Solutions for improved dispensing in public health
There have been numerous reports in the media about medicine stock-outs at public health facilities which have been framed as a crisis, and indeed, it has been a crisis.
Therefore 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.
© Karuna EM 123rf.com
Strengthening resilience
Department of health chief operating officer, Dr Gail Andrews, highlighted the need for countries to strengthen the resilience of medicine supply chains.
“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,” she said.
Andrews said the minister of health has appointed an advisory team on pharmaceuticals and related commodities security, comprising local and international experts, including World Health Organisation (WHO) members, who have 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“We know the current medicine supply chain is characterised by outdated, duplicative processes and infrastructure ill equipped to service the growing disease burden and programme requirements.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,” she said.
Attracting more pharmacists
This is exacerbated by staff shortages in health facilities as only a third of the country’s 13,500 registered pharmacists work in the public sector.
However, she said the DOH has started to attract more pharmacists since the introduction of the occupational specific dispensation (OSD) as a result of improved working conditions. And it has introduced interventions to improve medicine availability and access to bring the medicine value chain “into a modern state of preparedness”.
National Surveillance Centre
Andrews said the department has set up a National Surveillance Centre with dashboards showing current medicine stock levels at primary health care 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.
Harnessing technology
“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 smart and efficiently,” she said.
Innovative technology to disseminate standard treatment guidelines and to allow healthcare workers to report stock-outs directly have also been introduced.
“With these systems we hope to empower healthcare workers and patients to support us in improving service quality,” she said.
Chronic medication
Andrews said 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 health care providers, often resulting in poor medicine availability and poor access to medicines even when they are available,” she said.
“A large number of our patients 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,” she said.
Implementing external pick up points would reduce the number of patients visiting health facilities just to collect medication, she added.
