Technical Assistance At All Levels: Strengthening Medicine Selection and Use Across South Africa’s Public Health Supply Chain

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April 16, 2020
Lead Paragraph/Summary

When a person infected by tuberculosis (TB) in South Africa visits their local public sector clinic for treatment, they trust that the medicines they need will be available. What may seem simple to the patient is actually a complicated process dependent on open communication and strong relationships between the National Department of Health (NDoH), specifically the Affordable Medicines Directorate (AMD), provincial pharmaceutical services, and health care establishments and professionals at the district level.


Many different governance structures make crucial decisions about the selection and use of medicines in South Africa. At the national level, the National Essential Medicines List Committee, supported by the AMD, is responsible for selecting which medicines are required to treat patients within the public sector. The AMD works with provinces so that the medicines needed are accessible when and where patients need them. At the provincial level, Pharmaceutical and Therapeutics Committees (PTCs) are the primary implementing bodies of national policies relating to the selection and use of medicines. They are charged with establishing and managing provincial and health establishment formularies which contain medicines relevant to the health establishment services and the disease burden within their provincial jurisdictions – thus informing which medicines are stocked by health establishments and provided to patients. They are also responsible for providing information about the medicines selected, monitoring the use of this medicine as well as other interventions to make sure that patients receive the right medicine at the right dose and at the right time.

According to one AMD official, “Outcomes [of policies on medicine selection and use, when implemented] will be more-equitable access to essential medicines, improved health outcomes, and cost-saving because of using the medicines rationally.” The AMD and PTCs thus play an important role in South Africa’s public health medicine supply chain.

The United States Agency for International Development (USAID)-funded Global Health Supply Chain Program – Technical Assistance (GHSC-TA) is working with the AMD and PTCs to strengthen medicine selection and use processes and procedures in South Africa. In 2019, GHSC-TA worked with the AMD to draft and finalize The National Guideline for the Establishment and Functioning of PTCs (the PTC Guideline). This national guideline aims to promote rational selection and use of medicines by providing guidance and tools to strengthen the governance and support the functioning of PTCs at provincial, district and health establishment levels. GHSC-TA has also worked with the AMD to draft the supporting National PTC Guideline Implementation Plan. This plan will allow the AMD and GHSC-TA to work together to implement the new guideline and promote transparency, efficiency and equity in the management and use of formularies. The National Guideline for the Management and Use of Formularies (the Formulary Guideline), also developed with support from GHSC-TA, was recently approved and published on the NDoH website. This document will make it easier for PTCs to follow nationally adopted guiding principles relating to formulary development and management.

Provincial heads of pharmaceutical services are already asking the AMD and GHSC-TA for assistance in improving the functioning of their PTCs, particularly around formulary management, showing that the AMD has been successful in communicating about the PTC Guideline and Formulary Guideline to the provinces. These two guidelines, together with the Medicine Master Data Policy (also developed with support from GHSC-TA), will assist in defining and standardizing the method of development, maintenance and use of formularies at all health establishments in the country.

Moving forward, GHSC-TA will work through its Provincial Support Team to provide support to provinces as they roll out implementation of the new guidelines. Work behind the scenes to develop and implement policies and strengthen governance structures will help to make sure that the TB patient at the beginning of the story continues to receive their medication without interruption, resulting in a full recovery.

“Outcomes will be more-equitable access to essential medicines, improved health outcomes, and cost-saving because of using the medicines rationally.” – AMD Official