CCMDD: A vehicle towards universal access to Anti Retrovirals and other chronic medicines in South Africa. HST Project Manager: CCMDD Helecine Zeeman

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1 CCMDD: A vehicle towards universal access to Anti Retrovirals and other chronic medicines in South Africa HST Project Manager: CCMDD Helecine Zeeman

2 PROBLEM STATEMENT Long queues, long day, no medicines!

3 BACKGROUND The provision of an alternative chronic medicine access programme for stable patients in the public sector which includes: Recruitment of patients on programme. Dispensing and Distribution of prescriptions by a contracted service providers. Contracted Pick Up Points (PUPs) more suitable to patient needs. National Dept of Health to pay for the services and HIV (Fixed Dose Combination) medicines Provinces to pay for the medicines for comorbidities and other chronic medicines

4 CONTRACTING OF SERVICE PROVIDERS CCMDD SERVICE PROVIDERS PICK UP POINT SERVICE PROVIDERS MEDIPOST OPTIPHARM PHARMACY DIRECT Kwa Zulu Natal Limpopo North West Eastern Cape Free State Gauteng Mpumalanga Northern Cape PHASE ONE Pharmacies General Practitioners Occupational Health Clinics PHASE TWO Adherence Clubs Community Based Pick Up Points

5 OBJECTIVE To improve access to Anti Retrovirals and Chronic medicines for stable patients in the Public Sector in South Africa

6 METHODOLOGY CENTRAL DISPENSING COLLECTION FROM A PICK UP POINT (PUPs) Distribution

7 IMPLEMENTATION OF PROCESS MAP Tracing Collection Registration Distribution Dispensing Registration by the facility Patients are enrolled Repeat script issued Script authorized Dispensing by the Service Provider Capturing of script Dispensing of script Distribution by the Service Provider Distribute to Pick-up points Send patient an SMS to collect Collection at the Pick Up Points (PUPs) Checking and receipt of parcels Identify patient and issue parcel Notify facility of uncollected parcels Return uncollected parcels to service provider Tracing Defaulter tracing Provide feedback to facilities

8 RESULTS: IMPLEMENTATION IN THE FACILITIES Province District Facility KZN Amajuba 27 KZN umgungundlovu 53 KZN umzinyathi 56 KZN Additional districts (3) 262 Limpopo Vhembe 130 North West Dr. Kenneth Kaunda 47 North West Additional districts (3) 7 Gauteng City of Tshwane 79 Mpumalanga Gert Sibande 77 Free State Thabo Mofutsanyane 73 Eastern Cape O R Thambo Northern Cape Pixley ka Seme Total 949

9 RESULTS: PICK UP POINTS APPOINTED Province District Facility Private Amajuba, 73 KZN umgungundlovu umzinyathi & other Limpopo Vhembe 13 Dr. Kenneth 12 North West Kaunda & other Gauteng City of Tshwane 71 Mpumalanga Gert Sibande 14 Thabo 44 Free State Mofutsanyane Eastern 21 Cape O R Thambo Northern 6 Cape Pixley ka Seme Total Criteria for Appointment: Geographical accessibility to the population to be served Security and storage of parcels to enable easy retrieval Preferably operate for extended hours Ability to verify identity of patients Availability of appropriately skilled persons to issue parcels Ability to provide required reports to the district/province/ndoh

10 RESULTS: MEETING OF TARGETS PER PROVINCE ACTUAL PATIENT FIGURES Northern Cape ,500 Eastern Cape Free State FY 2015/16 500,000 Mpumalanga FY 2016/17 650,000 Gauteng North West FY 2017/18 850,000 Limpopo KZN

11 RESULTS: END MARCH Yearly Target Patients Enrolled 0

12 CHALLENGES No Pick Up Points in rural areas Decanting of patients from facilities <20% collections from external PuPs System challenges Late/non-deliveries Lack of data at facility level Lack of patient and parcel tracking Facility parcel management

13 ACHIEVEMENTS 1. Political Buy In - Included in APP 2. Communication - Promotional Material 3. System Strengthening - SOPs & Tools 4. Strengthening M & E for the programme 5. Facility files all CCMDD information 6. Integration within different health programmes 6.1 CCMDD - Ideal Clinic medicine repeat collection strategies 6.2 Integration with Adherence Strategy 7. Strengthen 90:90:90 strategy

14 CONCLUSION Innovative programme to improve access Reduce waiting times Improve patient satisfaction Successful business model for private sector involvement in the provision of health care services in the public sector The CCMDD project is a pilot for NHI implementation

15 ACKNOWLEDGEMENTS National Department of Health Sector Wide Procurement Cluster HIV and AIDS Cluster PHC Cluster Communications Cluster NHI Districts- CCMDD Project Teams Health Systems Trust PPS Team