Having woken up at around 05:00 to come to the hospital to collect her medication, sixty-nine-year-old Gogo Nophumzile Cwane had been hoping to be among the first few patients to arrive.
But, to her dismay, she finds dozens of other people ahead of her already queueing and seated on the benches in the waiting room. Cwane has no choice but to join the queue and settle in for the wait.
On a scorching summer day, Spotlight sat down to listen to the stories of some frustrated gogos (grannies) and mkhulus (grandpas) queueing to collect their chronic medicines at the busy All Saints hospital in the rural town of Ngcobo in the Eastern Cape.
We then asked the province’s health department about its plans to get chronic medicines to people in rural areas.
Yearning for home delivery
“It normally takes me two to three hours before I can be attended to. But I have no choice but to be patient because I need the medication to survive,” says Cwane, who suffers from diabetes and high blood pressure.
Back in Lower Gqaga village, about 40km away, she had to walk a kilometre distance to catch a taxi to town and then another one to the hospital. “My ankles are still aching from sitting at the back of a bakkie,” she says.
“The transport system here is really bad. When it rains, it becomes a nightmare and I’m unable to come and collect my medication.”
In most parts of the rural Eastern Cape, bakkies are often used as taxis to transport people.
Shaking her head, Cwane tells Spotlight that the R100 transport money she spends every two months to come to the hospital should really be going towards her groceries.
“I am yearning for the day when my medication will be delivered on my doorstep so that I don’t have to go through this daunting experience. They keep warning us about Covid-19, but if they want to reduce the risks of contracting it, then they must ensure we don’t stand here in these big numbers,” she says, holding her lunchbox she brought along for the wait.
‘A huge challenge’
Sixty-one-year-old Gogo Nozukile Gwangwa is also queueing patiently. She says for the past 12 years since being diagnosed with diabetes and a heart condition, her life has never been the same.
Taking out a handkerchief to wipe away the sweat, she says access to medication remains a huge challenge. Roads, she says, are a nightmare in Tsalaba village and the recent floods in the Eastern Cape have meant that her village often gets cut off.
“There are days when I am unable to collect my medication due to the lack of transportation. It is a matter that needs to be addressed. Lives are lost because of a situation that could have been avoided. It is as simple as fixing the roads and providing mobile clinics so that people don’t have to travel distances to seek medical attention,” she says.
Vusikhaya Thekwana (66) echoes her concerns. He says he wakes up at 05:00 on days when he has to collect medication. “The queues can be long and you have to be an early riser. I stay in a faraway village and have to ensure that I am here on time,” he says.
A report published in September last year by community healthcare monitoring group Ritshidze painted a picture of widespread understaffing at healthcare facilities in the province, which they said contributes to longer waiting times and staff being overburdened. 54% of people living with HIV surveyed by Ritshidze in the province said they would like to collect ARVs closer to their homes. While the report registered demand for more pickup points closer to people’s homes, satisfaction with current medicines collection options was high.
The Ritshidze report stressed the benefits of giving people enough chronic medicines for three or more months at a time – which, among others, means they have to travel less often to collect medicines.
CCMDD in the Eastern Cape
Yonela Dekeda, acting communications manager for the Eastern Cape Department of Health, says the department is working tirelessly to ensure that medicines get to people, especially senior citizens.
As in most provinces (the Western Cape has a slightly different system), the Eastern Cape makes use of the Centralised Chronic Medicines Dispensing and Distribution (CCMDD) system.
In theory, this system should allow people to collect chronic medicines for conditions ranging from diabetes and heart disease to asthma and HIV at private pharmacies and other pickup points closer to their homes so that they don’t have to travel long distances and end up queueing for hours at clinics. (Spotlight last year published an article assessing the state of the CCMDD programme.)
Dekeda says 282 303 people are currently receiving chronic medicines through the CCMDD programme in the province. “This programme has been seeing a steady increase in the number of patients, for example, between 2019 to 2020/21 there was an increase of 8 247 patients while in 2020/21 the programme recorded a noticeable increase by 13 218 patients, in addition to maintaining the clients already on the programme,” she says.
“According to the Annual Performance Plan, the target for end of 2020/21 was to have 300 000 registered patients, but the programme achieved 282 303 patients,” she says.
“The Covid-19 pandemic continued to impact negatively on the programme through reduced number of clients visiting facilities and therefore collection of prescriptions. This negatively impacted the number of active patients. Despite travelling and curfew restrictions being relaxed, the remnants of those restrictions earlier in the year could still be felt in the programme.”
According to Dekeda, all 796 facilities that are participating in the CCMDD programme in the province are used as pickup points for those clients who are in direct proximity to the facility or choose not to opt to take medicines externally. She explains that “the difference though is they are then fast-laned in the health facility.”
Dekeda says there are 210 external (not at public healthcare facilities) pick-up points. “For an establishment to be a pick-up point, they submit an application form in the district they are in. The applicants are assessed against a set standard and if found eligible, they are registered on the central supplier database for government (CSD).
That establishment is then contracted by the National Department of Health. CCMDD patients in that locality are made aware of such an external pick-up point and have an option to choose it as their pickup point,” Dekeda says.
Bicycle deliveries and other planned improvements
According to , a bicycle delivery service has been introduced as part of the CCMDD programme in selected districts, including Sarah Baartman. This involves delivery persons transporting medicine packs from facilities to people’s homes. She did not indicate what number of people in the province are getting home deliveries of chronic medicines in this way.
Dekeda says the province also plans to engage NPOs and churches to help make medicines available closer to people’s homes.
“The Methodist Church has been the first to be registered in OR Tambo District. Furthermore, the plan is also to engage NPOs that have capacity and local businesses in the rural areas that meet the CSD criteria. Also, the programme makes use of adherence clubs where pick-up points are not able to be established. There are external pick-up points that are closer to where people live. This is across all districts,” she says.
Dekeda also says the department is rolling out the “Synchronised Communication in Health” (SynCH) system to facilities providing CCMDD services in all districts within the province.
“This software automates the CCMDD process which allows instant transmission of CCMDD medicine prescriptions from health facilities to CCMDD pharmacy service providers for dispensing and distribution of patient medicines packs,” she says.
President Cyril Ramaphosa, in his State of the Nation Address earlier this month, acknowledged that while roads and bridges provide access to social services such as healthcare, millions of South Africans in rural areas still have to brave overflowing rivers to reach clinics and hospitals.
He also stressed, “The Covid-19 pandemic has starkly demonstrated [that] a nation’s health is inextricably linked with its economic progress and social development. We will therefore continue with the work underway to ensure universal health coverage for everyone in the country, regardless of their ability to pay.”
But these words offer little comfort for people like Thekwane.
“Government must just talk less and do more and bring healthcare services closer to the elderly. We need more clinics and hospitals in our villages now,” says Thekwane.
*This article was published by Spotlight – health journalism in the public interest.