Scaling Differentiated Service Delivery for an Aging Population: Insights from the Central Chronic Medicines Dispensing and Distribution Programme in South Africa
1
National Department of Health, Pretoria, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1794
ABSTRACT
INTRODUCTION:
South Africa’s Central Chronic Medicines Dispensing and Distribution (CCMDD) programme was launched to decongest public health facilities and improve access to chronic medication. Initially focused on stable patients on antiretroviral therapy (ART), the programme has rapidly expanded to include non-communicable diseases (NCDs). With a growing number of older adults and patients with comorbid conditions now accessing medicines through community-based pick-up points, this model offers critical lessons in health systems resilience and patient retention amidst workforce and infrastructure constraints.
METHODS:
We analyzed national CCMDD programme data generated in November 2025 to assess scale and demographic shifts. The analysis focused on patient enrolment, age disaggregation, collection trends, pick-up point utilization, and indication uptake. Descriptive statistics were used to compare patient volumes by age band and the proportional distribution across ART and NCD indications. Additionally, stakeholder feedback from national coordination meetings was synthesized to contextualize operational successes and challenges in scaling the model.
RESULTS:
The programme currently supports over 3.6 million active patients. Notably, nearly 850000 participants are aged 60 years and older, demonstrating significant uptake among older adults with chronic conditions. While ART remains the primary indication, non-ART conditions now account for 23% of enrolments, indicating successful NCD integration. Over 76% of patients collect their medicines from external pick-up points, reinforcing the success of decentralization. Programmatic data indicates higher retention rates among participants compared to traditional facility-based models, attributed to the convenience and reliability of the distribution network.
CONCLUSIONS:
The CCMDD programme represents a scalable and sustainable model for chronic medicine delivery in low-resource settings, particularly in the context of aging populations and a rising NCD burden. As the programme evolves, it provides a blueprint for expanding decentralized care to a broader range of conditions. Lessons from this expansion can inform global strategies for strengthening health systems and improving patient-centred outcomes.
South Africa’s Central Chronic Medicines Dispensing and Distribution (CCMDD) programme was launched to decongest public health facilities and improve access to chronic medication. Initially focused on stable patients on antiretroviral therapy (ART), the programme has rapidly expanded to include non-communicable diseases (NCDs). With a growing number of older adults and patients with comorbid conditions now accessing medicines through community-based pick-up points, this model offers critical lessons in health systems resilience and patient retention amidst workforce and infrastructure constraints.
METHODS:
We analyzed national CCMDD programme data generated in November 2025 to assess scale and demographic shifts. The analysis focused on patient enrolment, age disaggregation, collection trends, pick-up point utilization, and indication uptake. Descriptive statistics were used to compare patient volumes by age band and the proportional distribution across ART and NCD indications. Additionally, stakeholder feedback from national coordination meetings was synthesized to contextualize operational successes and challenges in scaling the model.
RESULTS:
The programme currently supports over 3.6 million active patients. Notably, nearly 850000 participants are aged 60 years and older, demonstrating significant uptake among older adults with chronic conditions. While ART remains the primary indication, non-ART conditions now account for 23% of enrolments, indicating successful NCD integration. Over 76% of patients collect their medicines from external pick-up points, reinforcing the success of decentralization. Programmatic data indicates higher retention rates among participants compared to traditional facility-based models, attributed to the convenience and reliability of the distribution network.
CONCLUSIONS:
The CCMDD programme represents a scalable and sustainable model for chronic medicine delivery in low-resource settings, particularly in the context of aging populations and a rising NCD burden. As the programme evolves, it provides a blueprint for expanding decentralized care to a broader range of conditions. Lessons from this expansion can inform global strategies for strengthening health systems and improving patient-centred outcomes.
| eISSN: | 2654-1459 |
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