Novel models to improve access to medicines for chronic diseases in South Africa: an analysis of stakeholder perspectives on community-based distribution models.

Bvudzai Priscilla Magadzire,Bruno Marchal,Kim Ward

doi:10.1186/s40545-016-0082-6

Bvudzai Priscilla Magadzire, Bruno Marchal + Show 1 more

Open Access

https://doi.org/10.1186/s40545-016-0082-6

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Abstract

BackgroundThe rising demand for chronic disease treatment and the barriers to accessing these medicines have led to the development of novel models for distributing medicines in South Africa’s public sector, including distribution away from health centres, known as community-based distribution (CBD). In this article, we provide a typology of CBD models and outline perceived facilitators and barriers to their implementation using an adapted health systems framework with a view to analysing how future policy decisions on CBD could impact existing models and the health system as a whole.MethodsA qualitative exploratory study comprising in-depth interviews and non-participant observations was conducted between 2012 and 2014 in one province. Study participants consisted of frontline healthcare providers (HCPs) in the public sector and a few policy, supply chain and public health experts. Observations of processes occurred at two CBD sites. We conducted deductive analysis guided by the adapted framework.ResultsModels varied in typology ranging from formal (approved by the Department of Health) to informal (demand-driven) and with or without user-fees. Processes and structures also differed, as did HCPs’ perceptions of what is appropriate. HCPs perceived that CBD models were largely acceptable to patients and accommodating of their needs. Affordability of services linked to charging of user-fees was a contested issue, requiring further exploration. CBD models operated in the absence of formal policy to guide implementation, and this, coupled with the involvement of non-health professionals, issues regarding medicines handling and storage; and limited patient counselling raised concerns about the quality of pharmaceutical services being delivered. Policy decisions on each of the health system elements will likely affect other elements and ultimately influence the structure and operational modalities of models. In anticipation of a future CBD policy, stakeholders cited the need for a context specific lens in order to harmonise with current implementation efforts.ConclusionA formal policy on CBD is required in an effort to standardise services for quality assurance purposes. Frontline HCPs should be involved in the development of such policy to ensure that existing arrangements already working well are not undermined. Further research will seek to contribute towards evidence-based development of policy and service delivery guidelines for CBD activities in South Africa.

Highlights

The rising demand for chronic disease treatment and the barriers to accessing these medicines have led to the development of novel models for distributing medicines in South Africa’s public sector, including distribution away from health centres, known as community-based distribution (CBD)
This section starts by presenting an overview of how CBD services are organised (Typology of CBD models) presents the remaining findings according to the elements of the framework
Typology of CBD models From the interviews with key informants, we found variation in focus and structure of CBD models implemented in the Western Cape Province

Summary

Introduction

The rising demand for chronic disease treatment and the barriers to accessing these medicines have led to the development of novel models for distributing medicines in South Africa’s public sector, including distribution away from health centres, known as community-based distribution (CBD). The increased burden of disease has illuminated the need for the government to be more responsive to population needs and to ensure that people obtain health services (including accessing essential medicines) without suffering financial hardship The latter are in line with principles of universal health coverage (UHC) [3]. The South African government released the National Health Insurance (NHI) White Paper in December 2015 This policy document discusses various health insurance modalities and reforms aimed at strengthening the country’s health system. These include: expanding access to pharmaceutical products, a primary healthcare re-engineering strategy and establishment of an office of health standards compliance. It describes a vision of what is required for the successful implementation of NHI [4]

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