Novel models to improve access to medicines for chronic diseases in South Africa: an analysis of stakeholder perspectives on community-based distribution models

摘要: The rising demand for chronic disease treatment and the barriers to accessing these medicines have led development of novel models distributing in South Africa’s public sector, including distribution away from health centres, known as community-based (CBD). In this article, we provide a typology CBD outline perceived facilitators their implementation using an adapted systems framework with view analysing how future policy decisions on could impact existing system whole. A qualitative exploratory study comprising in-depth interviews non-participant observations was conducted between 2012 2014 one province. Study participants consisted frontline healthcare providers (HCPs) sector few policy, supply chain experts. Observations processes occurred at two sites. We deductive analysis guided by framework. Models varied ranging formal (approved Department Health) informal (demand-driven) or without user-fees. Processes structures also differed, did HCPs’ perceptions what is appropriate. HCPs that were largely acceptable patients and accommodating needs. Affordability services linked charging user-fees contested issue, requiring further exploration. operated absence guide implementation, this, coupled involvement non-health professionals, issues regarding handling and storage; limited patient counselling raised concerns about quality pharmaceutical being delivered. Policy each elements will likely affect other ultimately influence structure operational modalities models. anticipation stakeholders cited need context specific lens order harmonise current efforts. required effort standardise assurance purposes. Frontline should be involved such ensure arrangements already working well are not undermined. Further research seek contribute towards evidence-based service delivery guidelines activities Africa.