Table 3

Challenges with implementation of CCMDD

IssueQuotes
Barriers to registering patients in CCMDD
Need for ID card“If a patient wants to be registered on CCMDD, strictly that patient must have a South African ID (or foreign passport) and every time the patient is going to collect the medication, they have to positively identify themselves using their ID. Something that we are not doing in the clinics. Some patients are not happy with that, ID’s do get lost from time to time and then once the ID is not there, then they cannot give you that package at the pickup point, then the patient would be forced to come back to the clinic… (and) then they get de-registered in the process.” Staff interview 4*
Problems with electronic prescription system“The online registration system crashes quite often so there’s days where the nurses can’t get online, they just have to register manually. It creates a problem because online registration is a lot quicker, so on the days when they have to do manual then they are backed up for quite a while, and then it just makes the work a lot more.” Staff interview 6
TB prophylaxis“There’s a category of patients that can be stable on ARV’s but still don’t qualify for CCMDD. A typical point in example, if at any given point you decide to put this patient on IPT, which is Isoniazid Preventive Therapy for TB, they don’t take that patient. You see, for the patient to qualify for CCMDD they must be stable, but now CCMDD will not take a patient that is on IPT. So we have to keep that patient up until they finish the course of IPT before you can enrol them on CCMDD.” Staff interview 4
“They said because I am still taking the ones for protecting me against TB and I will finish them in August… after that I will hear from them (about referral to CCMDD)” Client interview 21, Male.
Problems with CCMDD implementation
SMS“I will receive the text message the following day in the afternoon, after I collected today. I never receive the text message (on time). I receive it after.” Focus group 1 Participant 3, Female
ART not being found at the pickup point“I once received an SMS and I went there (to the private pharmacy) the very same day I received the SMS, and I got there and they said my name is not there (on the list of people with ART to collect). I then came here (to the clinic), and I got my treatment here. Fortunately, I had time on that day to end up coming here.” Focus group 2 Participant 4, Male
Inflexible pickup datesThe service providers are very strict when it comes to appointment dates, very strict. You get given a date and then you are expected to collect your parcel within 48 hours. After those 2 days then the medication will be sent back… and they get de-registered as a result. But here in the clinic they can miss the date by a day or two or three or four or five, it’s not that much of an issue.” Staff interview 4
“It was my fault because I came after 2 days and I found that my treatment has been sent back (to the depot).” Focus group 1 Participant 6, Male
Restricted ART pickup times“They (private pharmacy staff) don’t even take into consideration that I am coming from work… They are still at work and their job is to give me what I came here for (ART), but they tell me that they have closed and there is a queue.” Focus group 1, Participant 1, Male
Pickup points reaching capacity“Most of the pickup points were full, you know. They were full and some of the participants collect their medication far from where they stay, far from where they work you know. Jah, I think those were the disadvantages.” Staff interview 2
  • ART, antiretroviral therapy; CCMDD, Centralised Chronic Medication Dispensing and Distribution programme; TB, tuberculosis.