The minister of health, Selibe Mochoboroane, recently noted that Lesotho is making significant strides in improving access to quality healthcare.
He also indicated that the country is among those leading in working towards achieving the United Nations’ Sustainable Development Goal of universal health coverage, through initiatives such as BonoloMeds. Mochoboroane says the United States Agency for International Development (USAID) funded project highlights government‘s commitment to ensures that all citizens have access to the medication they need, saving patients time and money regardless of their socio-economic status.
theReporter’s Neo Kolane sat down with BonoloMeds programme communications manager, Tṥelisehang Motuba, to get more insights into the initiative.
What inspired the establishment of BonoloMeds, and how does it specifically address the needs of patients with chronic conditions?
The idea to come up with BonoloMeds was inspired by the emergence of the COVID-19. The pandemic called for social distancing and people were restricted from going to congested places like health facilities. We had to devise ways of decentralising services so that patients can just go and pick up their medication from the nearest point.
We held meetings with the ministry of health to deliberate the concept, before signing a memorandum of understanding (MoU) with (USAID) for funding. The project is referred to as the Decentralised Drug Distribution Model.
Most patients with chronic conditions are healthy and clinically stable; they have busy lifestyles – your teachers, lawyers, students etc.
Patients with chronic conditions normally go to health facilities for their clinical review, but BonoloMeds model meets them halfway by allowing them to collect their medication at the nearest e-locker or pharmacy, they spend less than five minutes. This leaves them with time to do other things.
The ultimate role of BonoloMeds is for patients with chronic diseases not to default on their treatment.
How does BonoloMeds differ from existing healthcare delivery models in Lesotho?
BonoloMeds is a decentralised drug distribution model, unlike where patients collect their drugs from centralised health facilities. We’re taking medication away from health facilities to where people can easily access them at places convenient to them.
Besides decentralising, the programme also takes medicines to pharmacies; our services are free of charge, hence our customers do not incur any additional costs.
Our systems at health facilities are digitalised. When a client registers with BonoloMeds, their names and details are written on a prescription sheet and sent to the central disposing unit where the information is captured. We also refer to it as the distribution point.
Nurses at the clinic will fill in the form, and in two minutes it is scanned and it immediately reflects at the central disposing unit. The dispatching and packaging of medicine is also done electronically.
From central disposing unit, the medication is tracked until it gets to pharmacies where client pick them up. For people collecting their medication from the e-locker, a message is sent to remind them and when the medication gets to the e-locker, three days before the pickup date. A one tip password is sent to them for use, and we also get notified when the medicine is picked up.
What specific chronic conditions does the programme target, and how will it help these patients better manage their health?
Initially, this was an antiretroviral therapy programme for patients with HIV. However, we have expanded the scope of dealing with people living with chronic diseases such as hypertension, and sugar diabetes but those who get their medication orally, not injections.
The priority population are people living with both HIV and sugar diabetes. We also have HIV prevention programmes whereby we offer Pre-exposure prophylaxis to the general population. Vulnerable groups such as young girls and women are also key.
We also have family planning commodities and psychiatric meds.
How does the BonoloMeds system work? Can patients sign up online, or is there an in-person registration process?
We are at health facilities in Maseru, Mafeteng, and Mohale’s Hoek and before the end of the year we’ll be available in Thaba Tseka.
Patients are given health information about BonoloMeds at engaged health facilities. If they are stable and meet the criteria, they consent to joining our programmes.
We do not have online sign-up services because there is need for interaction between the patients and clinician.
What steps are being taken to ensure the security and privacy of patient data in the BonoloMeds system?
We are regulated by the ministry of health. We can be sued if our clients’ information is disclosed, we therefore adhere to patient confidentiality.
There is no way our system can be breached to reveal patients’ sensitive information.
How are medicines dispensed to patients through the BonoloMeds service, and how quickly can they expect to receive their prescriptions?
We have three modalities that patients can choose from – going to an e-locker, a pharmacy, or a health post.
We are still trying to explore other modalities that may be convenient for people living in remote areas. But for now, we are using distribution through e-lockers.
How will the programme ensure equitable access for vulnerable populations, such as those in remote areas or with limited transportation options?
It is free, convenient and fast. We try as much as possible to reduce transport costs for patients by bringing services closer to them.
What metrics or data will be used to evaluate the success of BonoloMeds?
The success can be judged by the number of people being enrolled in the programme. Our numbers keep going up and also the number of people who remain in the programme, which is what we call retention.
Our clients are virally suppressed meaning they are adhering to their medicines; this shows the programme is working.
Our end goal is to empower people so that they get to a point where they take their medication without being pushed. We want them to have self-urgency.
How is the USAID Project involved in supporting the programme, and what role does it play in its ongoing development?
Without the U.S. President’s Emergency Plan for AIDS Relief and USAID funding, the programme would not exist, but remain ideas on paper.
USAID provides funding to make sure that the programme is running. It also provides an oversight to see whether the programme is being run ethically, and monitors its challenges, limitations, and successes. They also provide technical support.
What challenges were encountered during the development and implementation of BonoloMeds, and how were they overcome?
Some of the challenges during implementation were patient-centred. Patients did not understand how the whole model works, so they ended up being frustrated.
Making clients understand the process and model has been a challenge due to its uniqueness and complexity. However, we have made significant strides by having television and radio programmes to educate people.
Another challenge is that we have people who enrol in the programme but do not collect their medication. We’re therefore, working with the Lesotho Network of People Living with HIV and AIDS to address this.
What other plans do you have to educate patients on how to use the BonoloMeds platform or services?
We have a Facebook page where we disseminate information about BonoloMeds. This Facebook page is linked to a WhatsApp number, which allows patients or any other interested individuals to ask for information any time of the day and get response.
We also distribute pamphlets.
We further work with village health workers to teach people about the programme. We have a tollfree number 8002775.
