While the value of differentiated channel delivery (DCD) is becoming increasingly clear for healthcare in Africa, there are a number of opportunities and challenges that need to be considered as DCD models are applied in different countries and contexts. Many of these opportunities and challenges are linked. Additionally, increased awareness of the potential limitations will allow implementation programmes to optimise their use of DCD to avoid these pitfalls and to take advantage of the opportunities.
Many DCD models leverage existing systems, such as the use of third-party logistics providers that can facilitate the physical delivery of medicines to the last mile, and do not often require significant capital investment, meaning they are agile solutions that can be implemented swiftly.
This presents an opportunity where the impact and effectiveness of decentralising service delivery in healthcare can be seen quickly in many contexts. However, in some contexts, there is often a gap between policy, and subsequent state funding, to support a DCD approach, and this limits the scalability of some projects in the long term. At the Africa Resource Centre (ARC) we have seen that effective large-scale implementation may work best as a ‘franchise’ type approach where different regions and local implementation of a DCD model can happen. This should be under the guidance and oversight of a central body within the ministry of health that sets the standards for different components of the supply chain that support the delivery of medicines and healthcare.
One of the more complex aspects of DCD models that we have grappled with to date is how best to define and integrate the role of healthcare workers when decentralising medicine and healthcare access.
In some instances, such as in rural contexts, healthcare workers are already dispersed in such a way that they are able to reach people where they live and work without integration into a DCD model thereby adding to their burden of care or increasing the complexity of their work and ability to effectively deliver services. However, in other models, there need to be different types of service providers who are integrated into a supply chain system so that healthcare workers are not being expected to undertake work that is beyond the scope of their training and thus places them under undue strain. The intention of DCD models should be to free up capacity in healthcare systems to allow these healthcare workers to focus on service delivery.
The focus on HIV treatment in many DCD models was a positive step towards increasing the availability of medicines to chronic but stable patients. Going forward, there is substantial opportunity to increase the basket of healthcare products and services that can be delivered using these models. Again, the challenge of modifying policies to support such expansion will need to be addressed. However, the opportunity to shift primary healthcare services to a more local context for patients can have a hugely positive impact on their experience of healthcare, adherence to treatment and their quality of life.
The enormity of the logistical, administrative and professional components that need to be balanced when introducing a new healthcare delivery approach like DCD can cause the needs of the patient to be lost or forgotten in the midst of implementation. It is important that donors, implementing partners and governments continually seek and implement feedback from patients receiving a service to understand if it is achieving its intended targets for recipients of care.
As with any alternative approach that is applied to healthcare delivery in a range of contexts, there are challenges that need to be well understood in order to be effectively mitigated, but the immense opportunities presented by DCD solutions for Africa render it well worth pursuing.
Trip Allport is the 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.