The Head of the Pharmaceutical Policy, Research and Services Support Unit at Right to Care, Dr Shabir Banoo, talked to eHealthNews about South Africa’s growing interest and value in pharmacy automation and what it means for the country’s eHealth strategy.

Pharmacy automation is new in South Africa. What is it and why is it a better alternative to manual systems?

Automated medicine dispensing systems are robotic devices that allow medications to be stored and dispensed in a safe and controlled manner near the point of care, while controlling and tracking drug distribution.

The use of pharmacy automation technology could enhance the delivery of medication services for patients whilst also ensuring the availability of medicines. This could deliver tangible benefits in crucial segments of our health service. For example, South Africa has about 2.5 million patients on ARVs at present and is the largest procurer of these types of medicines in the world.

There are numerous considerations and challenges in the public sector that can compromise the way pharmacy services are delivered: staff shortages, stressful working environments and the intermittent availability of medicines for patients. This not only means that patients often get a lower quality of care due to pharmacy staff being overworked, but also that patients end up having to wait in queues for hours to collect their medicine, which is valuable time lost – especially when it cuts into their workday.

Implementing pharmacy automation in high-volume public sector healthcare facilities would improve the efficiency of medicine dispensing and eliminate handling errors, thereby reducing waiting times and improving patient safety. Automation would allow pharmacy personnel to spend more time counselling and monitoring patients. Pharmacists and their staff could also work in other areas, such as wards, where they can provide more effective patient care and management – instead of having to do mundane tasks like sticking labels on packages.

Right to Care was involved in the implementation of an automated pharmacy dispensing system at Themba Lethu Clinic. What kind of impact did the automation have?

Themba Lethu Clinic at Helen Joseph Hospital in Johannesburg is one of the largest HIV treatment programmes in the country, which is why the site was chosen for the pilot. The clinic sees more than 750 patients a day and has more than 17,000 patients on ARVs. Prior to the system’s implementation, patients waited approximately 4.5 hours in the pharmacy queue alone. They now spend no more than 30 minutes for routine medication collection visits and all patients are served within a normal eight-hour working shift.

From the drastically reduced waiting times alone it’s evident that automation has vastly improved the clinic’s overall performance. Pharmacy personnel also know exactly what stock will expire in the next 30 to 60 days and are able to respond in a timely fashion to minimise wastage.

Because of the overall success of the pilot, wider implementation of this technology is being considered for the Helen Joseph Hospital main pharmacy.

What does the success at Themba Lethu Clinic mean for the rest of the country?

The pharmacy automation pilot at Themba Lethu Clinic was the first of its kind in the public sector in South Africa; it has laid the ground work for this technology in the public sector and has demonstrated the efficiencies needed in this setting. The lessons learned from this project have also enabled a strategy for wider implementation of this technology to be considered for similar high-volume facilities in Gauteng and other provinces. Academic and tertiary level hospitals are likely to benefit most from this technology.

Representatives from the various provinces as well as the Zambian Ministry of Health have visited the facility to benchmark the system. Right to Care is currently in discussion with the Gauteng DoH to scale up the technology to Chris Hani Baragwanath Hospital and other hospitals in the province.

Does pharmacy automation eliminate the reliance on paper?

South African healthcare facilities are still required by law to have a paper trail although I strongly believe these needs to change. Doctors are still required to handwrite signatures and there is a need to evolve the current situation to enable acceptance of electronic signatures and other eHealth practice methods. I think we’re demonstrating the necessity for this change and offering the evidence that eHealth is the answer to a number of issues within the public healthcare system.

There’s a lot of concern about robots replacing jobs, what’s your opinion?

Pharmacy automation does not reduce staff; it is primarily intended to improve the efficiency of delivering pharmacy services and, in this regard, makes the best possible use the limited pharmacy human resources we currently have, particularly in the private sector.

We have a shortage of health personnel in this country, a situation which is worsened when pharmacists are often not able to spend sufficient time counselling and monitoring patients. Introducing automation relieves personnel of repetitive tasks like prescription preparation and picking of drugs which are frequently error-prone in busy pharmacies, and allows more time for patient engagement and improving the quality of patient care. So I would say the fears about job losses as a result of automation are misguided.

What is Government’s view on pharmacy automation?

Government is committed to engaging with innovation, such as pharmacy automation, as long as it supports the wider public health objective.

One of Government’s top priorities currently is to engage private-sector providers to continue the management of chronic but stable public-sector patients. This strategy to transfer these stable patients out of public sector facilities is intended to make room for new patients and enable treatment scale-up for priority diseases. Several initiatives are already underway in which public sector patients use community pharmacies or local GPs as convenient pick-up points for collection of their medications. Automation also has the potential to support these objectives.

Are there any other pharmacy automation initiatives underway?

A pilot project aimed at enabling stable patients to access their chronic medicines conveniently outside of public health facilities is being considered. The real innovation here is that patients would be able to collect medication conveniently and after hours.

There are similar systems in the UK whereby an automated, pre-packed system dispenses repeat prescriptions to patients – but this project would also incorporate the services of a “virtual pharmacist” who would verify the patient’s details, ensure that the right medicines are dispensed and labelled correctly, and also answer any questions the patient might have.

This approach has enormous potential particularly with regards to therapy schedule adherence since they could quickly and easily collect their medicine whenever they choose.

The reality is that we’ve only begun to scratch the surface of the potential benefits of pharmacy automation and how it can be extended to benefit all parties involved. I am certain we will realise many more benefits as automation becomes standard practice.

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