It’s a cold, grey Tuesday morning as Jonathan Thomas steps into the grounds of St Mary’s church in Woodstock, Cape Town. There’s a quiet bustle in a corner of the clean and airy church hall — not of worshippers, but of patients who have come to collect their prescription medicines.

Thomas, a 52-year-old driver, is making a small detour on his way to work in an informal settlement in Langa, where he supervises a team of toilet cleaners. With his boss’s permission he has stopped off at the church to fetch his monthly supply of pills for high blood pressure and cholesterol.

"I find this ideal. I am in and out in less than five minutes," he smiles. "Before, I had to wait at the Woodstock Hospital. It could take hours, depending on the [queues] there."

Thomas is a beneficiary of the Western Cape health department’s pioneering chronic medicine dispensing programme, which offers patients an alternative to lining up for hours at public hospitals and clinics to get their regular monthly prescriptions filled. It achieves this by providing pick-up points at places such as community halls, old-age homes, churches and mobile clinics. Health facilities also have separate collection points for chronic patients, who are given appointments to minimise congestion.

The initiative began with a small pilot programme in Cape Town in 2005 that serviced just under 1,000 patients. Today it covers the entire province, providing on average 380,000 packs of medicines each month through its service provider, DSV Healthcare, to sites stretching from Plettenberg Bay to Bitterfontein. In the year to March 31, more than 1.5m patients benefited from the service.

Patients get an SMS to remind them of their appointment time, and have a 10-day window in which to get their drugs if they can’t make their allotted slot. They can also authorise someone else to collect their repeat prescriptions if getting to a pick-up point doesn’t suit them.

Unemployed single mother Qudsiyyah Genadien says: "I volunteer to collect medicines for bedridden elderly patients who are themselves unable to collect [their medication], and also for some working people who have good jobs in factories and supermarkets. I do this for between 30 and 40 patients, and come to St Mary’s Church two or three times a week. I save the people time and money."

The programme has significantly reduced the workload for health-care staff, enabling them to spend more time talking to patients, which has in turn improved compliance, says Western Cape health department spokesman Mark van der Heever.

The clinics are far away, and people have limited transport. Now they can just take an hour off and they don’t lose a day’s income travelling to town
Madelein Bauer

DSV Healthcare’s Parow site runs a sophisticated operation using equipment that was designed for sorting mail. Bulk supplies of medicines come into the facility from the Western Cape depot, and the "production" line turns out separate boxes for each designated collection point. The boxes contain clearly labelled and sealed patient packets, neatly stacked in alphabetical order.

Each patient has a unique identification number, which enables DSV’s pharmacists to stop patients collecting at multiple sites and assists them in spotting prescribing errors, says company logistics manager Michael Rossi. "There is a national shortage of pharmacists and pharmacy assistants. Our technology allows us to use fewer people," he says. His staff electronically capture 6,500 prescriptions a day, some of which have as many as 15 line items — a reflection of the immense burden of noncommunicable disease facing the province.

"Many of these patients are really sick. The main diseases we see are diabetes, hypertension, high cholesterol and HIV," says Rossi.

Similar initiatives are now under way in other parts of the country, says the national health department’s deputy director for regulation & compliance, Anban Pillay. "In other provinces, however, our approach is to use courier pharmacies to deliver to private pharmacies and GP rooms [in addition to community-based sites]," he says. "Over 1.5m patient packs are delivered each month [around SA]."

Saving time: St Mary’s church, Woodstock, is just one medication pick-up point. Picture: TREVOR SAMSON
Saving time: St Mary’s church, Woodstock, is just one medication pick-up point. Picture: TREVOR SAMSON

Medipost won the tender for KwaZulu Natal, and the other provinces are serviced by Pharmacy Direct.

Rossi says DSV could readily deliver to private pharmacies in the Western Cape, but it all hinges on what the provincial health department considers affordable: it pays DSV R24.25 a pack for delivery to the sites it has chosen, considerably less than the R35 paid by other provinces to their service providers, he says. Delivery to private pharmacies would push up costs.

Nevertheless, the Western Cape health department can boast that it reaches parts of the country that no other service provider does.

Nurse Madelein Bauer oversees the handover of repeat prescriptions to contract workers on the apple and pear farms owned by Dutoit Agri in the Koue Bokkeveld region near Ceres. "The clinics are far away, and people have limited transport. Now they can just take an hour off and they don’t lose a day’s income travelling to town," she says.

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