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National Health Act, 2003 (Act No. 61 of 2003)


National Health Insurance Policy towards Universal Health Coverage

Chapter 6 : Reorganisation of the Health Care System and Services under NHI

6.4 Medical products and technologies

6.4.1 Improving access to pharmaceutical services


181. A key element of improving service delivery is to ensure that the full range of essential medicines and other medical supplies are available in all public health facilities. Various interventions are currently being assessed and initiated to improve the distribution of medicines, including direct delivery by suppliers to health facilities of pharmaceuticals, dry dispensary and related supplies to facilities by suppliers to ensure improved turnaround times and prompt payment of suppliers. Other strategies include the implementation of the Direct Delivery Strategy (DDS), Central Chronic Medicine Dispensing and Distribution Programme (CCMDD), the operationalisation of the Control Tower and Provincial Medicine Procurement Units (PMPU); end-to-end visibility in the supply chain and electronic data interchanges and direct purchasing.


182. A national surveillance centre to monitor medicine availability in all districts has been established as a Control Tower. The surveillance centre serves as the national hub for contract management, including overall efficiency and effectiveness monitoring. The centre will has be responsibility to monitor stock availability in facilities and serve as an early warning system of when stocks are not available. Provincial Control Towers have been established for the direct delivery of medicines in order to improve availability of medicines at facilities, reduce the risk related to depot holding stock. The PMPU serve as tactical operational units responsible for managing the procurement of medicines within the provinces, using the modern delivery methods and supported by modern systems and processes. Additionally, an electronic system for the early detection of stock outs of medicines at hospitals and clinic has been implemented through stock management done on two electronic systems.


183. The direct purchasing method enables hospitals to place orders directly with contracted suppliers and manage the full procurement cycle. This method enables facilities to proactively manage their medicines stocks and to minimise or eliminate stock-outs. The central procurement mechanism for Antiretrovirals (ARVs), small volume parenteral, insulin and devices has also been initiated.


184. Chronic stable patients in the public sector are usually required to travel to a health facility and wait several hours to collect their chronic medication on a monthly basis. Ultimately, this system will be eliminated so that patients will not be required to travel long distances and wait long hours for their medication. There are several alternatives that are more efficient, including the use of chronic medicine pre-dispensing and delivery to a point closest to the patient. These alternatives are already being piloted in some areas.


185. To improve patient access to needed medicines, especially for patients on chronic medication, as well as to assist with decongesting public clinics, the Department implemented the Centralised Chronic Medication Dispensing and Distribution (CCMDD) programme. The program is comprised of two program components, Central Chronic Medicines Dispensing and Distribution (CCMDD)i and Pick-up Points (PuPs)j. These collection points comply with good pharmacy practices (GPP) standards68.


186. To-date, the implementation of CCMDD has focused primarily on the provision of ARVs, Fixeddose Combination (FDC) in particular, to stable HIV patients receiving Antiretroviral Treatment (ART); however, the program is eventually intended to encompass all stable patients with chronic conditions whose management consists of bi-annual clinical visits and check-ups.



i Relates to individual patients’ medicines being centrally dispensed and distributed to the point of service delivery
j Relates to the provision of pre-dispensed medicines at private sector pharmacies, or ‘Pick-Up-Points’ (PuP), that is conveniently located for patients