South Africa’s drug ATMs offer formula to treat chronic illness

Once a month 63-year-old Eunice Mkhize wakes at 4am to make the 7km trip to a medical clinic in the northern Johannesburg township of Alexandra. On a good day, her arrival two hours before the clinic’s 7am opening will ensure she sees a doctor to treat her chronic hypertension. On a busy day, she will have to endure an eight-hour wait and still not be seen by a doctor before the clinic closes.

“Sometimes I would leave after waiting for hours in the queue because I must go to my job. When I don’t get my medication I get very sick and can’t work,” says Ms Mkhize.

With a high rate of poverty and more than 7.5m people living with HIV — the largest number in any country — South Africa last year launched a programme of self-service pharmacies in an effort to give patients with chronic illnesses such as HIV, hypertension and diabetes easier access to medication.

The programme, which is aimed at relieving pressure on the country’s congested medical system, has expanded to cover a dozen dispensaries.

The Pharmacy Dispensing Unit (PDU) was developed by a team from Right to Care, a healthcare-focused non-profit organisation, and its subsidiary Right ePharmacy, in conjunction with several national and provincial health departments.

Funding for the PDUs, which cost R2.2m ($159,000) each, was provided by the US Agency for International Development, the Global Fund to Fight Aids, Tuberculosis and Malaria, and GIZ (the German Agency for International Cooperation).

Fanie Hendriksz, managing director of Right ePharmacy, says the PDUs work like an ATM for medication. After scanning a barcode or a pharmacy card and entering a PIN, patients discuss their conditions with a pharmacist over a Skype-like interface. The units then use robotic technology to label and dispense the medication, and a follow-up appointment is confirmed by receipt.

“It makes a process that could take five to eight hours take three minutes, because the PDUs are situated in malls near transport nodes,” Mr Hendriksz says. “The PDUs are open during the mall’s hours, which are longer than clinic hours and include weekends and public holidays, [so] we are able to give patients an additional 80 hours per month to collect their medicines.”

ATM-style pharmacies: how PDUs work

1. The patient scans a bar-coded ID or pharmacy card and enters a PIN
2. The patient talks to a pharmacist remotely over a Skype-like interface
3. The required prescription and other medical items are selected
4. Medicines are robotically labelled and dispensed, dropping into a collection slot
5. The patient leaves with their medicine and a receipt that indicates the next collection date

Some critics say, however, that PDUs are a costly gimmick that distract from the deeper crises afflicting the country’s public health system. Last year, Aaron Motsoaledi, national health minister, said South Africa’s healthcare system was distressed and one of the biggest problems was a shortage of drugs.

In October, the Stop Stockout Project, a consortium including medical relief agency Médecins Sans Frontières that monitors medicine shortages in South Africa, warned that the country was running out of antiretroviral drugs, used to treat people with HIV and Aids. “Responsibility for this monumental crisis lies at the door of the affected provincial and national departments of health,” the group said. The authorities blamed industrial action for poor availability of pharmaceuticals.

“Interventions like the PDUs can be part of the solution, but they need to be increased significantly in number to deal with the need in the health sector,” says Jack Bloom, an opposition politician in the Gauteng provincial legislature.

“The private sector also needs to be brought in, so people can collect medication at private pharmacies. We also don’t have 100 per cent availability of essential medications,” he adds.

Life expectancy of South Africans has improved to an average of 62 years following the widespread rollout of antiretroviral treatments — an increase of some 10 years since the mid-2000s. But poverty has had a devastating impact on nutrition, health and education.

Proponents of the PDUs say the data they collect provides analytical insights that current medical records — mostly still on paper — in South Africa’s public healthcare system cannot provide.

“In the past we couldn’t measure certain data because the current system just [doesn’t allow that],” says Mr Hendriksz. “The PDU and its cloud-based system allows us unprecedented insight. Since the launch of the first PDU we have done 100,000 dispenses. That means we have critical mass.”

The PDUs dispense two months’ medication at a time, meaning fewer trips to the pharmacy. While the conditions covered by PDUs are limited to HIV, tuberculosis, hypertension, diabetes, epilepsy, asthma and hyperlipidemia (high cholesterol), Mr Hendriksz says the system could be “expanded for over-the-counter medications for malaria or flu medication”.

Although she is a fan of PDUs, Ms Mkhize says they are not the silver bullet to fix the country’s stressed healthcare system.

“Yes they are good, and we save time, but we are still poor. We have no houses; we are not safe. We still have a lot of problems,” she says.