iDART - iDART in Action

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iDART – An easy to use and robust Pharmacy Management System

In collaboration with the  Desmond Tutu HIV Foundation (DTHF) , Cape Peninsula University of Technology and University of Cape Town, iDART ( Intelligent Dispensing for Anti Retroviral Treatment)  was developed as a software solution designed to support the dispensing of ARV drugs in the public health sector.

Since its release, product development has been based on extending the operational functionality of the original system and iDART is currently being used in over 100 District Clinics and over 260 down referral sites. The system deployment has grown to the point where, throughout South Africa, more than 300 000 patients every month are receiving ARV treatment managed via iDART.

Cell-Life has, over the previous 5 years, been able to successfully implement and train users on the iDART system. This, coupled with Evolutionary Prototyping in its development with Pharmacists, Research organisations and M&E specialists, has led us to believe we are able to enhance the Capacity of the current users and also benefit a significant number of new users especially in the under-resourced Public Health facilities. Cell-Life has cultivated extensive partnerships with District, Provincial and National stakeholders as well as Academic Research organisations.

Advantages of the iDART System as opposed to manual dispensing:

  • Significantly improved throughput of Patients at dispensing sites thus reducing waiting time for Patients.
  • More accurate dispensing of Drugs reduces errors and improves call-back rates.
  • More systematic controls of drug supply chain management improves stock ratios and prevents over- and under-stocking of EDL drugs.
  • More controlled stock and dispensing information reduces losses through drug write-offs and theft.
  • Automation of procurement requirements ensures the maximum application of drug/budget ratios to ensure cost effective application of available funds to Essential Drug stocks.
  • Dispensing software allows the maximum effective use of trained personnel leading to improved Health Care Worker satisfaction and capacity building.
  • Improved reporting of drug dispensing information allows for better procurement decision making, drug stock planning and drug supply chain workflows at District Clinic, Regional, Provincial and National levels.

The iDART system can more accurately address the reporting requirements of Government, International Funders, internal clinical data (such as identifying patients who are have not collected their medication for an extended period) and ARV Clinic Management (such as number of patients initiating ARV therapy by date, drug “switches” and retention ratios of patients on treatment).

iDART already interfaces via the Department of Health Tier.Net communications initiative, connects to the Western Cape eKAPA Patient Record System and is integrated with PREHMIS so it includes existing electronic, and thus more accurate, data reporting functionality.

iDART creates clearly identifiable, multi-lingual bar-coded labels for each and every drug and patient package

iDART Quality Assurance Areas:

Drug supply management – Software based drug dispensing, drug stock control and drug re-order statistics will significantly improve the overall management and control of drug supply to all dispensing points.

Reduction of waiting times – Cell-Life research has shown that the installation of the iDART system at dispensing clinics dramatically reduces waiting times for Patients on ARV Treatment.

Even though no formal studies have been conducted in this area, Cell-Life’s experience is that clinic and Health Care Workers’ attitudes and motivation improve significantly after the installation of an automated dispensing system. Feedback from iDART users supports this observation.

Needs Addressed by the iDART Dispensing System:

  • Inadequate dispensing services allow for areas of Patient dissatisfaction because of long waiting periods, incomplete or incorrect dispensing.
  • Dispensing services are a vital component in the overall provision of Primary Health Care, and because of the nature of the service, provide opportunities for error, loss, cost excesses, shrinkage (theft) and misplaced expenditure through inadequate reporting.
  • Manual dispensing is a labour intensive exercise and leads to delays, misapplication of trained persons, Clinic staff dissatisfaction and poor reporting of essential information.
  • Patient delinquency (“dropping out” after starting ARV treatment) ratios are often unmonitored leading to inadequate follow up of Patients and subsequent deterioration of quality in Patient Service Levels.

Qualitative Comments from iDART Users:

Before what I don’t like, we were using the register to enter the patient after hours. And it takes a long time. But since we used this iDART system, everything is easy. Even the receiving of the stock, and the stats. Before we are marking some papers – one by one as the patient comes in, but since we are getting this system, we just enter the patient, and at month end, we just print out the stats of the daily dispensing stats. It’s easy and fast.” – Margaret Kekana (Pharmacy Assistant, Taung Treatment Centre).

Hand written labels are a thing of the past as we have clearly identifiable, multilingual bar coded labels which are created for each and every drug and patient package. We are able to save a large amount of time dispensing as we use a [bar-code] scanner to capture information at the click of a button. Dispensing [using] iDART takes about 15 seconds and generating a monthly usage report is roughly 5 minutes which is a huge convenience as this takes a day when done manually.” – Ntombiyoxolo Mchunu (ART Pharmacist, Africa Centre).

The good thing is, every week the pharmacist assistant gives us a list of patients that didn’t show up in time for their treatment. We don’t even have to check the files anymore.” – Programme Manager, Rural ART site.

I really do appreciate what you have done to make it easier for us to do our duty to the community” – Alan Ah Yui (Pharmacist, Andries Vosloo).

Quantitative Evaluation of iDART System Impact:

In 2009 iDART was installed into 18 sites which were monitored over two and a half years to determine the increase in capacity as a result of the use of the iDART system. Monitoring the growth in the number of patients receiving antiretroviral treatment showed that all the sites increased substantially over the period. The average number of patients in 2009 in the 18 sites was 775. Latest figures available to Cell-Life show that the average is now 2706 – an increase of 249%.

Whilst a portion of this increase can be attributed to capacity enhancing activities by the Government as well as natural growth of the clinics, nonetheless, Cell-Life remains confident that iDART has made, and will continue to make, a significant impact on the Patient capacity and throughput capability of ART Dispensing public health facilities.

Target Groups – Existing iDART Installations:

Potential Beneficiaries:

  • Pharmacies in Public Health Clinics:
  • Basic Pharmacy Management (stock level monitoring, prescriptions, dispensed drugs) and reduced drug losses.
  • Health Care Program monitoring.
  • Health Care Workers.
  • Pharmacists and Clinicians
  • Government & other Donors.
  • Personnel and Staff in Public Health Clinics.

Specific Beneficiaries:

  • ART Patients – 300 000+ Patients at the current 100 iDART Primary sites and approx 260 “down referral” points benefit.
  • Governmental Bodies – District, Provincial and National Departments of Health.

Value Added Elements:

Besides the benefits listed above, some value added elements emerge as worthy of noting due to their overall ability to contribute towards systems strengthening in the relevant installations.

The training at sites which forms part of the installation of the iDART system often includes basic computer training, thus improving IT skills in the relevant clinics. This contributes to capacity building in the Primary Health Care Infrastructure in South Africa.

The cascading effect of improved throughput, better drug stock management, improved reporting and clinic staff motivation has a general positive impact on the DOH perception amongst Patient groups, Clinicians and Health Worker groups.