Western Cape's Chronic Medication Dispensing Largest of Its Kind in Africa

At a press conference at the site where medicine parcels for the Western Cape Department of Health's 200 000 chronically ill patients are packaged, provincial Minister of Health, Theuns Botha, said that the new contract is moving into new territory in the dispensing of medication.

"With this system, the Western Cape is certainly leading the country. It is envisaged that eventually the service will include deliveries to patients' homes. Eventually, delivery of patient chronic medication parcels to their homes in the Metropole and postal delivery will be rolled out within the financial constraints and allocated budgetary framework," said Minister Botha. "With this service, government is delivering an improved health service. When government provides the service and our patients take the responsibility to take their medication, we are better together," he emphasised.

Initially, in August 2011, UTi Pharma was appointed to provide a chronic medication dispensing service to the Western Cape Department of Health for some 40 000 patients. However, from 1 April 2012, this tender was extended to nearly 200 000 patients per month - making this the single largest pharmacy operation of its kind on the continent.

The R500 million contract was awarded for a five-year period.

At present, services cover 118 facilities and provide chronic medicines and ARVs to sites in the Metro District Health Services mainly, as well as to parts of the West Coast and Winelands districts.

The Sisonke Partnership t/a UTi Pharma collects prescriptions from sites, dispenses the medicines according to the prescription, makes patient medicine parcels into sealed tamper-evident parcels and distributes these parcels to facilities. This is in accordance with legislation and good pharmacy practice.

UTi Pharma electronically tracks the dispensing of parcels from the site to facilities and hands over the parcels with feedback prompts for the next patient medicine parcels. Patients also receive text message reminders to collect their next patient parcel.

The service provider's helpdesk assists patients and facilities with queries, tracks the progress and reports on resolutions.

Minister Botha said that the service will be rolled out in a staggered manner from the Metropole to rural districts encompassing the entire province during the contract period.

The first five months - April to July 2012 - provide time for UTi to take over existing services and sites. In the six months thereafter - August 2012 until January 2013 - dispensing services will expand to the relevant central and regional hospitals in Cape Town, followed by the expansion of the balance of the West Coast District facilities. Thereafter, a staggered roll-out will take place in the rural districts. Thereafter, home deliveries will commence in a pilot phased manner in the Metropole, according to the operational needs and financial constraints.

Each further expansion will be prefaced by a review by the department of the service delivery at that time, in consultation with role players and operational service needs.

The benefits of the service being provided by UTi Pharma include:

• More patients will benefit: In time, the expanded service will include all patients in the Western Cape, and not just those covered by the Cape Town Metropolitan service. When full coverage is reached, some 500 000 people will benefit from the service.
• Patient waiting times will reduce: Waiting times for patients collecting chronic medication will reduce significantly.
• Communication with patients will improve: Patients with cell phones will be able to be notified via SMS that their medication is ready.
• Added convenience with direct deliveries: With an expanded number of healthcare facilities participating and the introduction within the next 12 months of servicing of retirement homes, and in selected instances home delivery, the Department of Health is taking service to levels never before experienced in South Africa.
• Improved efficiencies: The Department of Health will be better placed to deal with new patients.
• Enhanced service: The contract will over time improve service levels and add services to chronic patients and patients in retirement homes and house deliveries, and a streamlined handover process at the facilities will reduce waiting time on collection days. The enhanced service will also reduce wasted time and thus improve productivity.
• Enhanced data will lead to better decision making: The Department of Health will access dispensing data that will enhance informed decision making on disease management and drug utilisation trends and enable better insight into patient compliance, one of the most challenging healthcare issues worldwide. Updated and current patient profiles will allow the department to communicate with patients who forget to collect their monthly medication, and the possibility exists in the future for proactive communication with patients in high-risk categories.
• Improved quality control: The UTi Pharma dispensary in Cape Town will be the first dispensary in South Africa to batch track pharmaceuticals from the point of supply (manufacturer or Central Medical Stores) into the hand of the patient. This creates significant product quality control benefits and enables the department to initiate a recall if necessary.

The benefits of the new service will become increasingly apparent as the project settles down, notwithstanding the challenges in the interpretation and integration of data that occurred in the take on of the additional 160 000 patients.

UTi Pharma and the Department of Health have committed significant resources to resolving the issues over the past three weeks, and the situation has now been stabilised and the service is operating normally (ie medication for collection on 23 April is being dispensed today, 19 April).

Despite the unfortunate challenges that occurred, and the regrettable inconvenience to some patients, it should be noted that even where a script has not been available, a patient has still been served and medicine provided.

Going forward, additional safety margins of dispensed products will be built into the system and any possible future technical challenges will have no operational effect - and importantly, will not negatively impact on patients in any way.

In addition, as the new service beds down in the coming months, the full range of benefits detailed above will become apparent to patients throughout the Western Cape.

UTi Pharma SA vice-president, Robin Botha, said the service is a significant step in improving the dispensing of chronic medication to all patients in the Western Cape, and will become the standard by which dispensing will be judged.