Getting medicine packs closer to chronically ill patients in rural South Africa

Many chronically ill patients in rural South Africa travel long distances to pick up their medicine packs yet these can be delivered closer to their homes with investment in external pick-up points, this was the message delivered by Doctors Without Border (MSF) at the 2023 Rural Health Conference in Chintsa (14-16 September).

At present, South Africa’s Differentiated Service Delivery (DSD) programme offers patients who are stable in care three different options that simplify the picking up of chronic medications, namely Fast Lane Pick-up at clinic pharmacies, which is where patients do not have to queue in clinics; Adherence Clubs, where a group of people meet to pick up their medicine packs at a facility or community venue, and External Pick-up Points, being drug pick-up points run by private providers, who dispense drug packs to patients on behalf of the government. However, patients in rural areas still struggle to get their medication easily.

“The system is not working optimally,” said Dr Manivasan Thandrayen, who works in MSF’s Non-communicable Diseases (NCD) project in Butterworth in the Eastern Cape.

“The adherence clubs system is little implemented outside urban areas, and there are very few authorised External Pick-up Points because the registration process is complicated,” said Thandrayen, adding that the institutions with the capacity to navigate this system are the big pharmacy chains, “and they do not have outlets in rural areas.”

Rural patients are left with the fast-lane pick-up model, but this requires them to travel to their nearest clinic or pharmacy. In short, for many rural patients, DSD does not bring treatment closer to home.

To bring chronic treatment and care closer to patients in Eshowe and rural Mbongolwane in South Africa’s KwaZulu-Natal Province, MSF established nine healthcare posts that were initially called Luyanda Sites, and later Phila Mntwana health posts. After patients asked if they could pick up their chronic medication at the sites, all nine were registered as External Pick-up Points.

“The sites are performing well since the first was opened at the end of 2018, there have been more than 5,000 visits to the nine sites. The sites appear to be attractive to young and old, and best of all they have now been integrated in the work of the Department of Health’s outreach team, ensuring their sustainability,” said Ntombi Gcwensa, Patient Support Manager for MSF in Eshowe.

However, the processes to register, set-up and begin operating an External Pick-up Point is complex.

“It took us a year to get to grips with the system, and after we had worked out how to navigate it, the approval wait-time ranged from three to five months” said Gcwensa.

At the Rural Health Conference, MSF hosted sessions aimed at supporting interested parties with the establishment of External Pick-up Points, and called for the expansion and improvement of the External Pick-up Points model. MSF is continuing to support the establishment of External Pick-up Points in Amathole District in the Eastern Cape, with a focus on enhancing the relevance of these sites for people with non-communicable diseases like diabetes-2, and hypertension.

Nobuhle Titus, an MSF nurse technical support, packs sputum samples collected from a Luyanda site in the town of Vuma. She collects and transports the samples from MSF’s Luyanda sites to the hospital where they are tested. Luyanda sites provide a link between patients and hospitals where patients can have sputum samples tested and receive information on TB and other diseases. Photographer: Tadeu Andre. Date: 14/02/2020. Location: South Africa.

A member of the Mqalana community in rural KwaZulu-Natal has her blood pressure tested by a healthcare worker at a newly opened Luyanda Site. Luyanda Sites are decentralised hubs for HIV and TB services. The Mqalana site is housed in a park home unit donated by MSF. During the COVID-19 epidemic, Luyanda Sites have served as medicine pick-up points for patients with chronic conditions. Photographer: Chris Allan. Date: 25/08/2020. Location: South Africa.

About Doctors Without Borders (MSF)

Doctors Without Borders (MSF) is a global network of principled medical and other professionals who specialise in medical humanitarian work, driven by our common humanity and guided by medical ethics. We strive to bring emergency medical care to people caught in conflicts, crises, and disasters in more than 70 countries worldwide.

In South Africa, the organisation is recognised as one of the pioneers of providing Antiretroviral Treatment (ART) in the public sector and started the first HIV programmes in South Africa in 1999. Until today, the focus of MSF’s interventions in the country has primarily been on developing new testing and treatment strategies for HIV/AIDS and TB in Eshowe (Kwa-Zulu Natal) and Khayelitsha (Western Cape).

In Tshwane, we run a migration project, and we offer medical and psychosocial care to migrants, refugees, and asylum seekers, who struggle to access public health services under South Africa’s increasingly restrictive.

Previously we offered free, high-quality, confidential medical care to survivors of SGBV in Rustenburg.

To learn more about our work in South Africa, please visit this page on our website (www.msf.org.za). To support MSF’s work: