Innovating health appropriate_technology_right_to_care

• A South African non-profit organization, founded in 2001,

specializing in HIV and TB disease management

• Funded by USAID since 2002 and PEPFAR since 2004 to support

technical assistance and HIV and TB treatment service delivery in

SA

• Current Global Fund Principal Recipient together with Government

• Right to Care supports Government, Private and Community

Treatment Facilities and aims to build partner’s capacity to deliver

safe, effective and affordable antiretroviral therapy.

• Since 2004 RTC has grown to be one of the largest treatment

groups in South Africa

To deliver and support quality clinical and pharmaceutical services, in Southern

Africa, for the prevention, treatment, and management of HIV and associated

diseases.

Provide TA at national, provincial and district level to improve implementation of pharmaceutical services.

Support medicine and health product SCM and implementation of PMIS to facilitate decision-making.

Training and capacity-building of pharmacy personnel.

Innovation and research to support service delivery and improve public health outcomes.

Chronic shortage of pharmacy personnel Long pharmacy waiting times in facilities Poor operational efficiencies Sub-optimal inventory management and medicine

stock-outs Inadequate counseling and monitoring Medication errors and medicine safety No offsite patient communication Risk to employed patients and economic impact of

missing work Patient costs - HE2RO study indicated average

patient spent R150/day to visit a clinic Patient adherence significantly compromised

Pharmacy Automation at Helen Joseph Hospital (Themba Lethu Clinic)

• Full stock control from bulk storage through to patient dispensing,

eliminating stock theft.

• Reduction in patient waiting times from 3 hours and 38 minutes to

less than 30 minutes.

• A reduction in the required daily dispensing hours in the pharmacy

from 11.5 hours to 8.5 hours.

• An increase in patient volumes from 7,491 a month to 11,461 to

6,101

• In the first six months the pharmacy has re-structured the staff

requirement by 40%, increasing ward services in the hospital

Outputs from Phase IThemba Lethu Clinic at the Helen Joseph Hospital

• Improved pharmacy operational efficiencies

• Prescriptions are being validated

• Prescription picking is error free

• Patient satisfaction is improved

• Patient monitoring and counselling is intensified

• Newly-initiated patients given specialised attention

• Improved focus on patient medication needs

• Improved stock management and reporting

• Better forecasting

• Staff fatigue and burnout reduced

Function: Before Step 1Automated Dispensing

Step 2Integrated

Clinical/dispensing

Step 3ATM (PDU) Dispensing

Manual File Handling √ x √ √

Patient Counselling x √ √ √

Patient Database x √ √ √

Dispensing Control x √ √ √

Labelling √ √ √ √

Stock Management x √ √ √

Automated Stats x √ √ √

E-Script (HL7 Interface) x x √ √

Themba Lethu Clinic

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High-burden Hospitals◦ HJH Main Pharmacy

Tertiary and Academic Facilities◦ Steve Biko Academic Hospital

◦ Dr George Mukhari Academic Hospital

◦ Chris Hani Baragwaneth Academic Hospital

◦ Charlotte Maxeke Johannesburg Academic Hospital

◦ Others:

Groote Schuur Hospital

Tygerberg Hospital

Scenario Setting….

HIV/AIDS in SA

>6.8 million Infections

±2.5 million on treatment (37%)

Typical treatment regime:

1/6 Visits - Medical visit

5/6 Repeats - Medication collection visits (Down refer, into an automated/distributed solution….)

Next Steps for AutomationOut-of-Pharmacy Remote Automation Services

Function: Before Step 1Automated Dispensing

Step 2Integrated

Clinical/dispensing

Step 3ATM (PDU) Dispensing

Manual File Handling √ x √ √

Patient Counselling x √ √ √

Patient Database x √ √ √

Dispensing Control x √ √ √

Labelling √ √ √ √

Stock Management x √ √ √

Automated Stats x √ √ √

E-Script (HL7 Interface) x x √ √

Current Project

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We

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All pick-up points will be managed by on-site staff, giving patients access to a pharmacist which they may not have at clinic sites.

Integrated cloud-based data system between central dispensing and pick up points for reporting and accountability.

All patients will receive integrated communication through sms reminders and follow-up calls for missed visits.

Stock control management meeting the highest standards to eliminate stock loss and eliminate expired stock.

Pharmacy Dispensing Units (PDU)Additional Benefits

• Convenient, practical medication collection.

• 78 hour availability per week for patients to collect medicines.

• Quick patient collection process (3.5 minutes) reducing patient queues.

• Chronic medicine solution for all chronic diseases

• Data held in cloud, allowing patients to collect at any collection point.

• Patient cost minimised

Solution Architecture

MedicalCentre

MedicalCentre

Cloud

eDR

PharmacistCall Centre

RMDUDispensing

Automation Instrument

RMDU

Remote Medicine

Dispensing Unit (ATM

Like Device)

eDR

Electronic single Dispensing

Register (one central view)

Patient

DISPENSING

AUTOMATION

An Instrument like

the “Rowa”

RMDUDispensing

Automation Instrument

Pharmacist

Patient

Patient

Dispensing Automation Instrument

Pharmacist

Patient

Virtual Pharmacist

Physical Pharmacist on call,

when needed

* Consult (with/without

dispense)

* Process Manual Script

• Pharmacy Act No. 53 of 1974, as amended (“Pharmacy Act”);

• Medicines and Related Substances Act (101 of 1965 as amended);

• Supported the development of minimum standards for In-Pharmacy and Out-of-Pharmacy Automation;

• In-Pharmacy Automation standards published in November 2014;

• Framework to support electronic prescribing;

Regulatory Framework for Automation

Department of Health◦ Soweto (4 sub-districts), City of Johannesburg

◦ Bushbuck Ridge, Mpumalanga

◦ Mbombela, Mpumalanga

◦ White River, Mpumalanga

Funding support:◦ USAID/PEPFAR

◦ GIZ

◦ GFATM (Concept Note)

THANK YOU