Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa; A Preliminary Study

Abstract

Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction.Method: Principally a structured review of current and planned activities.Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to the Standard Treatment Guidelines and the Essential Medicines List with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance through instigating stewardship programmes as well as improving adverse drug reaction reporting and associated activities.Conclusion: Overall, there are an appreciable number of ongoing activities within the public healthcare system in South Africa attempting to ensure and sustain universal healthcare. It is too early to assess their impact, which will be the subject of future research.

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…Successful initiatives typically target all key stakeholder groups, are usually country specific, take into account issues of culture as well as the availability, access and affordability to physicians and medicines, and are evidence based 29,52,243 . Given continuing concerns with AMR rates, activities and strategies to improve future prescribing and dispensing of antibiotics for URTIs will grow in all countries, including LMICs, as they develop and monitor their antibiotic prescribing as part of their national action plans (NAPs) 66,180,240,242,[249][250][251][252] , with 'essential medicine' policies typically associated with lower antibiotic prescribing in LMICs 119 .…”

“…South Africa South Africa has also been active with developing national action plans to combat rising AMR rates for a number of years 307,308 , providing guidance to other sub-Saharan African countries. Activities include the development of the National Department of Health Antimicrobial Resistance National Strategy Framework, 2014-2024 building on the WHO global strategy to contain and reduce rising AMR rates these and other hospitals 250,307 . As part of this, a number of hospitals in South Africa have instigated ASPs to reduce AMR rates, with published guidance on ASPs helping to instigate such programmes [309][310][311] .…”

“…This includes promoting community pharmacists to help drive ASPs forward to improve the utilization of antibiotics for respiratory tract infections in ambulatory care 159 . Such initiatives are likely to grow to further improve the prescribing of antibiotics in ambulatory care across all sectors, with the South African guidelines regularly updated 250,313 .…”

“…However, it is important that there is only one national reference guideline since where multiple guidelines exist contradictions can occur 236 . Guidelines should be readily available and combined with educational inputs and auditing of antibiotic prescribing to reduce inappropriate use 57,250,270,313,335,349 . Regular updates of antibiotic guidelines are also essential to enhance their utilization and updates should be rapidly disseminated to achieve agreed goals.…”

Knowledge regarding medicines management of type 2 diabetes amongst patients attending a Community Health Centre in South Africa

“…CHCs are an important part of ambulatory care in the public healthcare system, with currently over 80% of the population in South Africa being treated in public health facilities . This is particularly important at this time in South Africa following the introduction of universal health coverage for all South Africans through the National Health Insurance scheme . Under this initiative, there are ongoing programmes to improve the availability and accessibility of medicines to patients with chronic diseases such as T2DM, with regular six monthly clinical monitoring of patients.…”