Evaluating the implementation of home delivery of medication by community health workers during the COVID-19 pandemic in Cape Town, South Africa: a convergent mixed methods study

Abstract

Background Primary care services in South Africa have been challenged by increasing numbers of people with communicable and non-communicable chronic diseases. There was a need to develop alternative approaches for stable patients to access medication. With the onset of the coronavirus pandemic there was an urgent need to decongest facilities and protect people from infection. In this crisis the Metro Health Services rapidly implemented home delivery of medication by community health workers. This study aimed to evaluate the implementation of home delivery of medication by community health workers during the coronavirus pandemic in Cape Town, South Africa. Methods A convergent mixed methods study evaluated six implementation outcomes: adoption, feasibility, fidelity, coverage, cost, and sustainability of the initiative. Data sources included routinely collected data, a telephonic survey of 138 patients, an analysis of set-up and recurrent costs as well as 17 descriptive exploratory qualitative semi-structured interviews with 68 key informants. Results Over a 6-month period 1,054,657 pre-packaged parcels were sent to primary care facilities, 819,649 (77.7%) were delivered and of those 97,297 (11.9%) returned. The additional costs were estimated as 1.3% of a total health budget of R2,2 billion. The initiative was rapidly adopted as it decongested facilities and protected vulnerable patients. Although it was feasible to implement at scale, numerous challenges were encountered, such as incorrect addresses and contact details, transporting parcels, communicating with patients, having a reliable audit trail, and handling out-of-area patients. All role players thought the service should continue and 42.3% of patients reported better adherence to their medication. Conclusion Home delivery of medication by community health workers is feasible at scale and affordable. It should continue, but as one of a menu of options for alternative delivery of medication. The following need to be improved: efficiency of the system, the audit trail, adequate support and resources for community health workers, transport of medication, communication with patients, empanelment of patients, governance of the system and training of the community health workers.

Acceptability and feasibility of leveraging community‐based HIV counselling and testing platforms for same‐day oral PrEP initiation among adolescent girls and young women in Eastern Cape, South Africa

“…Community‐based service delivery has been shown to improve access to HIV services during previous health and conflict emergencies [ 74 ], and when compared to accessing clinic‐based services even during non‐emergency times [ 75 ]. Due to historic over‐crowding of primary health clinics, we and others continue to suggest that community‐based service delivery is crucial both to minimize COVID transmission in primary health clinics, including to healthcare workers, and to maintain access to PrEP and other HIV care and treatment services during and after the COVID‐19 pandemic [ 71 , 72 , 73 , 74 , 76 , 77 , 78 ]. However, the effectiveness and sustainability of such community‐based service delivery platforms during and after COVID‐19 will depend on the mobilization of health resources.…”

Home delivery of medications: Community pharmacists' perspectives on the pros and cons of the service

“…In addition, pharmacists serving more patients per day were found more willing to use the service than those serving less patients in this study. This could be explained that implementing home delivery of medications may contribute in decreasing congestion at the community pharmacies and thus, protect people from infection, yet meeting patients' demands ( 19 ).…”

Public Perceptions About Home Delivery of Medication Service and Factors Associated with the Utilization of This Service

“…The behavioral shift of patients towards adopting remote pharmaceutical services and filling prescriptions at home has become an increasingly more common practice. 7,[29][30][31][32] The COVID-19 pandemic has contributed to accelerating and expanding this service, aiming to decongest facilities and combat disease transmission, while meeting patients' demands 9 . However, many patients are not accustomed to these services, and the adaptability has been reported to be lower in low-and middle-income countries, which limited the implementation of these remote patient care services.…”

“…However, many patients are not accustomed to these services, and the adaptability has been reported to be lower in low-and middle-income countries, which limited the implementation of these remote patient care services. 9,10,33 In addition, home delivery of medication was not the standard practice in providing pharmaceutical care services in several countries across the globe until the surge of the 2019 pandemic. In Jordan, home delivery of medications has been recently launched; however, no clear policy from health authorities is in place yet.…”

“…Some home delivery pharmacy initiatives were implemented successfully, for example in China, Cape Town, South Africa, and Qatar. [6][7][8] Home delivery of medication is a service provided by pharmacies to deliver prescription and non-prescription medications to patients at their homes 9 . In Jordan, the government regulatory authorities granted a special allowance to implement home delivery and internet pharmacy because it is not permitted in standard practice 10 .…”