Improving Access to Medicines through Centralised Dispensing in the Western Cape Province, South Africa

Rationale / Objectives

Access to necessary medications is considered a crucial part of universal health coverage and an important part of the delivery of health services and care in South Africa. Due to the increasing burden of chronic disease in addition to a shortage of healthcare professionals and pharmacy employees, this combination threatens the ability of supply chain systems to perform effectively. 

Project/Program Description & Major Achievements

To aid in the distribution of medications to stable patients with chronic diseases, the Western Cape Department of Health (WCDoH) established the Chronic Dispensing Unit (CDU), an out-sourced and centralised dispensing intervention for medicine. The CDU was introduced in the Western Cape in December 2005 and dispenses medicines for stable, public-sector patients. The CDU collects prescriptions for stable chronic patients from health facilities, dispenses the medicines, and returns them to the facilities which the patients attend, packaged in tamper-proof parcels identified with outer labels. The program is used to: reduce pharmacists’ workload (by relieving pharmacy staff from repetitive and time-consuming tasks that detract from patient-focused elements); decongest health facilities; and improve the patient experience by reducing waiting times. On average, most patients can recieve their medicines within 20 minutes, and the capacity of the CDU has expanded considerably over time.

Lessons Learned

Missed appointments by patients are a problem, affecting an estimated 8 %–12 % of patients each month, with associated cost and workload implications that require further review. Larger patient cohorts were also more difficult to manage.

People / Organizations Involved

Further Description

The WCDoH CDU program started with eight facilities in 2005, and had increased to 216 facilities by early 2015. An average of five to six items per prescription are delivered in one Patient Medicine Parcel. In early 2015, the CDU dispensed over one million items each month. The first step is that prescriptions are collected from the facilities. The prescriptions are then pre-assessed for compliance to legal requirements, if they do not comply they are returned to the originating facility. If they do comply an image of the prescription is scanned for use during future phases of the dispensing process. Details of each prescription are captured in software, and is vetted by a pharmacist before it is approved for further dispensing. Once prescriptions have been vetted, the captured data is stored electronically. The stored data is then transferred to a semi-automated pick- to-light system. The Dispensary Manager releases prescriptions to the picking stations for picking according to collection dates and daily targets. Additional, quality assurance checks are then performed with the content of each picking basket checked against the scanned image of the prescription. Following quality assurance, the medication and copy of the prescription is packaged into a tamper evident bag to which an outer label is applied. The PMPs are packaged into boxes with each box having a specific barcode. The boxes are then distributed to the various facilities accompanied by an alphabetical list of all the patients for whom a PMP has been delivered for a specific collection date. 

Major Achievements

The benefits for the patients involved in the CDU included decreased waiting times, improved compliance with medication use, and improved perception of quality service at facilities. The benefits for pharmacy staff included decreased pressure in the working environment, increased morale and increased time for patient counselling and other pharmacy functions. Additionally, benefits for the Department of Health included improved disease management, improved capacity to manage increasing patient numbers and improved management of information and data collection.

Metric Result Additional Detail
Patient wait times for medicines Reduced to an average of 20 minutes After implementation of the new process