Doctor Educationis / Background: Since 2005 the Chronic Dispensing Unit (CDU) has been part of the Western Cape Government’s strategy to address increasing demand for chronic medication for patients with non-communicable diseases. However, some patients are unable to collect their pre-packed chronic medication parcels from health care facilities on the due date. Recent research reported that some patients utilise collectors or medicine agents to collect their prepacked chronic medication parcels. Currently little is known about this phenomenon of collectors. Aim and Objectives: This study explored the acceptability of collectors of CDU chronic medication parcels to improve access to medicines for patients with non-communicable diseases at Lotus River Community Day Centre (LRCDC). Methodology: An exploratory descriptive qualitative study using semi-structured interviews in English and Afrikaans was conducted with six purposively selected collectors, three patients who use collectors and three key informants who have intimate knowledge of the collectors and system at the health facility. Interviews were recorded, transcribed, translated into English (where applicable) and thematically coded to derive themes from the data. Ethical approval was provided by the University of the Western Cape Bio-Medical Research Ethics Committee and informed consent was obtained from all study participants. Results: Patients reported that their collectors exhibited positive characteristics such as trust, patience and reliability, as well as, a passion for helping the community and organisational skills. All patients acknowledged the benefits of utilising a collector and found them to be highly acceptable. Key informants, however, had some reservations about the characteristics of collectors and their role in medication distribution and were sceptical as to whether collectors were suitably equipped to perform this function. Patients were grateful when their collector had some knowledge about their condition and were able to converse with them regarding their medication. Key informants suggested that with sufficient training and skills development, collectors could potentially improve access to chronic medication parcels and impart basic knowledge about chronic medication adherence to patients. iv Conclusion: The collector system that has emerged at LRCDC is highly acceptable to patients, but health facility staff were more measured in their assessments. Health facility staff, however, acknowledged the potential of collectors to improve access to chronic medication parcels for patients with chronic conditions and the benefit of upskilling collectors to perform this function. Recommendations: As a short-term measure, collectors should be formally accepted at facilities as medicine agents. They should receive basic education about safe medication distribution practices. Patients should screen collectors to ensure that they have the desired positive attributes. Furthermore, future research is necessary to comprehensively understand the current scope of practice of collectors within communities

Magister Public Health - MPH / Background: Optimal management of Type 2 diabetes requires that patients have a convenient method of collecting chronic medication. In the Western Cape Province, Type 2 diabetes patients can collect chronic medication from primary health care facilities including community health centres. The Chronic Dispensing Unit (CDU) was established to facilitate the dispensing of chronic medication by making medication collection more convenient for patients and was expected to improve medication collection. However, it has been observed that some Type 2 diabetes patients fail to collect pre-packed CDU parcels on the prescribed date and time which could result in poor treatment outcomes and secondary complications. This study therefore aims to explore the factors that influence collection of CDU chronic medication parcels by Type 2 diabetes patients from the Elsies River Community Health Centre (CHC), a primary health care facility in the Western Cape Province. Methodology: An exploratory qualitative research design was used to explore the personal-, social-, health system-related factors that affect collection of pre-packed CDU parcels. Semistructured interviews were conducted in English or Afrikaans with 18 purposefully selected Type 2 diabetes patients who are registered to collect pre-packed CDU parcels from the Elsies River CHC, and three key-informants from the Elsies River CHC. Data was recorded using a digital recorder. Interviews were transcribed and analysed using inductive content analysis. Results: The main factors that facilitate collection of pre-packed CDU parcels were support from family and social support. On the other hand, social factors that were reported as barriers to collection were the safety of the patients and collectors failing to collect on behalf of the patient. Patients' recognition of the value of their treatment and value of the service were the main personal factors which facilitated collection. Personal factors that were reported as a barrier to collection included forgetfulness, laziness and tiredness. Other personal factors that were reported by participants as barriers to collection were illness, transport problems, financial constraints and anticipating non-collection. Health service related factors reported as facilitating factors were reduced waiting time and mistrust of the off-site collection system. In addition, participation in the diabetes chronic club and pharmacy support were also reported as facilitating factors. Negative staff attitude and a limited collection time for pre-packed CDU parcels were reported as barriers to collection by Conclusion: Various personal-, social and health service related factors affect the collection of pre-packed CDU parcels by Type 2 diabetes patients from the Elsies River CHC. To improve collection among patients who fail to collect on their appointment date, the factors that have been found to facilitate collection should be extended to more patients. Recommendations: It is recommended that patients surround themselves with support structures including family, friends and community organisations to assist and motivate them in displaying adherent behaviour. Patients who make use of independent collectors should ensure that these individuals are reliable to avoid an undersupply of medication. Counselling and health promotion should be provided to patients by health service staff as a means of encouragement and empowerment. The diabetes club which serves as a source of information and support should be accessed by more patients. Open communications channels between health service staff and patients should be constructed to ensure that staff are aware of the barriers patients face.