4th edition Ritshidze report reveals long clinic waits & too few people getting longer ARV refills in North West

  • 4th edition of State of Health report compares data over the last four years of community-led monitoring in the North West
  • The data, together with stories from people living with HIV, members of key populations and other public healthcare users, will be presented at a community meetings in Mafikeng 
  • The meetings will be live streamed on vimeo, facebook and YouTube.

Mafikeng, 11 July 2024“You will be at the clinic as early as 7am, but they will attend to you around 11am to 12pm. You will leave late around 2pm starving… I always tell them that I am not coming back to the clinic because we spend too much time.”

Waiting all day at the clinic remains an exhausting and frustrating reality for people in the North West. While waiting times have decreased — down to an average of 3:40 hours waiting after the facility opens — the average waiting time remains over 3 hours at 53 facilities monitored, over 4 hours at 32 of those, and over 5 hours at 8 of those. “Just imagine coming early around 5am then being assisted around 2pm,” one person exclaimed to us.

Compared to other provinces monitored by Ritshidze, the North West continues to have very long waiting times (second only to the Free State). This is a major source of dissatisfaction and 76% of public healthcare users interviewed complained about long waiting times. 

One reason for the long waits is the knock-on effect of the staffing crisis. 69% of people blamed staff shortages for the delays. 88% of facilities reported there were too few clinic staff in place to meet the needs of public healthcare users — with 35% blaming one or more unfilled vacancies and 30% saying there are not enough positions. 

In addition to too few staff in place, 35% of the people blamed staff not working or working slowly for the hold up. One person told us: “They do not work. They go up and down while we sit looking at them. If you come early around 7am, you will only be done at 12pm.”

Long waiting times are among ten key issues outlined in the fourth edition of a new Ritshidze State of Health report in the North West. The report will be launched at a community meeting in Mafikeng today.

One simple solution to reduce waiting times is to give people longer supplies of ARVs. That way they will come back to the clinic less often. This is recommended in National ART Guidelines, however implementation is deeply varied across districts. While positively 97% of people living with HIV interviewed in Bojanala reported getting a 3 month supply of ARVs — only 37% of people in Dr Kenneth Kaunda did.

“In February I missed an appointment date — my first time ever — and they didn’t want to understand or let me explain, they just put me back to one month,” one person living with HIV from Dr Kenneth Kaunda explained. “I am not happy; this was a first time mistake. Going to the clinic isn’t easy; I wake up early to walk there and to be there by 7am. And then I will only leave around 4pm.”

Not only would a longer ARV supply mean fewer trips back to the clinic — making medicine collection easier for people living with HIV — but it would also reduce the burden on congested and overstretched facilities.

Another strategy to reduce waiting times is to allow people living with HIV to collect their treatment at pick-up points or adherence clubs, either at the facility or externally in the community. However, 33% of people living with HIV said they had never even been offered one of these options — and 51% still wish they could collect their ARVs closer to home. 

Of those using facility pick-up points, 51% told us that they must still collect files, take vitals, and see a clinician before getting their parcel — making clinic visits drag on longer than they need to. National ART Guidelines emphasise that a facility pick-up point should be an ART refill only collection, in under 30 minutes. There should be no requirement to go anywhere, except to collect your pills.

In other findings, only 42% of people interviewed thought that the staff were always friendly — having worsened since we began monitoring five years ago. Once on treatment, it is important to recognise that people living with HIV live dynamic lives, may miss appointments, and may even miss taking some pills. However, often when people return to the clinic they are treated badly. 

Only 58% of people said that staff were welcoming. For one community member we spoke to, it feels like one “mistake” of missing an appointment date has wiped out all the careful treatment adherence she has worked on and because of this she’s now being punished by her clinic and made to go back to a monthly refill.

Only 9% of people said staff asked how they can make ARV collection easier if they miss or are late for appointments — only 6% were offered a longer supply of ARVs and only 8% were told about external pick-up points closer to home. Yet a differentiated service approach is required for people living with HIV who re-engage in care. Some will require intensive clinical management or psychosocial support, but the majority need it to be made easier to collect treatment.

Poverty can also make it hard to stay on treatment. “When you take the medication on an empty stomach it gives you cramps and when you walk you fall. That is why sometimes I default… I don’t have an income… When you explain that it is difficult to take the medication they tell you to kill yourself,” one person living with HIV explained to us.

Another person told us: “I don’t take my ARVs every day due to my situation. I am not working… I don’t skip a month just two days due to not having food as the medicines are strong. They need you to eat. They said there’s nothing they can do at the clinic.” Food parcels are a key component of psychosocial support, yet only 11% of people report being able to access them. 

The report also looks into stockouts — an issue that has plagued the North West for several years. This year there were 148 reports of shortages or stockouts of different medicines, contraceptives, vaccines, and dry stock across 63 facilities. While fewer reports than previous years, the province remains one of the worst culprits among those monitored by Ritshidze. 

“It can happen that I go there to pick up my contraceptives and I will get to the front of the queue and they will tell me that they don’t have my pills and I must come back the following week. Waiting for medication for a whole week is too long,” one community member told us. There remains a way to go to improve stock management and ensure people are not sent home empty handed without the medicines they need.

Overall, these failings in the health system contribute to slow progress towards getting everyone to start and stay on HIV treatment. This year’s report continues to call for urgent action and reform. In the words of one community member: “Can they please assist us? I am pleading with them.”

For more information or to arrange interviews contact:

Ngqabutho Mpofu | +27 72 225 9675 | ngqabutho.mpofu@tac.org.za 

Lotti Rutter | +27 82 065 5842 | lotti@healthgap.org

Note to editors:

This is the fourth edition of the North West State of Health report; the first was published in June 2021, the second in July 2022 and the third in July 2023.

Today, Ritshidze is providing a platform for community members to raise their concerns directly to the North West health department, the Bojanala Platinum, Dr Kenneth Kaunda, and Ngaka Modiri Molema health departments, the national health department, and PEPFAR partner working in the province, The Aurum Institute. Duty bearers are afforded the right to respond. 

To follow proceedings virtually please join at: 

Vimeo | YouTube | facebook

The full North West State of Health report is available here

The full North West presentation is available here

A summary report is available here

A summary of recommendations is available here

About the report: 

The report has been developed using data from Ritshidze — a community-led monitoring system developed by organisations representing people living with HIV, including the Treatment Action Campaign (TAC), the National Association of People Living with HIV (NAPWA), Positive Action Campaign, Positive Women’s Network (PWN), and the South African Network of Religious Leaders Living with and affected by HIV/AIDS (SANERELA+). 

Ritshidze monitoring takes place on a quarterly basis at more than 400 clinics and community healthcare centres across 29 districts in 8 provinces in South Africa — including 32 facilities across North West: 10 in Bojanala Platinum, 14 in Dr Kenneth Kaunda, and 8 in Ngaka Modiri Molema. Additional once off data was collected during this data period in a further 40 facilities: 15 in Bojanala Platinum, 14 in Dr Kenneth Kaunda, and 11 in Ngaka Modiri Molema. Ritshidze collects data through observations, as well as through interviews with healthcare users and healthcare providers. All monitoring tools are available here: https://ritshidze.org.za/category/tools/ 

Data in this report were collected between April 2024 and May 2024 (Q3 2024).

  • 72 facilities were assessed
  • Interviews took place with 66 Facility Managers
  • Observations took place at 67 facilities 
  • Interviews took place with 3,364 public healthcare users
    • 48% (1,623) identified as people living with HIV
    • 16% (538) identified as young people under 25 years of age

Additional quantitative and qualitative data were collected within the community specific to the quality and friendliness of health services provided for people who use drugs, sex workers, and the LGBTQIA+ community. Data collection took place between July and September 2023 across three districts: Bojanala Platinum, Dr Kenneth Kaunda, and Ngaka Modiri Molema. A total of 1,579 surveys were taken, combining 377 gay, bisexual, and other men who have sex with men (GBMSM), 576 people who use drugs, 376 sex workers, and 250 trans people.

Follow Ritshidze on twitter, facebook and instagram for regular updates or go to www.ritshidze.org.za for more information.


“Ritshidze” — meaning “Saving Our Lives” in TshiVenda — has been developed by people living with HIV and activists to hold the South African government and aid agencies accountable to improve overall HIV and TB service delivery.

Partner organisations include the Treatment Action Campaign (TAC), the National Association of People Living with HIV (NAPWA), Positive Action Campaign, Positive Women’s Network (PWN) and the South African Network of Religious Leaders Living with and affected by HIV/AIDS (SANERELA+)—in alliance with Health Global Access Project (Health GAP), the Foundation for AIDS Research (amfAR), and Georgetown University’s O’Neill Institute for National and Global Health Law.

CLICK HERE to read more and see where we work.