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Game changer: Automated pharmacy dispensing in South Africa

How Pharmacy of the Future makes it faster and easier for the chronically ill to receive their medications

Brigitte Zypries, Minister of Economic Affairs and Energy (third from left) and Michel Sidibé, Executive Director of UNAIDS (far right) with representatives of Mach4, GIZ and Right to Care after the presentation of the German Global Health Award

A German company, Mach4, has received the first-ever German Global Health Award for its role as technology provider to Pharmacy of the Future, a development partnership which is improving pharmacy dispensing and access to medicines for the 22 million South Africans who require chronic medication.

At a ceremony at the Allianz Forum in Berlin on May 17, Germany’s Minister for Economic Affairs and Energy, Brigitte Zypries, presided over the presentation of the inaugural German Global Health Award for small and medium enterprises to Mach4 Automatisierungstechnik GmbH, a Bochum-based engineering company which specialises in automated pharmacy solutions.

Mach4 was awarded the prize for its role as the technology provider in the Pharmacy of the Future project, a German-South African initiative to improve drug distribution through the use of automated Pharmacy Dispensing Units (PDUs) located in shopping centres and other public places. PDUs allow patients to collect prescription medications at a time and place of their choosing, without having to wait in lengthy queues at health facilities. Until now, most South Africans who take chronic medications, including antiretrovirals for HIV, have had to travel to clinics and hospitals every month to refill their prescriptions, even if they are stable and do not require medical attention from a health worker.

Honoring cutting-edge solutions to problems in developing and emerging economies

Germany’s Minister of Economic Affairs and Energy, Brigitte Zypries, at the presentation of the German Global Health Award

The German Global Health Prize was created by the German Healthcare Partnership to recognise innovative products, services, technologies or solutions that are tailored to global health needs in developing countries and emerging markets. Citing both the high prevalence of chronic diseases and the low pharmacist to population ratio in South Africa, the members of the jury praised Pharmacy of the Future as a highly relevant and innovative solution to a pressing problem.

The award ceremony was the culmination of ‘Global Health: The International and the German Agenda,’ an event attended by representatives of government, the private sector and civil society, as well as distinguished guests such as the Executive Director of UNAIDS, Michel Sidibé, on the eve of the first meeting of G20 health ministers in Berlin.

Accepting the award on behalf of Mach 4, Dirk Beils, the company’s lead engineer, said how glad he was that their contribution to a pathbreaking effort was being noticed at such a high level. ‘Sometimes people are skeptical about new ideas and automatically assume that they won’t work. But our experience shows that it’s really important that governments and funders trust small projects and help them grow.’

Drug distribution systems in South Africa overwhelmed by patient volumes

Pharmacy of the Future is an effort to tackle an urgent challenge: establishing a differentiated model of drug distribution for the millions of South Africans who require regular medication to manage chronic illnesses, including HIV, hypertension, diabetes, asthma and cardiovascular disease. As a result of the rapid scaling-up of antiretroviral therapy – 3.8 million of the estimated 7.5 million South Africans infected with HIV are on treatment – the number of patients requiring chronic medication has outstripped the ability of the country’s pharmacies and drug distribution systems to keep pace.

As a result, waiting rooms are overflowing, patients are forced to take time off work to queue for their medications, and pharmacists don’t have the time they need to properly counsel new patients on the correct usage of their medications and on potential side effects – a fact which negatively affects treatment adherence.


A strategic alliance of German and South African partners

One of the answers to this challenge is being provided by Pharmacy of the Future, a development partnership between Mach4; Right e-Pharmacy, a subsidiary of the South African NGO Right to Care, which is one of the leading providers of HIV and TB services in South Africa’s public healthcare system; and the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH.

The partnership is supported by develoPPP.de, a program set up by the Federal Ministry for Economic Cooperation and Development (BMZ) to foster the involvement of the private sector at the point where business opportunities and development policy initiatives intersect. DeveloPPP.de provides financial and professional support to companies investing in developing and emerging countries. Further funding for the project is provided by the United States Agency for International Development (USAID). Pharmacy of the Future also enjoys support from the Department of Health in Gauteng Province, where the project is being implemented.


PDUs are conveniently located in public areas in three townships

Under the current three-year pilot project, Pharmacy of the Future is setting up 16 PDUs in shopping centres in three Johannesburg townships. Patients with chronic illnesses who are designated as stable – that is, they require clinical visits only twice a year – are eligible for the program. Once enrolled, they are issued a chip card which allows them to retrieve medications from any PDU, much like one draws money from an automatic bank machine.
The PDUs are linked to a cloud-based computing system which manages an electronic dispensing register, notifies patients by text message when their drugs are ready for collection, and initiates a tracking process when patients fail to collect their medications on time. The PDUs are also equipped with a video link to a call centre staffed by pharmacists, allowing patients who need to ask a question about their medications to speak directly with a pharmacist through the PDU.

GIZ was instrumental in putting the partnership together and supports the project in the areas of monitoring and evaluation, training, human resources, project coordination, equipment and the establishment of the call centre. Mach4, which was unique in its willingness to customise a solution for the specific needs of the South African market, is responsible for the technology and automation, while Right e-Pharmacy acts as the chief implementer, enhancing the partnership through its pharmacy engineering and design expertise, innovative thinking around cloud-based solutions, and strong networks with public institutions including the Pharmacy Council and the Department of Health.

In-pharmacy automation opens the door to a unique solution

The German-South African partnership dates back to 2012 when Mach4 and Right to Care joined forces, with support from USAID, to automate pharmacy dispensing at the Themba Lethu Clinic at Helen Joseph Hospital in Johannesburg, one of the largest HIV clinics in the country with more than 25,000 patients on treatment. Mach4’s standard automated system stocked shelves, tracked expiry dates, managed drug supplies, eliminated dispensing errors and dramatically improved efficiency. Waiting times in the dispensing area fell from an average of four to five hours to just 25 to 30 minutes; simple refills of prescriptions could be done in as little as 5 to 10 minutes. Suddenly, there was the opportunity to re-assign many staff pharmacists to more clinically-oriented roles.


The ‘Speedbox’ dispensing system is designed for fast-moving inventory and high volumes

Although in-pharmacy automation yielded many benefits, it didn’t solve the core problem, explains Daniela Rudner, a Senior Technical Advisor with GIZ in South Africa. ‘The challenge was to find a way to decongest busy clinics and to give patients the chance to collect medications closer to where they lived and outside of standard working hours.’ Right to Care and Mach4 began to work on a prototype of a stand-alone PDU modelled on the in-pharmacy technology, but with additional features such as automatic labelling and a computer interface to a cloud-based data solution. GIZ got behind this effort, securing support for the initiative through develoPPP.de.

Bernd Appelt, who at the time was the head of the GIZ-implemented Multi-sector HIV and AIDS Prevention Programme in South Africa, was an early champion of the idea. ‘For the Department of Health to be able to distribute drugs on a regular basis to millions of people, there will have to be different distribution channels for different categories of patients,’ he said recently. ‘What PDUs help to do is to separate out stable clients and to make time in the facilities for those patients who actually need to spend time with a health care provider.’

A novel approach for South Africa and beyond

Although the roll-out of the PDUs is still in its early stages – four machines are now dispensing automatically, with eight more soon to come online – they have already generated intense interest in other countries and on the part of numerous development partners. ‘PDUs are a novelty - not only in Africa, but globally,’ explains Shabir Banoo, the Chief Technical Specialist for Pharmaceutical Programmes at Right to Care. ‘In Johannesburg we are currently testing this approach in peri-urban areas, but PDUs could be tailored for other settings as well.’

The Gauteng Department of Health is a strong backer of Pharmacy of the Future and has signed a service level agreement with Right e-Pharmacy to ensure continued operation of the PDUs at the end of the pilot phase. The dispensing units are well aligned with the government’s broader strategy to decongest health facilities through use of out-of-facility pick-up-points, treatment adherence clubs and partnerships with retail pharmacies. Improving the efficiency of drug distribution is important for strengthening trust in the public health system and in the government’s ability to deliver services.

‘The PDUs are game changers,’ says Shabir Banoo. ‘The excitement on the faces of patients when they get their medicines in minutes – rather than hours – is truly something to behold.’

Karen Birdsall
May 2017


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