C Botha
Student number: 112586

Assignment 5a
Due date: 19/11/2013

ASSIGNMENT 3

SECTION 1: RESEARCH PROPOSAL

TITLE
Courier pharmacy in South Africa, a study into the viability of courier pharmacies in the South African market.
KEYWORDS

South Africa, Courier pharmacy, South African pharmacy act 1974, Good pharmacy practice, Post office strikes, Road fright strikes, Cold chain management, Retail pharmacies, Medicine.

ASSIGNMENT 4

During the last decade or more the pharmaceutical environment in South Africa has changed dramatically. Laws that governed the ownership of pharmacies was changed making it possible for anybody to own a pharmacy, laws was passed that governed the pricing of medication making medicine more affordable to all the people of South Africa. Pharmacy in South Africa has always been characterised by two distinct legs from which patients could get their medication.
During the last couple of years a new form of pharmacy appeared in South Africa, the courier pharmacy model makes use of courier companies to deliver medication to the patient. With mottos such as “anywhere, any place and any time” and “nowhere is to far” courier pharmacies promises patient that they will deliver their medication to them at the patient’s convenience. Medical aids tend to favour these models because they offer advantages to the schemes that retail and hospital pharmacies are not able to offer. Some of these advantages include reporting on drug usage, prescribing habits of doctors and geographic distribution of members. A further advantage these models offer to the schemes are better control on prices, as most of the medication delivered by the courier pharmacies are the more expensive chronic , HIV and transplant medication price control are very important to the scheme. For this reason medical are now almost exclusively making use of Courier pharmacies to deliver the more expensive and lucrative chronic medication.

A clear indication of the popularity of these pharmacies can be seen in the growth obtained by these pharmacies in the last couple of years. The two largest Courier pharmacies now dispatch a total of 600 000 prescriptions per month between them, most of these prescription being for the more expensive chronic, HIV, transplant and renal medication. Between these two companies they also employ almost 2000 staff members in their branches in Gauteng and Cape Town. In total there are 7 courier pharmacies doing business in South Africa of which the two mentioned are by far the largest. In total the total staff complement of all the courier companies are around 3000 with a total script volume in the region of 675 000 prescriptions. The staff employed does not take into account the staff employed by the courier companies to serve the ever increasing demand put on them by the Courier pharmacies.
As with any expansion of an existing industry the courier pharmacy model has a fair share of challenges and difficulties to overcome. Most of these challenges are set in the legislation that governs the pharmaceutical industry as stipulated in the Pharmacy act 53 of 1974 (Act) and the ethical rules and regulations as stipulated by the South African Pharmacy Council in their publication called “The Good Pharmacy Practice “(GPP). Other challenges faced by the courier pharmacy companies are the South African labour issues especially in the form of road fright and postal strikes. These strikes seem to happen every year and puts enormous strain on all the resources of the courier company for this model to be successful it has to be shown that these companies can continue to deliver medication to the patient without delay or compromising the quality and safety of the product. It is the objective of this paper to look at some of these laws, ethics and regulations to see if the Courier pharmacy model taking into account some inherent shortcomings of the model is able to adhere to these rules and regulations. The paper will investigate some of the more important stipulations of the Act and GPP to see if the Courier companies are currently compliant to the Act and GPP and if not what can be done if anything to ensure compliance. The aspects of the act and GPP that will be looked at in more detail are the flowing:
• Patient confidentiality especially in the case of HIV medication but also normal chronic medication. Patient confidentiality means that only the patient and those people he nominates are allowed to know that he/she is on medication. The pharmacy or any staff member are not allowed to divulge the fact that a patient is on medication to just anybody. This is a real problem for a courier pharmacy as the majority of all patient communication is done over the telephone and conformation of a person’s ID is difficult to verify.
• Maintaining of the cold chain, this relates to both Diabetic medication that has to be stored and transported between 5 and 8 degrees and other medication that cannot be stored at temperatures higher than 25 degrees. Maintaining the cold chain becomes difficult for the courier pharmacy to control and guarantee as soon as the courier takes control of the parcel. A large number of courier companies makes use of 3rd party drivers for remote areas which makes control for the courier company even more difficult
• The need for the pharmacy to have in its possession a valid original prescription for medication dispensed to patient. GPP dictates that any pharmacy must have the original prescription in its possession 7 work days after dispensing the medication. This is not a problem for a retail pharmacy as the patient normally walks in to collect his/her medication. It is however a very big challenge for the courier company to a hold of that the original prescription
• The requirement

The motivation for this study is to find out if the courier pharmacy model in its current shape is a viable option in the South African context considering the Act and GPP. It is clear to see that the courier pharmacy model is growing in popularity with medical aids and to some extend with certain segments of the population. It currently employs around 3000 staff excluding those employed by the courier companies. As a job creator the courier model has huge potential, as a money saver for medical aids and patients the potential is even bigger. A further objective of this paper is to see what effect the courier model has had on the existence and profitability of the retail pharmacy. As mentioned earlier in the this paper the business taken away from the retail pharmacies by the courier pharmacies are the expensive and lucrative medication.

3.2 Research questions
• What are the obstacles faced by Courier pharmacies in South Africa taking into account the Act, GPP and the socio economic issues in South Africa?
• What steps are the leading courier companies taking to overcome these issues?

A.3 Expected contribution of the study
I believe that this study will give some insight into the short comings if any of the courier pharmacy model. This study will also help to better understand what is needed by these companies to continue doing business while ensuring that all aspects off the pharmacy act and GPP are complied with. It will also show what effect a strike in either the postal or fright industries might have on the capability of these companies to deliver medication to patients as prescribed by the act and GPP, but will also try and show what possible steps these companies can take to ensure that medication is delivered in good condition.

4 RESEARCH OBJECTIVES
4.1 General objective
The general objective of this study is to better understand the general operations of a Courier Pharmacy as seen in a South African context. To dissect the legal, social-economic and political influences that will have an effect on the effective operation of a courier pharmacy.
4.2 Specific objectives
The specific objectives of this study are;
• To use the Pharmacy act 53 of 1974 and the GPP of South Africa to evaluate the operational effectiveness of courier pharmacies
• To determine the effect of strikes in the postal and fright industries on the operational effectiveness of courier pharmacies.

B. RESEARCH HYPOTHESES
The expectancy is that this study will prove that courier pharmacies as they operate in South Africa today does not conform to the requirements of the South African Pharmacy Act 53 of 1974 nor do their operations conform to the stipulations of the South African Good Pharmacy Practice, this study will further show that strikes in the postal and fright industries makes it impossible for a courier company to ensure adherence to all the requirements of the Act and GPP.
The conceptual model for this study can best be depicted by the following. The study will focus on the ability of the courier pharmacies to deliver medication to patients in accordance with the Act and GPP. It will look at all the aspects that will influence this delivery process from the moment the medication is handed over to the courier company to the moment it is delivered by the courier company to the patient.

SECT
ION 2: QUALITY CIRCLE SESSION 1: GETTING STARTED
Assignment 5a
6. Research design
6.1 Research approach.
The study will follow a quantitative approach to the research. The reasons for using this method is because we want to measure the differences if any between what is prescribed by the Pharmacy act of 1974 and the GPP of South Africa pertaining to the safe delivery and storage of medication and what is currently being done by Courier Companies across South Africa. According to Weare et al (1995:18) when analysing quantitative data you are looking for relationships or differences between variables.
The Pharmacy act of 1974 has very clear and specific instructions for the storage, shipping and delivery of medication in South Africa. The aim of this study is to find out if the Courier companies are adhering to these stipulations in the day to day running of their business. The Study will also follow the lines of a longitudinal series study.
The research will include interviews with the CEO of the two most prominent Courier pharmacies in South Africa. An interview with the COO of Dawn Wing Couriers – the courier company used by Medipost to deliver up to 85% of their parcels and the COO of GEMS medical aid. Gems is currently the largest closed medical aid in South Africa and the first medical aid to see the advantages in making use of Courier pharmacies. An interview with the Head of Law and ethics at the South African Pharmacy board. Closed questionnaires will also be given to patients of these two companies in an attempt to find out how patients are experiencing the delivery of their medication and to find out what issues if any the patients have with the delivery of their medication.
This study will follow the line of Grounded theory research as most of the people that will be interviewed have extensive experience in their respective fields and the theory developed by this study will help explain the processes involved in the delivery of medication so much better.

6.2 Research method
6.2.1 Literature review
The sources that will be use will include the following
• The South African pharmacy act of 1974
• The Good Pharmacy Practise of South Africa
• Standard operating procedures – Medipost pharmacy
• Standard operating procedures – Pharmacy Direct
• Proof of delivery documents – Dawn wing couriers
6.2.2 Research participants
The research participants will be the following;
• The main two participants will be the two biggest courier pharmacies currently operating in South Africa
• The South African Pharmaceutical Council
• The South African Pharmaceutical society
• The study population will also include the patients belonging to medical aids that are being forced by Preferred service provider contracts to get their medication from one of the two courier companies mentioned in earlier.
• The sample size can be as big as I want it to be as long as the patient is getting his/her medication via the courier pharmacies
• Closed questionnaires will be send to patients asking questions relating to the delivery of medication, condition of delivered parcel, length of parcel in transit and temperature of parcel on final delivery.
• Members of the retail pharmacist association of South Africa
6.2.3 Measuring instruments
The instruments of measurement will predominantly be the stipulations of the pharmacy act of 1974. The aim of this study is to determine whether or not the courier pharmacies in S.A are adhering to these stipulations. The most important points that are going to be looked at are;
• Maintenance of the cold chain
• Patient confidentiality
• Transport and storage conditions
• Who has the right according to South African law to handle medication outside of the pharmacy
6.2.4 Research procedure
The procedure that will be followed to collect the data will be as follows;
• An interview will be held with the legal representative of the SAPC, with the pharmacy act of 1974 and the GPP.
• Interview with CEO of Medipost pharmacy, with SOP on delivery issues detailed in this study
• Interview with the CEO of Pharmacy Direct, with SOP’s on delivery issues detailed in the study
• Interview with the COO of Dawn Wing Couriers with their SOP’s and proof of delivery paperwork.
• Both CEO’s of Medipost and Pharmacy Direct as has given permission to send questionnaires to their patients. The aim of these questionnaires is to get the opinion of the end users on the conditions of the delivered medication. The answers to the questionnaires will also be used to validate the claims made by the CEO’s of the two companies.

6.2.5 Statistical analysis
The first research questions ask what are faced by the courier companies, to answer this question I would make use of descriptive statistics, frequencies and percentages. The aim would be to collect numerical information and characterize the data for the purpose of presentation. From these data I will then identify the obstacles faced.
6.2.6 Ethical considerations
While doing my research I will make sure to keep the following points as mentioned by Walliman (42-50) in mind
• My individual values relating to honesty and frankness
• The way I treat other people involved in the research especially concerning confidentiality and informed consent
• To be free from any form of bias
• And to never knowingly distort any form of data

Quality circle assignment
1a)
Case study design
b)
This design is an in depth study of a particular research problem, it is often used to narrow down a very broad field of research. It is also a useful design when not much is known about the research
2a)
Quantitative study
b)
This approach looks for first-hand experience to solve the problem, it identifies and isolates specific variables within the study and the data is collected under controlled conditions
c)
Longitudinal. I have chosen this approach because the study will take place a period of time, the time it takes for a parcel of medication to be delivered.
3a)
All parcels delivered by the two most prominent courier pharmacies in South Africa.
b)
Interviews and questionnaires
c)
The sample will be all delivered parcels. It will not be necessary to make the sample any smaller because it will be very easy to get the information required from the two companies involved
4a)
Late delivery - refers to delivery of medication to the patient outside the arranged time or place
Braking the cold chain – refers to any action that leads to the medication being exposed to higher than prescribed temperatures
Breach of confidentiality – refers to any action that allows the medication used by a patient to become public knowledge
b)
I feel that these definitions give the best description of the requirements set forth by the Pharmacy act of 1974. There can however be many more such definitions and should I choose to continue with this study I will use them all.