick-up points and healthcare facilities. “Using the mapping data and information from the ground, we were able to identify which CCMDD pick-up points were affected by the July 2021 riots,” Merlin says.

“We were able to visualize this and then find solutions to help patients access their medicines by redirecting them to other pick-up points,” says Merlin. “We also mapped out which facilities were closed and what solutions we could implement around those facilities too.”

Project Last Mile also helped develop a Standard Operating Procedure (SOP) for home delivery, based on previous work on an SOP developed to deal with COVID-19.

This work enabled rapid responses, adaptive learning, and resilience, ensuring the NDoH continued to serve patients with minimal impact. All the lessons learned came into play in April and May 2022, when the floods occurred.

Developing agile solutions

Phil Roberts, Route-to-Market Lead for South Africa at Project Last Mile, says the foundational documents developed during the riots became the basis for dealing with everything related to patient support in the wake of following disasters.

The SOP is aimed at healthcare facilities and pick-up points and outlines what needs to happen in the event of a disaster in a step-by-step plan.

Project Last Mile has also acted as a bridge between public and private sector partners, which tend to have different operating models and logistics, sharing guidance and processes to help prioritize patient care.

Tracking the patient numbers, Phil says he was encouraged that no significant drop-off was detected across the 400 000 patients affected by the riots and floods. “It all happened in very short time period, showing the team’s and the health systems flexibility,” agrees Munsamy.

“We view this as a massive success and a demonstration of the effectiveness of the alternative pick-up points and the downstream and upstream logistics that were possible due to having recovery plans in place,” Phil says. “I see it as a defining moment for the Project Last Mile team.”

This initiative is funded and supported by USAID. The content and information provided on this website is the responsibility of Project Last Mile and is not official United States government information and does not necessarily represent the views or positions of USAID or the United States Government.