Authors: Trip Allport and Bonnie Fundafunda
Patient-centric healthcare consists of services that are designed and developed with the patient in mind. Whether a clinical service or a support service, like supply chain, it must have patient needs as the foundation of its design and development. Part of doing this well requires understanding the challenges that affect patients in accessing health services or products.
Healthcare systems in Africa have historically been based on the resources and capabilities governments have available to implement services. However, with the limitations of existing approaches becoming increasingly evident, particularly as demand for services grows, governments and healthcare partners are beginning to ask important questions about how patient needs can be placed at the centre of healthcare planning.
Can governments in Africa really hope to achieve patient-centric supply chains? Yes, they certainly can. However, there are some existing barriers that have slowed down the rate of patient-centric supply chains being developed.
One of the complications of delivering patient-centric health supply chains is the scale and scope of need in public healthcare – it has to reach vast numbers of people and supply very large inventories of medicines to treat a range of illnesses. There are far more demands of scope and scale on healthcare than in, say, a fast moving consumer goods context.
One of the things that has been done to address this is to segment medicine delivery into some of the main chronic diseases prevalent in each country, such as HIV, TB and diabetes, and then to work out a differentiated channel delivery (DCD) model for that particular disease. This way, governments can begin to develop a service that patients can access conveniently. This type of delivery is especially effective for stable patients with chronic diseases where health departments know that patients will need access to the relevant medicines for the rest of their lives. This gives governments a long-term incentive to develop patient-centric solutions that will ultimately relieve pressure on the rest of the healthcare system.
Another barrier to achieving a patient-centric supply chain is the limited number of health facilities. As a solution, governments are partnering with donors and the private sector to develop DCD models that decentralise medicine access points for some patients and leverage other means, such as private pharmacies or medicine drop-boxes, as one possible step to address this challenge.
The idea of patient centricity is not new. However, because healthcare is a public service, as people become more aware of their rights around healthcare, the lack of patient-centrality in existing structures is being increasingly questioned. People are looking at different ways of engaging with government so that they can have better experiences of healthcare. Governments need a paradigm shift in health policy design to better cater for patient needs.
Part of this includes cultivating a conviction that it can be done. In some African countries there is clear evidence of government awareness and appetite for pilots to improve patient access to medication. This will have a significant, positive impact in the long term as these programmes grow.
For instance, some of the nascent patient-centric initiatives that Africa Resource Centre has worked on include developing DCD programmes in South Africa and Uganda for ART, where the model for medicine delivery to chronic patients has been reconceptualised to focus on what works best for the patients. This, in turn, has a positive impact on treatment adherence and ensures that government finances are targeted and focused to better achieve their intended purpose.
Patient-centric healthcare also requires legal and regulatory provisions to be put in place to accommodate this approach. Once the impetus is there, patient-centric healthcare can be achieved when decision makers and implementers are open to innovation and challenging existing structures in order to respond effectively to patients.
About the authors
Bonnie Fundafunda, PhD. is the regional lead, supporting East and Southern Africa countries for ARC. He has over 30 years’ experience in health policy, planning, strategy, operational systems and business development in Africa. Trip Allport is managing director of ARC. For over a decade, he has helped to shape and manage partnerships supporting market-oriented solutions to the world’s most challenging development issues between the private and development sectors.