South African Press Association - April 20, 2004
Jenni Evans

Under the Medicines and Related Substances Act, by May 2 dispensing doctors, nurses and dentists must obtain a dispensing licence from the Department of Health or they will be breaking the law.

However, even though the law came into effect last May, only 10% of the approximately 11 000 dispensing doctors have applied for the licence that will allow them to continue. This is in spite of the department's efforts to speed up the application process in time for the deadline for compliance next month.

More than 5 000 are still completing the distance learning course required for the licence to be issued.

Although permission has been granted for doctors without a licence to dispense emergency medication, the low compliance is a worry for people in remote communities or in areas with few pharmacies who pay a set fee to see a doctor, which includes the cost of their medication.

"Whether the doctors are wrong or not [in not applying or applying late], patients are going to suffer," said Jonathan Berger, a lawyer with the Treatment Action Campaign.

Berger said that the principle of separating prescribing from dispensing is necessary and will address a range of abuses such as prescribing medication that is cheaper but less effective to retain a profit on the consultation, and will cut down on financial incentives offered to doctors by drug companies.

"The danger is if you don't allow doctors to dispense, there is no access to medication," Berger said. "There must be a healthy balance."

He said some people with HIV/Aids prefer to get their medication from their doctor to retain confidentiality.

"These are people who don't want to be in a pharmacy with the pharmacist shouting 'do we have any AZT left' in front of a full shop," Berger said.

It will also affect people paying for medication out of their own pockets as they will now have to budget for the additional cost of getting their medicine from a pharmacy on top of the doctor's consultation fee.

Department of Health spokesperson Sibani Mngadi said the regulations form part of efforts to get quality affordable medication for everyone, and affect the whole industry, from wholesalers to distributors, through a combination of laws.

"Many doctors receive discounted drugs and this influences dispensing choices, which are not purely based on the health of the patient," Mngadi said.

"So now dispensing doctors must meet certain standards of competence and provision of service," Mngadi said.

"[It] will no longer have the substantial gains as before," he said, adding that discounting and incentives will no longer be allowed.

"In an ideal situation people will see a doctor and then go to a pharmacy for their prescription," Mngadi said. "But in South Africa where there is a shortage of pharmacies, dispensing doctors have closed the dispensing gap and government appreciates the outstanding work they have done."

However, Norman Mabasa, spokesperson for the National Convention on Dispensing (NCD), said doctors find the process unnecessary, bureaucratic and expensive.

He believed that a better system would be to check if doctors already dispensing comply, and to introduce dispensing into the curriculum at medical schools.

The doctors also object to being forced to supply information of existing health facilities and pharmacies in the areas they are in and to supply disease patterns, a function they feel belongs to the Department of Health.

They are also concerned that they will lose their investment in their dispensaries if their applications are turned down because there are already enough pharmacies in the area.

Mabasa, who is a dispensing doctor, argued that dispensing doctors provide a valuable service to people who don't want to stand in long queues at state hospitals, even though they have to pay.

"We charge R120 for a consultation and that includes medication worth between R80 and R120," Mabasa said.

"That R120 is hard-earned and people only come here when they are very sick. This includes the elderly who have all the diseases on one person and they are afraid of dying in a queue.

"We don't get paid for the consultation fee and if we did we would have to charge extra. We only make money from the medication. At some clinics people arrive at 4am and the gates are shut at 8am so that the nurses can see them all. People rely on dispensing doctors," he said.

The NCD is putting the finishing touches to an application for an interdict to have the May 2 deadline set aside until the Constitutional Court hears its case.

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