HIV has been recognised in Zambia as a major public health problem, in the last decade it has seen successful scaling up of Antiretroviral Treatment (ART) provision resulting in over 900,000 clients. Continued scale up also led to an increase in demand for HIV services thus leading to congestion in health facilities, and straining the health system thereby threatening the quality of care. Some clients had difficulties with accessing the ART service because the time these services are provided compete with client busy work schedules.
Due to this, Centre for Infectious Disease Research in Zambia (CIDRZ) with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partnership of U.S. Centers for Disease Control and Prevention (CDC) has been implementing Differentiated Service Delivery (DSD) models which include the Community Adherence Groups (CAGs) which has benefited 12, 558 people, the Urban Adherence Groups (UAGs) with 1, 741 people, Health Post/Fast Track Dispensations with 37,640 beneficiaries, Scholars’ model which has 2, 073 people and the newly introduced community pharmacy dispensation model which has 237 people.
In appreciating the role of private companies in the delivery of health services, CIDRZ has since October 2018 partnered with private pharmacies to implement the community pharmacy dispensation model to ensure improved access to ARV’s by stable HIV positive patients. The Community Pharmacy Model stands out because it allows clients to access ARVs at flexible times. The clients may collect their drugs at any time provided the retail pharmacy is open. Most if all the private pharmacies that participate in this programme have long operating hours of up to 22:00 hours even over the weekend as well as holidays. This means that clients are free to access the ARV’s at times that do not compete with work/lifestyle schedules.
Mary Mwango, who recently enrolled on the model at Kabwata Health Facility, says “due to congestion and stigma, my husband has had challenges to be initiated on ART even when he always encourages me to take my medication, and ensures that I go for medical checkups at the clinic. With the coming of this model, I am confident that he will accept to be initiated on treatment.”
Mary said she discovered that she was HIV-positive in 2006 and was immediately put on treatment. “I have always been coming to collect my medicine from this facility since 2006 and it has been inconveniencing as I am a sales person at the market. I always spare a day, and abandon my business to come and collect my medication. But with the coming in of the Community Pharmacy Dispensation Model, it will enable me to conduct my business without any disturbances of coming to queue up for the drugs which before used to take almost the entire day. It will also help my husband to start taking his medication now that he can collect from the pharmacy and only come here (at the clinic) for medical checkups. ”
She further added that the initiative will benefit people who have busy schedules during working days as they can collect the drugs after working hours and on weekends when they are free. “This is a good initiative for people who are mostly busy especially for men who fail to come to the clinic due to work and long queues. Most men fear to go to clinics as they don’t want to be seen by other people that they are HIV positive. Like my husband he fails to come to the clinic, but he shows interest in knowing more information other alternative ways of collecting drugs without being seen by other people.”
Messiah Sichone, a Pharmacy Technologist at Five Star Pharmacy in Chongwe, which is one of the dispensary points, expressed gratitude with the model saying it was a good initiative of promoting public/private partnership on delivery of health services.
“It keeps me abreast with knowledge in current HIV services. The initiative implemented in partnering with private pharmacies is very good and beneficial to both the company and the public. People get to know the company and appreciate the services offered.
“It also helps people who work to collect their medication on time without interfering with their busy schedules. I have experienced instances where some clients came to collect their medicine after 19hrs which is highly beneficial to them as their work and businesses now run smoothly while collecting their medication on time,” Mr Sichone says.
He added on that there was need to strengthen health talks in health facilities, in order to educate the public and raise awareness about the model, “we have had situations were people from other districts who came to visit come directly requesting to collect their medication from here because someone informed them about the model and the collection point when in fact they have not enrolled in the model. Health personnel should really educate the public on the model and emphasize on the need to go for medical checkups after the stipulated time. We would like to see a scale up so that more people are enrolled on this model as it is highly beneficial.”