Truly Understanding Health Systems Strengthening

Medha Vyavahare Yale School of Public Health 2017

Medha Vyavahare pictured on the far right with colleagues during a field visit in Clarens, South Africa

As a GHLI intern, I recently traveled to South Africa to learn about the Chronic Centralized Dispensing and Distribution (CCMDD) Initiative — a national effort to improve access to medicines for South Africans with chronic diseases.

When I learned about the necessity of system-wide approaches in global health as a public health student at Yale the term ‘health systems strengthening’ seemed vague. It wasn’t until I got to South Africa that I realized the nature of system change.

Patients diagnosed with HIV or other chronic diseases face significant challenges accessing their medications in South Africa. Congested public clinics, long waiting times, and stock outs are common. Many patients take days off work to get their medications in crowded clinics — sometimes to find the medicines aren’t even available.

Project Last Mile — a partnership applying The Coca-Cola Company’s supply-chain expertise to public health systems across Africa — works with the CCMDD to expand the availability of medicine across South Africa. Project Last Mile collaborates with the government and local non-profit organizations to create convenient pick-up-points for medicines in grocery stores, post offices, and other community locations.

Though restructuring wasn’t easy, what I saw in South Africa was impactful. I visited public pharmacies starting to receive shipments of the new, neatly packaged individual parcels of medicine. Through the use of mapping tools and strategic thinking, more accessible pick-up points were identified based on patient demand — a very exciting outcome for the resident pharmacists. There was a pervasive optimism about the program — one pharmacist remarked that the CCMDD was a transformation of the pharmaceutical industry.

The program still faces implementation challenges, but I believe that the emerging health system in South Africa is stronger. The nation’s openness to change makes me hopeful for meaningful improvement on patients’ abilities to lead healthier lives.


Originally published by Medha Vyavahare (YSPH ’17), GHLI Intern.