Ministries of health, donors, implementing partners and district support partners across Africa are increasingly investing in supply chain models that aim to expand the availability of medicines to the last mile. There has been a growing realisation that interventions which bring medicines closer to patients are an essential part of this. These alternative drug distribution models have many advantages, including that they often don’t require significant capital investment and have the potential to help decongest healthcare facilities.
It is essential, however, that patient voices and needs are placed at the centre of the process when developing alternative drug distribution solutions. Models that are driven solely by donor or government objectives can fail to account for patients’ actual pain points and socio-economic and cultural realities, which will result in lower uptake and less successful implementation.
THE VALUE OF ANECDOTAL DATA
Underserved communities with a low density of primary healthcare facilities face many challenges in accessing medication. To better understand their particular access challenges, it’s invaluable to collect anecdotal data directly from the people a solution is seeking to help.
In the Africa Resource Centre’s (ARC) work on a direct delivery solution in South Africa, the team began the model development process by talking to patients in underserved and hard-to-reach locations. This produced clear insights into the main challenges patients face in accessing their chronic medication, including the high financial and time costs they incur by having to travel regularly to facilities that are further than 5 km away to collect their medication.
This depth of understanding also helps create a compelling story that shows the value of a proposed solution when presenting it to partners, donors and ministries of health.
Understanding the economic characteristics of a patient cohort in terms of access to things like transport and infrastructure, from a realistic and pragmatic standpoint, can inform genuinely sustainable solutions.
In addition, environmental factors and psychosocial factors need to be taken into account. For example, in some instances, people who live below the poverty line are forced to choose whether to spend their limited available money on their next meal or on expensive transport to get a script refilled at a healthcare facility. Additionally, people who live in rural settings may also need solutions that provide services that are accessible despite a lack of basic infrastructures such as roads and electricity.
Having an accurate view of the burden of disease in each context is also essential when developing an alternative drug distribution model. In South Africa, for instance, there has historically been a strong focus on developing solutions for people living with HIV. Still, there is also scope to begin thinking about models that can incorporate chronic medication for other non-communicable diseases, like diabetes and hypertension, as medical schemes have projected that the non-communicable disease burden will be almost three times more than the HIV in 2027.
Some chronic diseases also carry different stigmas in different cultural contexts. Supply chain solutions need to account for this in their approach.
In the South African direct delivery example, any solution can seek to leverage the familiar social tool of stokvels as part of the inspiration for its model because of the inclusive, trusted nature of these social groups. Stokvels comprise community members, friends or people with any other social links, who come together to collaborate in achieving a shared goal. These goals are often financial, with collections going to different members of the group according to their needs at a particular time.
The direct medicine delivery solution proposed grouping stable chronic patients into clubs of about six people who take turns to collect the necessary medications for everyone in their cohort. The drugs are pre-packed at the healthcare facility. A club member only needs to go to a facility once or twice a year when it is their turn to get the group’s collective medication outside of their routine medical consultation.
The group model provides a socially safe space for patients to access medicines for a range of chronic conditions. It also decreases the stigma patients face from their community deducing their HIV status, which may happen for example, in an antiretroviral-only delivery mechanism.
Truly patient-centric healthcare solutions are designed and developed with the patient in mind from the very beginning. Alternative drug distribution solutions that aim to bring medicines closer to those who need them have significant potential to directly impact people’s healthcare experiences in Africa. However, patients need to be included in the development process to ensure that the solutions meet their actual needs and address their context-specific challenges.
ABOUT THE AUTHORS
Phenyo Shabangu is the Supply Chain Technical Manager within ARC’s Solution Centre. He is a seasoned supply chain professional with 11 years of industry and consulting experience spanning multiple industry sectors.
Rajeev Batohi is the South Africa Lead at the Africa Resource Centre. He has over 15 years of expertise in the Private Sector, including Supply Chain, Strategy, Revenue Management, Technical and Procurement.