South Africa remains at the center of the global AIDS epidemic and has one of the highest burdens of tuberculosis (TB) in the world. An efficient and effective health product supply chain that supports medicine availability is critical to addressing that disease burden. During the COVID-19 pandemic, there is an imperative to ensure that patients who need chronic medicines receive them without gaps. The United States Agency for International Development (USAID)-funded Global Health Supply Chain Program – Technical Assistance (GHSC-TA) works closely with the National Department of Health (NDoH) and the provinces to make this happen.
One of the consequences of the COVID-19 pandemic, has been challenges with the medicine supply chain, including shortages of antiretroviral drugs (ARVs) caused by production-related issues and importation delays. Another consequence of the pandemic is patients reducing medical visits to hospitals and clinics to minimize their exposure to the COVID-19 virus.
An additional challenge that arises during the holiday period at health establishments, is reduced capacity from a staffing perspective, and patients often traveling within and across provinces for family engagements.
Since March 2020, the NDoH with support from GHSC-TA and other implementing partners took proactive steps to mitigate the impact of COVID-19 on its HIV program and adopted numerous strategies to minimize clinical visits and promote adherence and retention in care, including multi-month dispensing (MMD) and delivery of patients’ medicines to convenient pick-up points.
GHSC-TA works closely with the Affordable Medicines Directorate of the NDoH, the Provincial Departments of Health (PDoHs), the HIV Program, Africa Resource Centre (ARC) and other implementing partners, to improve the security of supply of medicine. Over the holiday period, this support helped ensure that adequate supplies of medicines for chronic conditions were available and enabled patients to receive additional supplies of medicine – the so-called ‘holiday dispensing.’
GHSC-TA worked with NDoH and provinces to strengthen demand planning and inventory management, improve visibility via the National Surveillance Center (NSC) and strengthen analytics.
Demand planning involves combining statistical forecasting techniques and critical judgment to construct demand estimates for medicines to fulfill forecasted patient needs. GHSC-TA continues to review and update the provincial demand forecasts considering the current number of patients on treatment on TEE and TLD, as well as the availability of a 90-day TLD pack donated by USAID and Global Fund. The TLD was previously dispensed in a 28-day pack, with the 90-day pack now allowing for easier storage, transport, and use.
GHSC-TA works with the NDoH to introduce and sustain innovative processes, tools, and workforce training that result in more accurate demand forecasts. The forecasts are established through a centralized demand planning team based at NDoH. Accurate demand forecasts are thus the basis for an effective and efficient supply chain, improving medicine availability, and reducing costs. In South Africa, demand planning also improves the availability of medicines used to fight HIV/AIDS and TB and provides a good base for supply chain planning during the current and future pandemics.
In addition, GHSC-TA provides support to the provincial depots to improve the availability of TLD and TEE and avoid potential stock-outs while also assisting the HIV Program to secure Pre-exposure Prophylaxis medication (PrEP) for the national roll-out. Unfortunately, the holiday period where the consumption of alcohol and gender-based violence numbers peak mean this risk may be heightened. The availability of HIV medication is crucial to reducing infections.
The TLD dashboard developed by GHSC-TA, which is monitored weekly, tracks the transition of patients from TEE to TLD and enables visibility of the availability of TB medicines and contraceptives, which are crucial in ART treatment regimens. The dashboard enables stakeholders to manage stock levels down to the district and health establishment level and supports the movement of stock between facilities, where needed.
In addition, USAID GHSC-TA helped patients receive additional supplies of medicine to cover the holiday period by:
• Requesting the 90-day pack of TLD to be included in the formulary for reporting via RxSolution, the Stock Visibility System (SVS), and provincial warehouse management systems.
• Assisting the provincial depot in Mpumalanga and USAID and CDC partners resolve stock challenges in North West, Mpumalanga, and KwaZulu-Natal mainly on TB medicines and ARVs.
• Assisting health establishments in North West arrange for emergency orders to be processed and delivered to facilities due to the incorrect stock numbers resulting in TLD orders not being captured.
These interventions helped to increase the number of patients who received three months supply of medicine, as a result of a demand-driven supply chain. With good planning, ‘holiday dispensing’ helped patients on chronic medication have sufficient medicine during the holiday period enabling them to spend time with their families and loved ones.