“Because we serve such a large community, there would often be elderly patients having to arrive as early as 6AM in order to collect their medicine,” Dr. Dimakatso Letsie at the George Mukhari Academic Hospital. “Many of whom travel from areas that are further away and end up being hungry during the day while they wait in the long queues.”

Long queues of patients waiting for their chronic medication is a common sight at public hospitals. They are also a sign of an over-burdened health system, in which health care workers struggle to prioritise patients due to the sheer numbers.  The Central Chronic Medicine Dispensing and Distribution (CCMDD) programme eases this burden by enabling patients to pick up their medication away from the crowded clinic. A new report by the Health Systems Trust shows that the programme is working to make collecting chronic medication more accessible.

“The programme has assisted to lift the burden of the patient waiting time on elderly and ill patients, it has cut transport costs for patients who sometimes leave without getting helped due to the high numbers. It has also allowed us health workers to give more quality care and attention to patients who may often fall through the cracks of our under-resourced system,” said Letsie, who has been a paediatric registrar at the Pretoria hospital for five years.

Since the start of the CCMDD programme at the hospital, she has observed a positive influence of the programme on both the lives of patients and healthcare workers. The George Mukhari Academic Hospital serves the Ga-Rankuwa township, north of Pretoria, and serves a high number of patients from surrounding townships like Mabopane and Soshanguve.

“A programme like this, that is well functioning and efficiently resourced for the local communities that it serves continues to be necessary especially since the start of the coronavirus pandemic. Clinics and hospitals became increasingly crowded and patients are able to receive medication without having to expose themselves to contracting the virus .” said Dr. Letsie.

What is CCMDD?

Initiated by the National Department of Health in 2014, the CCMDD programme aims to increase and promote easy access to medicine. The free collection system dispenses registered patients medication from a convenient outlet or pick-up point. Patients pick up their pre-packaged medication at points approved by the health department. These include commercial outlets like Clicks, DisChem, Medirite and Pick ‘n Pay pharmacy chains or community-based sites like churches.

“Giving an eligible chronic stable patient the opportunity to collect his or her medication from a convenient pick-up point enables the facility to focus on the unstable chronic patients, as well as the acute and mother and child patients. As a result of less foot-traffic in the health facility, waiting times for visiting patients are shortened. Reducing the burden on healthcare workers in this way improves the quality of care at the health facility,” said a briefing document developed by Health Systems Trust.

According to the Health Systems Trust, the extent of the lack of resources in public hospitals and clinics has resulted in health facilities that provide patients with poor quality care. The CCMDD programme adopts a “task-shifting approach,” which  takes the responsibility of a high volume of patients out of the hands of the public health facility staff members, and placing it into the hands of the external dispensaries and distribution pharmacies.

In Ermelo, Mpumalanga, Gloria Shabangu has taken advantage of the convenience of the national programme.

“Before the CCMDD implementation, with my hours at work, I use to pay people to collect my medication at the clinic. But sometime the nurses would refuse to allow this and if that would happen I would sometimes go days without medication,” she told Health-e News. “This has caused me to default twice but now, with the CCMDD programme the defaulting days are over. I don’t stress myself anymore because my time is flexible and it takes less than 20 minutes for me to get to a Clicks pharmacy to collect my ART [antiretroviral treatment] and go back to work.”

Easing the burden

“There has always been a huge inequality gap within our health system, and we are currently still observing this both in rural and urban areas, and within the public and private sectors. It is observable that, rural areas and townships are inadequately staffed and have less medical facilities,” said Tinashe Njanji from the Public Health Movement.

Njanji, who has been a health activist for over 12 years, says the CCMDS has eased the burden.

“CCMDD is assisting in bringing drugs to the door steps of the patients, this means that our health facilities are less crowded resulting in lesser pressure on our health care workers. With drugs being delivered to the door step, which means that we will have lesser defaulters and more stable patients – which is an overall good step to lessening the strain on health facilities,” said Njanji.

The CCMDD provides medicine for chronic illnesses in particular. These include arthritis, asthma, congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus, hypertension and HIV infection.

Joyce Mokoena, a pensioner from The Orchards in Pretoria, is keen to sign up for the programme and say goodbye to standing in long queues.

“I wasn’t aware of the CCMDD programme but I definitely see the need for it, especially to assist the elderly. Since the pandemic, the need for a programme like this has increased. This is because the lines were unbelievably longer. I had to repeatedly request for a chair because my feet weren’t able to carry me for as long as they needed to. We started demanding the option to collect in order to avoid backlogs.”— Health-e News