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Table 3 Summary of how CBD elements facilitate or constrain CBD implementation

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

CBD element Facilitators Barriers
Medicines o Centralised dispensing simplifies distribution process. o Quality assurance processes must be fulfilled by HCPs prior to “last mile” distribution;
o Stock-outs of medicines cripples CBD models;
o Non-collected medicines cannot be re-dispensed.
Human resources Community Health Workers o Positive, close relationships with patients which can facilitate active follow-up when necessary. o Not able to conduct quality assurance processes.
HCPs o Missing medicines from patient-ready parcels can be dispensed manually by the HCP at the CBD site. o General shortage of HCPs undermine sustainability of deploying them to CBD sites.
Informal providers o Demand-driven therefore likely to suit beneficiary needs. o No governmental oversight which could lead to financial exploitation of patients;
o no accountability to professional statutory body which could compromise quality of pharmaceutical services.
Infrastructure and logistics o Government vehicles available for transportation of medicines for some models. o Poor transport systems for CHWs causing delays and posing security and environmental risks to medicines;
o Availability of venues not always guaranteed.
Patient (population)’s engagement with CBD models o Positive patient-patient; patient-provider relationships;
o Some patients knowledgeable about their treatment regimen and proactive in addressing medicine-related concerns.
o Stigma associated with HIV still a reality.