Differentiated Service Delivery in South Africa
Percent of health facilities providing less-intensive DSD models. All 3700 ART facilities in the country have enrolled at least 10% of eligible recipients of care into less-intensive models. Source: October 2019 CQUIN DSD Dashboard staging
% In Less-Intensive
Percent of people on ART who are enrolled in less-intensive DSD models.Of the 3,840,000 recipients of care on ART in the country, 1,600,000 received drug pickups through the Central Chronic Medicine Dispensing and Distribution (CCMDD) mechanism, which serves all less-intensive DSD models. Source: October 2019 CQUIN DSD Dashboard staging
# of Less-Intensive
Number of less-intensive DSD models designed for people doing well on ART. Less-intensive models include: Appointment Spacing + Fast Track, Facility-Based ART Groups, Community ART Distribution, and Peer-Led Community ART Groups.Source: October 2019 CQUIN Annual Meeting NDOH Presentation and October 2018 CQUIN data request
Number of groups for whom less-intensive DSD models have been designed and implemented. Less-intensive DSD models are available for adults who are stable on ART only.
Source: October 2019 CQUIN DSD Dashboard staging
Differentiated Service Delivery Implementation in South Africa
South Africa joined the CQUIN learning network in 2017 as a thought leader in differentiated service delivery (DSD) design. The country has cultivated a wide diversity of models—from appointment spacing to fast track to facility-based clubs to community-based antiretroviral (ART) groups, services for adolescents and key populations, and more. In 2015, South Africa’s National Department of Health (NDOH) introduced national adherence guidelines for chronic diseases, folding DSD into the guidelines with the overarching aim to improve the effectiveness of all health services.
South Africa’s less-intensive DSD models are put into action through models that allow patients to collect medication both in and out of health facilities. These models include:
- Spaced and Fast Lane Appointments: whereby recipients of care receive a six-month prescription for medication available for pick-up every two months in their nearest health facility. These patients do not need to wait in queues in the facility, but are fast tracked and are able to simply collect medication and leave the facility.
- Adherence Clubs: clubs comprised of approximately 30 people, meeting on a bi-monthly basis to facilitate ART pickup and adherence support. Participants are also required to attend health clinics annually for check-ups.
- External Pick-up Points: recipients can collect medication at community based, easy to access pick-up points such as private pharmacies, approved churches, post offices, and other collection points on a monthly basis. Recipients are still required to attend clinic visits at least once a year for clinical assessment and laboratory tests.
In addition to medication being distributed through the standard health system and facility mechanisms, South Africa has introduced the Central Chronic Medicine Dispensing and Distribution system. Through this mechanism, medication is pre-packed by an external service provider and delivered to pick-up points across the country. This reduces pressure on the South African medicine distribution system as the service providers become responsible for end to end distribution and only refer clients back into health facilities if they have issues that need to be addressed by a health care worker.
South Africa’s more-intensive DSD models include the Advanced Clinical Care models, which were shared with CQUIN colleagues from Malawi and Zimbabwe during a November 2018 CQUIN-supported south-to-south visit. The standardized package of care for patients at high risk includes daily and weekly home visits, spot pill counts, enhanced adherence counseling, clinical monitoring with viral load monitoring every two months, and decentralized pharmacovigilance. In addition to this more-intensive model, NDOH recognizes the importance of enhancing its community-based models to address the needs of patients at high risk of disease progression and is continually looking to strengthen and diversify models.
November 10-14, 2019 Johannesburg, South Africa Meetings Days 1-4 including Tools Lab