Department of Health seeks solutions for improved dispensing
The Department of Health is rolling out innovative solutions to overcome the country’s medicine and staff shortage crises and to improve service to frustrated patients who have to stand in long queues just to collect drugs at clinics and hospitals.
Computer software systems with dashboard alerts warning of imminent drug shortages and alternative pick-up points that include mobile electronic dispensing units where pharmacists can remotely prescribe drugs to patients are just some of the solutions.
Department of Health (DOH) Chief Operating Officer Dr Gail Andrews, addressing delegates on Saturday 22 October 2017, said the World Health Organisation (WHO) had highlighted the need for countries to strengthen the resilience of medicine supply chains.
“There have been numerous reports in the media about medicine stock outs which have been framed as a crisis, and indeed, it has been a crisis,” she said. “What we need to understand is that challenges relating to medicine availability are experienced across the world, including in many high income countries, and it is not only a public sector challenge but impacts the private sector as well.”
Andrews reported that Minister of Health Dr Aaron Motsoaledi had appointed an advisory team on pharmaceuticals and related commodities security, comprising local and international experts, including WHO members, who had been tasked to understand the factors contributing to medicine availability challenges. This followed the Auditor General’s audit of the performance of the management of pharmaceuticals over the years 2011/12 to 2014/15 and his recommendations.
“We know the current medicine supply chain is characterised by outdated, duplicative processes and infrastructure ill equipped to service the growing disease burden and programme requirements. Health facilities are often overcrowded and the supply chain is fragmented at provincial and even district levels,” said Andrews.
The situation was exacerbated by staff shortages in health facilities as only a third of the country’s 13 500 registered pharmacists worked in the public sector. But, announced Andrews, the DOH had started to attract more pharmacists since the introduction of the Occupational Specific Dispensation (OSD) as a result of improved working conditions. And it had introduced interventions to improve medicine availability and access to bring the medicine value chain ‘into a modern state of preparedness’.
Andrews said the department had set up a National Surveillance Centre with dashboards showing current medicine stock levels at primary healthcare facilities, hospitals and suppliers countrywide. “This system uses mobile applications or electronic systems to gather information and generate warnings where shortages are likely to occur. This means that in future we can look forward to preventing problems, rather than fighting fires,” she said.
“We need to use our scarce human resource capacity more smartly by leveraging technology to produce efficiencies. Technology plays an important role in reducing wastage and allowing us to work smartly and efficiently,” said Andrews.
Innovative technology to disseminate standard treatment guidelines and to allow healthcare workers to report stock outs directly had also been introduced. “With these systems we hope to empower healthcare workers and patients to support us in improving service quality.”
According to Andrews, another intervention that would improve access was the department’s central chronic distribution programme. This allows a patient’s medicine to be centrally dispensed and distributed to a local pharmacy pick-up point convenient for the patient.
“Many chronic, stable patients are currently required to travel on a monthly or bi-monthly basis to a health facility to collect chronic medication. Due to the high volume of patients requiring services, health facilities are currently overburdened and congested. Patients travel for hours and wait in long queues before receiving services,” she said.
“The current situation frustrates patients and healthcare providers, often resulting in poor medicine availability and poor access to medicines even when they are available.”
“A large number of our patient’s access healthcare services for a myriad of diseases and conditions, such as diabetes, hypertension, pain management and substance abuse. This situation is likely to worsen, placing additional strain on our already constrained resources.”
Implementing external pick-up points would reduce the number of patients visiting health facilities just to collect medication, Andrews concluded.