An estimated 85% of people living in South Africa are reliant on public healthcare in the country. It means when the service under-delivers it compromises the health and wellbeing of millions.
Understanding the impact of failures as well as their root causes gives a clearer picture of why some primary healthcare clinics are currently not able to do better. It makes hearing the experiences of patients a critical element in gathering insight into what is needed to improve services.
In September 2020 the Ritshidze Project held a community dialogue event in Daveyton to hear from patients themselves. This came as Ritshidze community monitors were increasingly hearing from patients about their challenges with medicine stockouts, being repeatedly given ‘short-scripts’, and not being communicated with about their medicines and treatments.
As the dialogue progressed it became clear that at Daveyton East clinic, stockouts are just one challenge faced by patients. As people spoke, it highlighted multiple failings as well as long-standing and deep structural issues that now affect stock and supply management, general administration and patient care and communication. It was also clear that there has been a creep in how bureaucratic authority has become bullying and how a slip in professionalism and commitment to serving patients better has become organisational norm.
The Ritshidze dialogue sessions’ key aims are to allow community members to voice these concerns and grievances. It’s also an opportunity to give information and tools to patients so they know their rights and responsibilities to become more empowered patients. There is power in getting patients to hear from each other and through this to recognise that they are not alone. And ultimately, providing this platform for public participation gives patients the space to offer possible solutions to the clinic-specific problems they understand best.
Here Rebecca Tshawe tells of her experiences at Daveyton East Clinic:
Standing and walking have become extremely painful for Rebecca Tshawe. The burden of HIV on the 57-year-old has left her frightfully thin and her joints ache. It slows her down and means she can’t move easily.
She manages a smile though as she’s helped to a bench to sit down to chat after a Ritshidze community dialogue session in Daveyton that was held this spring. She’s made the trip to the meeting because she says she wants to tell of her experiences at the Daveyton East Clinic. Problems are too many, she says and she’s hoping that dialogue and feedback can transform into solutions and change.
She talks while Ritshidze District Organiser Nontomi Lekoane translates. She tells that she was diagnosed as HIV positive in 2009. She’s been stable and she says there are no problems with the treatment. But her body is frail and she says “it’s very difficult because I am tired and my body is sore.”
Tshawe lives in Mayfield but uses the Daveyton East clinic. It’s a journey that takes two taxi rides. Each time she has to pay R88 for a return trip. Lately, because her pain have worsened she has tried to get someone to fetch her filled scripts for her. When she has to be present for a blood test or check-up she has to call a private taxi because it hurts too much to walk to and from the pick-up and drop-off points for regular Combi taxis. This costs her R140 for each of these round trips.
Tshawe as a stable long-term patient is supposed to be receiving a three-month script for her ARVs, but this hasn’t been happening.
“In July when I came to the clinic they gave me for one month, but when they wrote in my file they wrote it was three months,” says Tshawe.
“We have to sit outside for long time and you spend the whole day there waiting,” she says of a typical clinic visit.
She tells Lekoane that the long queues are because there’s always an issue of patient files that can’t be located. There doesn’t seem to be proper system in place locating file and managing patient flow.
“They don’t take care of the files, and when they can’t find your file then every time they just make a new one. There are many people there at the reception area but I don’t know what some of them are doing,” she says.
Tshawe says she hopes dialogue means the people will be heard. For her better mobile clinic services close to her home would help or improving the system of home visits by community health workers. She says this then shrugs and shifts on the bench — her comments remains wishful thinking.