South African Profile on access of medicine and the health system
My name is Johannes Mangane, I am 28 years old and a pharmacist in South Africa in rural Mpumalanga. South Africa has a lot of rural provinces that are widely stretched with limited healthcare facilities which sometimes forces people to travel a sizeable distance to access healthcare or fetch their chronic medicines. However in the process there are major developments in the country’s health system. The department of health has introduced programmes that focus increasing access to healthcare and medicines but majority of people are still denied healthcare. The Centre for Chronic Medicine Dispensing Distributors (CCMDD) and Remote Automation Dispensing Unit (RADU) are all focus of improving access to medicines. However South Africa's problem go beyond access, patient in rural province travel from a substantial distance to collect medicines and sometimes be turned away because medicines are out of stock or queue until its late that they cannot reach the pharmacies in time to collect their medicines. Patients are indirectly expected to dedicate a full day for collection of their chronic medicines from their healthcare facilities, because of the overcrowding and long waiting time that exist in the healthcare establishments. This also puts these patients at risk of contracting Hospital/Healthcare facility Acquired Infections (HAI). Furthermore it means that they lose a day of income and some spend an average of ± R130 for transport to reach a health establishment which sometimes cost more than the medication itself. Ehlanzeni is the proposed pilot district with 135 health establishments that are not uniformly distributed across the districts and a lot of villages are without healthcare facilities, thus forcing residents to travel long distances to access care and pharmaceuticals. Approximately 40% of communities have to travel an average of 25km to access healthcare; this means 40% of communities are virtually denied access to timely healthcare services including pharmaceutical services.
PillDrop increasing access of chronic medicines in South Africa, Mpumalanga
Therefore, my model for improving access to medicines for chronic patients is “PillDrop”. PillDrop is a mobile application (App) which will enable patients to register as users and motorists drivers to register as providers. The App will enable providers to be able to collect chronic medicines for clients in their clinics or remote automation dispensing units (RADU) and deliver the parcels to the patient without the patient having to visit the healthcare facility. The model will always locate a provider from the patients' area who is near the healthcare facility at the time of initiating the collection of the medicine. In the process the provider will charge a fee less than the traveling cost for patient to collect their medicines on their own. PillDrop aims to improve access to medicines and eliminate the traveling and days of queuing for merely collecting chronic medicines. The Application will grant third-party to collect medicine on behalf of patients and drop the medicines at their homes. In addition the App will enable the patient to remotely view the availability of their medicines at their healthcare facility before they can initiate a pick-up. PillDrop is a mobile application (App) which allows patients to register as users and drivers of (vehicles and motorcycles) to register as providers. In addition to access to medicine function the App will be utilize to educate patients on disease management and this function will be managed by the pharmacist responsible for patient education. Patients will be updated regularly about their disease and therapeutics use, in text, videos and pictogram format. The patient education will be individualized and focused, but it will also include education on other health risks factor that exist in the communities. Furthermore, it will be used as a platform to initiate a community pharmacovigilance programme where patients will be capacitated to report adverse drug reactions online.
Technical report for PillDrop application
PillDrop is a mobile application which connects patients with healthcare facilities (pharmacies, clinics and medical practice). Chronic patients will be registered on the application at the healthcare facilities (pharmacies, clinics and medical practice). The registration process will require demographic details of the patients and at the facility link the pharmacy; clinic dispensaries will link the patient medication through a bar-coding system.
PillDrop application main-frame
PillDrop main-frame will collect data about patient demographics, conditions (ICD10) and motorist details in the different healthcare facilities and the information classify stratified according to the patients’ treatment details and the date of collection. This data will be used to quantify number of patient served by programme and their disease categories. PillDrop will automatically send information of the next group of patients due for medication to the respective healthcare facility informing them to prepare the medicine packages and a list of registered PillDroppers. A barcoding system will be utilized to allocate unique identifier for PillDroppers. PillDroppers will be extended to healthcare workers, because they live in communities where some of the chronic patients live. The data collected through the programme will be used assist pharmaceutical services to plan and budget for the following year of operation.
Healthcare facility functionality for PillDrop
The main function for PillDrop in the healthcare facility is to link the patient PillDrop profile with the patient therapeutic treatment. The dispensary in the different healthcare facilities will use barcode scanning to link the patient treatment. In addition to the scanner, the healthcare facilities will have PillDrop Booth outside the dispensaries to assist with opening profiles for patients and PillDroppers. The application will also pre-allocate collection dates for the patient treatment dates and continuously alert the patients of their date for treatment. The scheduling function will only activate the patient collection date within the pre-allocated week. Outside these times, the patient cannot initiate a parcel pick-up. Further additional information will be pharmacovigilance function which allows patient to report adverse drug reactions (ADRs).
Patient PillDrop Function
The patient will be allowed to log a request to motorists, requesting the PillDropper to collect the patient’s chronic medicines from their healthcare facility. The application will triangulate and locate a registered motorist from the patient community who is at the time to the call is nearby the healthcare facilities. If the motorist accepts the Drop the application will send an electronic pick up note to the health facilities and a confirmatory message to the patient with an estimated delivery time. PillDrop’s customer satisfaction function will be the centre of the programme and patients will be asked five simple questions:
- How was the service of the PillDropper?
- Will you recommend the PillDropper to your family and friends?
- Will you recommend PillDrop to other patients?
- Has PillDrop improved your access to your medicines?
- How can we improve our services?
These five questions will be asked at the end of every service offered to the patient by a PillDropper.
The key function of PillDropper is to pick-up chronic medicines for patients in healthcare facilities to deliver them to the patients. The PillDroppers will be required to register to deliver within their community to not greater than five healthcare facilities. PillDroppers will be vetted and issued with contracts of fee for service. PillDroppers will only be transporting prepared patients parcels and not boxes of stock. Therefore a PillDropper will be allowed to transport a certain number of parcels at a time. A GPS tracking system will be employed to track the position of the parcel at any point in time during its transportation.
Model for application
The model for the mobile technology users was inspired by the Uber systems which connects commuters with motorists and its scale able ability in countries where it exist shows the possibility of PillDrop's survival. This is also because more people use automobile to travel and smartphones to communicate and communities have some sort of transport system for commuters which can be contracted and linked to play a major role in increasing access to chronic medicines. These existing transport systems can act as coordinated logistics platforms for deliveries medicines to patients in deep rural areas, urban and to their place of work at a reasonable fee, which is less than what they will pay for traveling cost to healthcare facilities. The criteria for vehicles that can register to provide these services will be drafted and communicated with the relevant regulatory authorities for approval. However this should not be seen as an impediment to increasing access.
Impact of programme
The primary impact is to increase access of chronic medicine to stable patients living with chronic disease. It also aims to reduce healthcare acquired infections (HAI) on patients living with chronic diseases and lastly reduce the cost of traveling to healthcare facilities only to collect medicine. In closure, patient will not be required to loss a day of work or income because they need to collect their chronic medicines.
1. What access to healthcare problem are you trying to solve in your country / local community and how serious is the issue?
The application aims to solve the disparities surrounding access to medicine in the country within the health system. South Africa has a lot of rural provinces that are widely stretched demographically with limited healthcare facilities poor medicine delivery. This disparities forces patients travel substantial distances and spend a lot of money for transport to collect their medicine and sometimes they loss a day of income or cost of transport is greater than than of the medicines.
2. How would you describe the stage of development of your idea?
3. What were the biggest challenges when realizing your idea?
The continuous traveling of chronic patients and the long hours of queuing to collect the same chronic medicines. This also exposed these patients to infectious disease like tuberculosis, influenza and etc. Acquiring these infectious will indirectly increase the cost of healthcare of these affected patients, however if there is system that eliminate regular visitation of the healthcare facilities, the risk of acquiring these infections will also be reduced thus improving quality of life for patients
4. How will your idea make an impact and in what way?
PillDrop will increase access to medicines and reduce traveling cost and risk of patients acquiring infections in the healthcare facilities. Moreover, patients will no longer have to miss a day of work which ultimately results in loss of income. Therefore, the impact is time utilization, economic productivity, monetary and health living.
5. Tell us about the scalability of your idea to other communities.
The application will be scale able, because of its ability to utilize resources that are existing in society, these ranges from transport systems, smartphone users and network coverage. These resources are in abundance regardless of the demographic location of patients and healthcare facilities that offer services. Therefore PillDrop will be designed to also be compatible with both android and IOS operating system.
6. How will winning the Euro 20,000 seed funding move your idea forward?
The seed funding will assist me to develop the concept into a prototype and initiate a piloting project. This fund will assist me to craft a blueprint in medicine access and healthcare innovation. I also think it will alleviate the defined problem around medicine access which might attract other funders to gain interest in improving the staggering statistics around health access global and South Africa. Lastly this will help public healthcare to improve its services and delivery streams.