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Innovating health appropriate_technology_right_to_care
This document discusses an organization in South Africa that provides HIV/TB treatment and management services. Some key points: - The organization is a large non-profit founded in 2001 that supports government HIV/TB facilities and aims to improve treatment delivery. It receives international funding. - The document discusses challenges with pharmacy services and long wait times. It implemented an automation system at one hospital that led to reduced wait times, increased capacity, and improved stock management. - The organization aims to expand pharmacy automation and implement remote dispensing units to further improve access and efficiency of medication collection for chronic diseases like HIV/AIDS. It discusses regulatory considerations and plans to partner with government departments and international funders to scale up these services
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Innovating health appropriate_technology_right_to_care
- 2. • A SouthAfrican 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
- 3. To deliver andsupport quality clinical and pharmaceutical services, in Southern Africa, for the prevention, treatment, and management of HIV and associated diseases.
- 5. Provide TAat 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.
- 6. Chronic shortageof 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
- 9. Pharmacy Automation atHelen Joseph Hospital (Themba Lethu Clinic)
- 11. • Full stockcontrol 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 I Themba Lethu Clinic at the Helen Joseph Hospital
- 12. • Improved pharmacyoperational 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
- 13. Function: Before Step1 Automated Dispensing Step 2 Integrated Clinical/dispensing Step 3 ATM (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 Additional Tasks Prev Work Prev Work CAPACITY (NotScaled) Prev Work Additional Tasks Capacity* Prev Work Additional Tasks Capacity* Consulting Time**
- 14. 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
- 17. Scenario Setting…. HIV/AIDS inSA >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 Automation Out-of-Pharmacy Remote Automation Services
- 18. Function: Before Step1 Automated Dispensing Step 2 Integrated Clinical/dispensing Step 3 ATM (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 Additional Tasks Prev Work Prev Work CAPACITY (NotScaled) Prev Work Additional Tasks Capacity* Prev Work Additional Tasks Capacity* Consulting Time** Weare here
- 21. All pick-uppoints 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.
- 22. 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
- 23. Solution Architecture Medical Centre Medical Centre Cloud eDR Pharmacist Call Centre RMDU Dispensing Automation Instrument RMDU RemoteMedicine Dispensing Unit (ATM Like Device) eDR Electronic single Dispensing Register (one central view) Patient DISPENSING AUTOMATION An Instrument like the “Rowa” RMDU Dispensing 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
- 24. • Pharmacy ActNo. 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
- 26. Department ofHealth ◦ Soweto (4 sub-districts), City of Johannesburg ◦ Bushbuck Ridge, Mpumalanga ◦ Mbombela, Mpumalanga ◦ White River, Mpumalanga Funding support: ◦ USAID/PEPFAR ◦ GIZ ◦ GFATM (Concept Note)
- 28.
Editor's Notes
- #4 Please display the mission statement as is and do not rewrite or paraphrase. If you wish to quote our vision, it is: “That every individual has ready access to quality medical services that prevent, treat, and manage HIV infection and associated diseases.” Picture shows MMC community mobilisation team
- #5 Right to Care’s focus is on providing technical assistance to the Department of Health for the treating of individuals for HIV and associated diseases, in particular, TB and cervical cancer. Right to Care also has a sizeable component of direct service delivery (for HIV and associated diseases). We provide support through training, mentoring, participation in technical committees, development of best practices, on-going operational research, and by seconding staff members to work at government or NGO clinics.
- #6 Shabir’s slide Support for medicine supply chain management (SCM) activities at national, provincial, district and facility level Training and placement of pharmacy assistants Support for implementation of pharmacy technician training Integration of clinical data systems and pharmacy management systems to streamline pharmacy operations Successful implementation of a SCM strategy for down-referred patients to providers in the private sector
- #14 * Where Step 1 required execution of additional tasks not formally performed in the pharmacy, it did create sufficient additional free capacity for the pharmacy to run without additional staff and serving same patient volumes, but also now able to properly manage stock at patient level, building up a proper ePHR, etc. Step 2 however will create even more capacity that could be utilised by the pharmacy, but expected to be consumed by perfecting operational tasks. ** Step 3 is expected to free up even more additional capacity that could be used either as patient consulting time or moving the queues quicker
- #19 * Where Step 1 required execution of additional tasks not formally performed in the pharmacy, it did create sufficient additional free capacity for the pharmacy to run without additional staff and serving same patient volumes, but also now able to properly manage stock at patient level, building up a proper ePHR, etc. Step 2 however will create even more capacity that could be utilised by the pharmacy, but expected to be consumed by perfecting operational tasks. ** Step 3 is expected to free up even more additional capacity that could be used either as patient consulting time or moving the queues quicker