Alternative mechanisms for delivery of medication in South Africa: A scoping review.

Robert Mash,Ruvimbo V Chigwanda,Carmen Christian

doi:10.4102/safp.v63i1.5274

Abstract

BackgroundThe number of people in South Africa with chronic conditions is a challenge to the health system. In response to the coronavirus infection, health services in Cape Town introduced home delivery of medication by community health workers. In planning for the future, they requested a scoping review of alternative mechanisms for delivery of medication to patients in primary health care in South Africa.MethodsDatabases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Data was analysed both quantitatively and qualitatively.ResultsA total of 4253 publications were identified and 26 included. Most publications were from the last 5 years (n = 21), research (n = 24), Western Cape (n = 15) and focused on adherence clubs (n = 17), alternative pick-up-points (n = 14), home delivery (n = 5) and HIV (n = 17). The majority of alternative mechanisms were supported by a centralised dispensing and packaging system. New technology such as smart lockers and automated pharmacy dispensing units have been piloted. Patients benefited from these alternatives and had improved adherence. Available evidence suggests alternative mechanisms were cheaper and more beneficial than attending the facility to collect medication.ConclusionA mix of options tailored to the local context and patient choice that can be adequately managed by the system would be ideal. More economic evaluations are required of the alternatives, particularly before going to scale and for newer technology.

Highlights

The South African health system is challenged by a number of colliding epidemics of chronic conditions.[1]
Access to medication was limited by the unacceptable waiting times at facilities and it was hoped that alternative mechanisms would improve access, adherence and clinical outcomes
Six alternative medication delivery systems were identified in South Africa: alternative PuPs, adherence clubs, workplace outreach, home delivery, smart lockers, and automated pharmacy dispensing units

Summary

Introduction

The South African health system is challenged by a number of colliding epidemics of chronic conditions.[1] The antiretroviral therapy (ART) programme for people with HIV is the largest in the world, and the epidemic of tuberculosis (TB) is closely related.[2] At the same time, there is a growing problem of non-communicable diseases, diabetes, hypertension, asthma, chronic obstructive pulmonary disease and post-TB structural lung damage.[1] Diabetes is the leading cause of death for women and affects 1 in 4 South Africans over the age of 45 years.[3,4] Human immunodeficiency virus on the other hand mainly affects younger people in the age range 20–35 years.[2] This means that millions of South Africans require chronic medication, often for life, while at the same time being part of the working-age population. In planning for the future, they requested a scoping review of alternative mechanisms for delivery of medication to patients in primary health care in South Africa

Objectives

Methods

Results

Discussion

Conclusion