Original Research

Alternative mechanisms for delivery of medication in South Africa: A scoping review

Robert Mash, Carmen Christian, Ruvimbo V. Chigwanda
South African Family Practice | Vol 63, No 1 : Part 3| a5274 | DOI: https://doi.org/10.4102/safp.v63i1.5274 | © 2021 Robert Mash, Carmen Christian, Ruvimbo Valerie Chigwanda | This work is licensed under CC Attribution 4.0
Submitted: 27 January 2021 | Published: 24 August 2021

About the author(s)

Robert Mash, Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Carmen Christian, Department of Economics, Faculty of Economics and Management Sciences, University of the Western Cape, Bellville, South Africa
Ruvimbo V. Chigwanda, Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa


Background: The number of people in South Africa with chronic conditions is a challenge to the health system. In response to the coronavirus infection, health services in Cape Town introduced home delivery of medication by community health workers. In planning for the future, they requested a scoping review of alternative mechanisms for delivery of medication to patients in primary health care in South Africa.

Methods: Databases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Data was analysed both quantitatively and qualitatively.

Results: A total of 4253 publications were identified and 26 included. Most publications were from the last 5 years (n = 21), research (n = 24), Western Cape (n = 15) and focused on adherence clubs (n = 17), alternative pick-up-points (n = 14), home delivery (n = 5) and HIV (n = 17). The majority of alternative mechanisms were supported by a centralised dispensing and packaging system. New technology such as smart lockers and automated pharmacy dispensing units have been piloted. Patients benefited from these alternatives and had improved adherence. Available evidence suggests alternative mechanisms were cheaper and more beneficial than attending the facility to collect medication.

Conclusion: A mix of options tailored to the local context and patient choice that can be adequately managed by the system would be ideal. More economic evaluations are required of the alternatives, particularly before going to scale and for newer technology.


primary health care; primary care; medication systems; adherence clubs, home delivery; alternative pick-up-points


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