Over 3.7 million South Africans on monthly chronic medication can now get their medicine faster and closer to home, thanks to a vast network involving government officials, private companies and couriers – some on bicycles.

But cuts to aid for global health will leave a hole in the programme that will be hard to fill.

In the past, these patients, most of whom are living with HIV, would have waited for around four hours at government clinics every month to fetch their medicine.

Many skipped collection dates as they could not manage the long monthly waits and the often costly transport to health facilities.

Meanwhile, pharmacy staff at the government health facilities spent around 70% of their time preparing repeat prescriptions, and there were also significant stock losses in places with poor security.

Almost 10 years ago, the South African government recognised that it needed to develop a more efficient system to get medication to stable patients to stem the defaulter rate and cut congestion in clinics.

South Africa has one of the biggest HIV positive populations in the world – over eight million people – and a growing burden of non-communicable diseases (NCD), particularly hypertension and diabetes.

The government established the Central Chronic Medicines Dispensing and Distribution (CCMDD) programme in 2016 with seed money from the Global Fund. Later, it received support from the US President’s Emergency Plan for AIDS Relief (PEPFAR) and Project Last Mile.

Convenient pick-ups

The key focus of CCMDD – rebranded recently as Dablapmeds (“dablap” is local slang for shortcut) – was to establish convenient pick-up points for patients and improve the dispensing and distribution of chronic medicine.

Merlin Pillay, the national programme manager, says that the programme has “improved access to medicine, allowed more control over supply chains, reduced waiting times and reduced stigma” (for HIV positive patients).

Some 3,76 million patients in eight of the country’s nine provinces are using Dablapmeds, collecting medication from 3,500 facilities. The vast majority of these pick-up points are private facilities – almost 3000 – and most are private pharmacies.

But medical practices and NGOs also pick-up points in places where pharmacies are scarce. Some rural patients get home deliveries, including from couriers on bicycles.

Around 60% of patients using the system are living with HIV, 23% have NCDs, and the remainder have both HIV and an NCD, says Pillay.

Patients usually get three months’ supply of medicine. From April 2026, stable patients in the system for three months will get six months’ supply, which will enable a significant saving to the project.

Less than $5 per patient

The cost per patient to pack, dispense and deliver their medicines is less than $5 per year, while pick-up points get paid around 60 US cents per patient, says Pillay.

The terms of use are strict: if they fail to collect their medicine within seven days, it is returned to the clinic where they were enrolled for the programme, and they will need to go back and start from scratch.

So far, only 5% have defaulted in comparison to at least 15% in the government clinics.

“The system is highly efficient, and enables tight control of medicines,” says Pillay, who was speaking to Health Policy Watch at the Johannesburg headquarters of Pharmacy Direct, the private company that packs and dispenses most of the scripts, which get sent to it from the different health facilities.

Pharmacy Direct’s chief pharmacist, Doreen Nchabaleng, explains that most clinics use handwritten scripts. These are collected by courier from health facilities and delivered to her company’s headquarters, where they are entered into the central database. 

Some 800 Pharmacy Direct staff pack the medicine in the company’s vast storerooms. Controls are strict. All bags are left outside to prevent theft. Each packer’s output is tracked in real-time. Speedy workers can earn up to 30% more if they exceed certain targets.

Around 6,000 scripts are packed every day at the facility, which stores 250 different medicines and up to four months’ supply of each. Two-thirds of the medicine is the most common antiretroviral medicine.

Substantial dangers

But Donald Demana, the Department of Health’s chief director for the Global Fund, says that the funding cuts to global health pose “substantial dangers” to South Africa’s HIV and tuberculosis response.

South Africa appears to be the only African PEPFAR recipient not to have been asked by the US to discuss terms for a new grant for 2026 amid a political row between the two countries.

“The government is mindful of the possibility of a PEPFAR pause and it will take a little while for the Treasury to be able to cover the gap,” said Demana. “Overall, development aid is shrinking and sustainability is difficult amid the reduced budget.”

While the South African government covers the cost of antiretiroviral medicine from its national budget, it has relied on donors like PEPFAR for assistance to reach groups where HIV is flourishing – “key populations” including young women, sex workers, gay men and people who inject drugs.

An estimated 1.1 million people in these groups are living with HIV and are not on treatment, but all community outreach funding for these groups has stopped.

While the Global Fund has committed to assisting all countries based on evidence of their need, US President Donald Trump recently cancelled all development assistance to South Africa. The US remains the largest donor to the Global Fund with its recent pledge of $4.6 billion.