by Roma Ramphal – HST Provincial Differentiated Care Manager

Over the years, South Africa's Central Chronic Medicines Dispensing and Distribution (CCMDD) programme has made remarkable progress in improving access to treatment for patients with chronic health conditions. Through the introduction of convenient collection models ‒ from smart lockers and mobile pick-up points (PuPs) to extended multi-month dispensing ‒ we've gone a long way in decongesting clinics and bringing health care closer to communities.

We've built a system that centres on the patient — and that's something to be proud of. 'Patient-centred' or 'patient-centric' care has become a cornerstone of how we think about strengthening health systems, and rightly so.

But let's pause and reflect: placing a patient at the centre doesn't mean that we've done enough. A patient isn't a passive figure around whom we design processes ‒ the patient is a person who is navigating real challenges, emotions and uncertainties and who needs support, guidance, encouragement and care.

That's why it's time to shift both our language and our approach by moving from 'patient-centred' to 'patient-partnered' ‒ because real progress happens not when patients are placed in the middle, but when they are brought to the table, heard, valued, and involved as equal partners in their own care.

Partnering with patients means involving them in shaping the unique programme of care that they should receive. It's the difference between delivering medicine for people and delivering solutions with them.

As implementers, our attention often leans heavily on refining processes, issuing circulars, and conducting one training session after another. While these are undoubtedly important, we must ask ourselves: 'Are we solving the right problem?' because often, the issue is neither a policy flaw nor a training gap — it's a behavioural or supervisory one.

Here's an example: a facility may have eligible patients properly transitioned into CCMDD, with their parcels being delivered and collected on schedule. On the surface, all seems well. But then a review of the viral load dashboard reveals poor suppression rates. What's going wrong? The patients are collecting their parcels ‒ but they're not taking their pills.

This is where partnership becomes crucial. Rather than reacting with new standard operating procedures or resorting to more training of clinicians, we need to go deeper, through engagement with the patient. Maybe they don't fully understand how or when to take the medicine. Maybe they're facing stigma, dealing with side-effects, or struggling with substance use. Or perhaps no-one has taken the time to check in and encourage their treatment adherence. These are not process failures — they are human challenges.

Strong and supportive supervision plays a pivotal role here. If patients are being enrolled into CCMDD but are never followed up, or if staff are simply ticking boxes without meaningful engagement, then we've missed the mark. Even the most robust system will fall short without ongoing coaching, accountability, and open, honest conversations with the people it's meant to serve.

So how do we shift?

Firstly, we must intentionally create safe spaces for patients to share their experiences, not only through complaint channels but also via advisory groups, community listening sessions, or even anonymous feedback at PuPs. These insights can help us to reshape and refine our services in ways that truly respond to patient needs.

Secondly, let's make communication more personal, consistent and practical. Every patient should walk away from each interaction — whether at a clinic, a smart locker, or a mobile PuP ‒ feeling informed, empowered and confident about their treatment. SMS reminders, visual materials, and even voice-notes in the patient's language can reinforce key messages in ways that resonate for them. And let's ensure that their cellphone numbers are regularly updated on the SyNCH system, so that every message reaches the right person, at the right time.

Thirdly, we must acknowledge the power of relationships: a Post-Basic Pharmacist Assistant who takes time to explain the regimen to the patient; a nurse who checks that the patient understands their treatment schedule; a PuP issuer who reminds someone of their next collection date. These small, human interactions build trust – and that trust leads to better adherence, stronger engagement, and ultimately, better health outcomes.

Finally, we need to evolve how we define and monitor success. Yes, parcel collection matters – but what truly counts is what happens afterwards. If a patient collects their medicine but doesn't take the pills, then our work is not done.

In the end, the success of CCMDD won't be measured by how many parcels are delivered. It will be measured by how many patients stay healthy, achieve viral suppression, and remain connected to care. That kind of success doesn't come from systems alone. It comes from partnership – from listening, engaging, and walking this journey with our patients, side by side.

For more information on CCMDD contact the Department of Health helpline on 0800 012 322, Whatsapp 0600 123 456 or email info@health.gov.za, or email the Health Systems Trust at communications@hst.org.za