Average dispensary waiting time was a patient care indicator that had not previously been suggested by WHO but that was considered to be interesting and relevant to our study of dispensary practices. Waiting times were defined as beginning the moment the patient left his/her card at the dispensary and ending when the dispensing of drugs began. Many patients would not leave their card if there was no one in the dispensary, or waited until the pharmacist personally took the card. Therefore, waiting times may actually be longer than recorded. Notably, the amount of time a patient waited for a drug was not affected by the number of outpatients seen at the clinic or the number of drugs in a drug package. In fact, busier clinics (excluding the hospitals) tended to have shorter waiting times. The only factor found to significantly affect wait times was off-site supervision. Facilities that received some off-site supervision had shorter waiting times. This is perhaps because off-site supervisors are able to objectively observe the dispensary and how it functions and hopefully provide useful insight into problems. The dispensary staff, because of their proximity to the situation, may not be able to see where problems exist.
A factor that may have contributed to shorter waiting times, especially in some of the busier facilities, was the pre-packaging of commonly prescribed drugs, such as regimens of chloroquine: quinine, paracetamol, etc. However, hospitals and busy clinics, such as MBH and Mutengene, which had significantly longer waiting times, did not appear to pre-package their drugs.
The patient care indicator "average dispensing time" presumably corresponds to the time that the dispenser spends explaining to the patient the drug regimen, side-effects, precautions and other important information regarding the drug. Consequently, a longer dispensing time corresponds to a better explanation. Of the variables studied, only secondary education correlated significantly with dispensing times. It is important to note that secondary education was the highest level attained by any CBC dispenser. Facilities where two-thirds or more of the dispensers had a secondary level education had longer dispensing times.
Another explanation offered for the variation in dispensing times between clinics, not examined in the study, is the problem of language. In clinics where patients come from a wide catchment area, or where many different languages are spoken, it may be more difficult for the patient and the dispenser to communicate. Those dispensers with a secondary level education may have an advantage as they will have studied more English and, more importantly, French. An alternative explanation is that when a language barrier exists, dispensers may take less time to explain. For example, BBH has one of the shortest dispensing times. At BBH, only 20% of the staff have a secondary level education, while BBH patients are a diverse group of people speaking many languages not common to the NSO area. Whether the short dispensing time is due to the lower level of formal education among the dispensers or the language barriers posed by the diversity of the patients is unclear. Maybe more important to note is that a longer dispensing time did not significantly correlate with increased patient knowledge.
Similar to consulting and waiting times, neither the number of patients seen by the facility per day, number of dispensing personnel, nor the number of drugs per prescription affected dispensing times.