Availability of registered pharmaceutical structures in South Africa : 2003 until 2008

AVAILABILITY OF REGISTERED

'PHARMACEUTICAL STRUCTURES IN SOUTH

AFRICA: 2003 UNTIL 2008

Ridovhusanae Rabali

12861502

.. Dissertation submitted in partial fulfilment of the requirements for the degree Magister Pharmaciae in Pharmacy Practice, School of Pharmacy at the Faculty

of Health Sciences of the North-West University, Potchefstroom

Supervisor: Mr. W.D. Basson

Co-supervisors: Prof. J.H.P. Serfontein

Prof. M.S. Lubbe

2009

Potchefstroom

.. 1

"When we build what God wants us to build

there is no

crumbling down"

Prof. T .C. Rabali

DEDICATION:

ACKNOWLEDGEMENTS

This dissertation would not have been possible without the contribution of many people and organisations. To them all, I express my sincerest appreciation and gratitude. The following however, deserve special mention:

• Mr. W.O. Basson, in his capacity as supervisor of this dissertation. My appreciation for his expert guidance, assistance and especially his patience, understanding and words of encouragement.

• Prof. J.H.P. Serfontein, in rlis capacity as a co-supervisor. For his assistance, expert guidance and invaluable input into this research.

• Prof M.S. Lubbe, in her capacity as co-supervisor. Much appreciation for her assistance and expert guidance.

• The Department of Pharmacy Practice at the North West University and its personnel for the assistance as well as financial and technical support towards the completion of this study.

• The National Research Foundation (NRF) for the financial support.

• Anne-Marie Bekker for her assistance with the data capturing, the words of encouragement and support.

• Mrs M.M. Terblanche for the language editing of this study.

• My colleagues and fellow M-students, Anri, Corlee, Janine, Joe, Mariet, Rial, Ulrich and Wilmarie. It helped to know I was not alone and, "nothing gives strength like knowing that what was accomplished yesterday, can be accomplished again today" J. Maxwell.

• The staff at Kopanong Hospital pharmacy especially for reminding me what pharmacy practice is all about.

• Tanie Marie & mme Johanna of West Campus residencies, who were always willing to accommodate me even in the most unseemly times.

• My father (Prof T.C. Rabali), my mother (T.J. RabalO and Makhulu for their constant support, advice, never-ending prayers, sacrifices and so much more that goes without mention. I cannot thank you enough.

• My siblings: Thiofhitshithu, Alunangi, Ndinavhushavhelo, Rendani, Hahangwivhawe, Uandwela, Asashanduki, Zwidorulwa and Vhamudivhe. I thank God for you and I am deeply grateful for your support, prayers and concern. Special thanks to Asa and Vhamu for their help with data organisation and to Hahangwi, Uandwela, Asa, Zwido and

Vhamu for their ready willingness and various ideas and inputs into the study.

• My friends: Berenice Campbell, Lilly Mokoena, Rofhiwa Nemutandani, George Mdluli, Asashanduki Rabali, and Mulalo Maselesele, for the support, being there for meand believing in me when I needed it most.

• To the Almighty God for His strength and spirit that brought me through the journey, His steadfast love and support and the blessing of the persons and institutions mentioned above.

I have followed the pillar

of

of

am

am

ABSTRACT

TITLE: The availability of registered pharmaceutical structures in South Africa from 2003 until 2008

KEYWORDS:

Access, availability, equity, geographical distribution, pharmaceutical structures, pharmacy per population ratio.

BACKGROUND:

Despite the deteriorated state of health care in South Africa, the government remains committed to realising the right of every citizen to access health care, including good, quality and essential drugs. In recognising the availability of pharmaceutical facilities as a major component of access to health care, and the previous imbalances in the distribution of pharmaceutical structures and services, laws pertaining to the licensing and ownership of pharmacies were amended and promulgated in 2003 to address the distribution problem. In addition, regulations relating to a transparent priCing system on medicines and related sUbstances were introduced in 2004. These, coupled with factors influencing the choice of a pharmacy location, and the deficiencies in human resourges exercising an impact on both pharmacy and other health care personnel, have influenced the distribution and availability of pharmaceutical structures in South Africa from the year 2003 to 2008.

OBJECTIVE:

The main objective of this study was to investigate the availability and distribution of pharmaceutical structures registered with the South African Pharmacy Council, in South Africa, as of 2003 until 2008.

METHOD:

Data on the total number and geographical distribution of registered pharmaceutical structures in South Africa were obtained from the South African Pharmacy Council's register of pharmacies of August 2003, 2004, 2005, 2006, 2007 and 2008. The registered pharmaceutical structures were categorised according to their nature of services to the patient into "direct service" and "indirect service" (support) pharmacies. Availability was taken to refer to the actual presence of the pharmaceutical structures in relation to the demand for the services and measured quantitatively using population: provider ratios. The 'population' for indirect service pharmacies was taken as the direct service pharmacies and,

the 'population' for direct seNice pharmacies was taken as the estimated population of the different geographical regions.

RESULTS:

The results revealed a 12% increase in the total number of registered pharmaceutical structures between the study years, to a total of 4227 pharmaceu'tical structures in 2008. Gauteng was identified as the province with the highest number of registered pharmaceutical structures, while the Northern Cape province contained the lowest number of registered pharmaceutical structures throughout the entire study period. The percentage of municipalities without any registered pharmaceutical structures decreased from 23% in 2003 to 19% in 2008.

The indirect seNice pharmacies constituted 14% of the total number of registered pharmaceutical structures in South Africa. Most of these structures were situated in the province of Gauteng throughout the study period. National availability of these structures only improved for the manufacturing pharmacies.

The registered direct seNice pharmacies increased by 13.2% to total 3642 pharmacies in 2008. Approximately 20% of the municipalities in the country (respectively 5.5% of the population) did not contain any registered direct seNice pharmacy in 2008. Most of these municipalities were situated in the KwaZulu-Natal province. The province of Gauteng contained the highest proportion (32%) of the direct seNice pharmaceutical structures. The decrease in the pharmacy per population ratio of the structures from 1: 14 547 people in 2003 to 1: 13 615 people in 2008 indicated an improvement in the availability of the structures. However, the improved availability did not take effect within each province as the Northern Cape, Mpumalanga and Gauteng provinces experienced an increase in the pharmacy per population ratio.

CONCLUSION:

The availability of registered pharmaceutical structures in South Africa improved between 2003 and 2008. However, the distribution of these structures remains geographically uneven and inequitable to the population of the country.

OPSOMMING

TITEL: Die beskikbaarheid van geregistreerde farmaseutiese instellings in Suid-Afrika vanaf 2003 tot 2008.

SLEUTELWOORDE:

Toeganklikheid, beskikbaarheid, gelykheid, geografiese verspreiding, farmaseutiese

instellings, apteek per populasie verhouding.

AGTERGROND:

Ten spyte van die dalende toestand van gesondheidsorg in Suid-Afrika, bly die regering toegewyd aan elke landsburger se reg tot toegang tot gesondheidsorg wat goeie, kwaliteit essensiele medisynes insluit. Die beskikbaarheid van farmaseutiese instellings is geTdentifiseer as 'n belangrike komponent wat toegang tot gesondheidsorg beTnvloed, te same met vorige ongelykhede in die verspreiding van farmaseutiese strukture en dienste, het aanleiding gegee tot die wysiging van wette rakende die Iisensiering en eienaarskap van ,apteke wat bekendgemaak is in 2003, om wanbalanse in verspreiding aan te toon.

Verder is die regulasies vir 'n deursigtige prys sisteem vir medisyne en verwante stowwe in 2004 bekendgestel. Hierdie regulasies, tesame met faktore wat die keuse van apteekligging be"invloed, en tekorte in mensehulpbronne het 'n impak op beide apteek- en ander gesondheidspersoneel uitgeoefen en het die verspreiding en beskikbaarheid van farmaseutiese strukture in Suid-Afrika beTnvloed vanaf 2003 tot 2008.

DOELWIT:

Die hoof doelwit van hierdie studie was om die beskikbaarheid en verspreiding van farmaseutiese instellings wat by die Suid-Afrikaanse Aptekersraad geregistreer is te bestudeer vanaf 2003 ten einde 2008.

METODE:

Data oor die totale aantal en geografiese verspreiding van geregistreerde farmaseutiese strukture in Suid-Afrika is verkry vanaf die Suid-Afrikaanse Aptekersraad se register vir apteke vir Augustus 2003, 2004, 2005, 2006, 2007 en 2008. Die geregistreerde farmaseutiese instellings is gekategoriseer volgens die aard van dienste wat aan die pasient gelewer word as "direkte dienste" en "indirekte dienste" (ondersteunend) apteke. Beskikbaarheid van farmaseutiese instellings verwys na die werklike teenwoordigheid in