Making it easier to access chronic medication in South Africa during COVID-19

South Africa has 7.7 million people living with HIV and supports the world’s largest antiretroviral treatment program. Up to 70% of a healthcare facility’s daily prescription load may, therefore, consist of repeat prescriptions. This can result in unnecessarily long queues and repeat visits for people who simply need to pick up their chronic medication (which increases their travel costs), as well as increased wait times for other patients who are trying to access the facilities. The COVID-19 pandemic exacerbated these issues by limiting access to medication through closed health facilities, lockdowns, and transportation restrictions.

To address this challenge, the National Department of Health and Project Last Mile investigated the effectiveness of leveraging community pharmacy involvement and pick-up points to help scale the Central Chronic Medicines Dispensing and Distribution (CCMDD) program during the COVID-19 pandemic.

Building on strong foundations

Since 2016, the CCMDD program has been instrumental in decongesting public health facilities and enhancing patient access to vital medications by establishing a network of community-based, private-sector medication pick-up points (PuPs).

During the COVID-19 pandemic, the CCMDD program rapidly scaled its efforts to ensure continuous access to chronic medication, as patients with chronic conditions were considered the most at risk population. This involved a multifaceted approach, including identifying and promoting the use of PuPs to enable patients to collect their chronic medicines closer to their homes, implementing regulation changes that allowed for longer prescriptions, and adopting multi-month dispensing processes. The result was that patients needed to visit clinics less frequently, thus minimizing their COVID-19 exposure risks and travel burdens.

Adapting enrolment criteria played a crucial role in increasing patient eligibility for the program and the number of patients who could access its benefits. This, in turn, freed up clinic capacity to focus resources on those patients who needed them most.

Continuous monitoring via GIS-based tools also facilitated real-time adjustments to meet evolving patient needs.

An agile approach

The CCMDD program was rapidly expanded between March 2020 and August 2022, accommodating an additional 327,121 patients (a 14% increase). This was achieved through:

• Increasing the number of pick-up points, including community pharmacies
• Multi-month dispensing to reduce clinic visits
• Enrolment criteria adjustments for broader eligibility
• Continuous monitoring using GIS-based tools
• Engagement of private sector partners to establish over 2,900 external PuPs
• Deployment of geospatial analytics to optimize PuP locations
• Implementation of innovations like smart lockers and modular containers
• Strategic marketing efforts to increase patient awareness and uptake

Results

From March 2020 to August 2022:

• The number of CCMDD-registered patients grew from 3.38 million to 5.29 million (+57%)
• External pick-up-points increased from 2,088 to 2,906 (+39%)
• The number of active patients collecting at external PuPs increased by 88%, from 873,480 to 1,642,129
• 63% of patients chose to collect their medication at external pick-up points.
• 40% of all HIV patients on ART received their medication through CCMDD.
• The number of patients on ART increased by 108%, from approximately 973,487 to 2,026,101.
• Patients collecting from external PuPs had an average waiting time of less than 10 minutes. In a survey of 954 patients, 99% reported being assisted within 10 minutes at the PuP.

Lessons learned and future plans

The results and data analysis suggest that the CCMDD program has been successful in expanding access to medicines for chronic, stable patients in South Africa and has:

• Improved the availability of chronic medication
• Reduced the burden on public healthcare facilities
• Improved patient adherence to medication.

The growth of patients enrolled in the CCMDD program highlights the importance of centralized medication dispensing and distribution systems in improving health outcomes for patients with chronic conditions.

Sustained collaboration with community pharmacies and innovative service delivery models will be pivotal in maintaining uninterrupted medication access for chronic conditions in South Africa and beyond.

Further research is needed to evaluate the impact of the CCMDD program on health outcomes and overall quality of life for patients. Ongoing monitoring and evaluation will be crucial to ensure the program continues to meet the needs of patients with chronic conditions, including those on ART.