The second edition of the Ritshidze Mpumalanga “State of Health” report was released in Nelspruit on 23 June 2022 with some steps forward, but continued glaring failures in service delivery.
The 2022 report for the province marks one full year of data collection and analysis for Ritshidze since the 1st edition of the report. The benefits of consistent tracking, continued efforts to build the Ritshidze presence in communities and having parameters for comparison are paying off. There is improved data collection and with it clearer pictures of on-the-ground challenges and budding hope for strategies for improvements.
In this reporting period, data was collected over the two months of April and May 2022. It included observations and monitoring at 42 facilities; interviews with 42 Facility Managers and 1,833 public healthcare users. Of these, 61% identified as people living with HIV.
There have been some notable positives for the province. One has been improvements in the number of people living with HIV being on 3-6 month ART refills. This year 49% of people living with HIV were getting 3-6 month supply compared to 41% of people reported last year. Longer ARV refills help to relieve congestion in clinics. It also saves people living with HIV’s time and makes it easier for them to stay on treatment. However, the data shows that more than 50% of people living with HIV still receive less than 2 months or less supply.
Also worrying, as outlined in the report, is that 17% of people living with HIV reported getting one month or less supply, with 10% reporting just two weeks supply. Amsterdam CHC, Mkhondo Town Clinic, Piet Retief Clinic, Ethandakukhanya Clinic alone accounted for 107 reports of people living with HIV receiving two weeks’ supply of ARVs between April and May 2022. The report also stresses the need to make more external pick-up points available, stating: “More people should be decanted to these options, especially given that 53% of respondents still said they would prefer to collect ARVs closer to home.”
There was also a call at the community meeting for adherence clubs in the province to be restarted and properly run. Many adherence clubs fell by the wayside over the past two years of COVID-19 lockdown restrictions but the group support of clubs is essential to help people more easily keep taking treatment.
Last year, the Mpumalanga Department of Health committed to train healthcare workers on new adherence guidelines and to improve its messaging to healthcare workers to be consistent in their counselling of people living with HIV. The impact can be seen in certain improvements in the understanding among people living with HIV of their treatment. The report states that 74% of people living with HIV understood the “undetectable = untransmittable” message, up from 62% last year.
There were also small but positive shifts in terms of being able to reduce overall clinic waiting times by about half an hour to four hours — still unacceptably high, but moving in the right direction downwards.
Reported staff shortages also saw some improvement in the province. Last year only 7% of Facility Managers reported that there were enough clinical and non-clinical staff to meet demand. This year this 41% of Facility Managers in the same reporting period this year said they had enough staff. Of the facilities with data in both reporting periods, 38% of facilities have improved across the time period. The improvement though still comes off a base of glaring staffing gaps and the still massive vacancy gap that the remaining nearly 60% of Facility Managers complain of.
It’s still staff attitudes and a culture of bullying from nurses that rank as a key problem in the province. Two public healthcare users who spoke during the community meeting talked about their distressing engagements with staff.
One woman described how she arrived at the Buffelspruit Clinic and found three nurses in one consulting room. She said, speaking through a translator: “My issue was very confidential so I requested for one nurse to see me. But they told me I had too much pride and rejected my request and they refused to help me. I felt so bad I had to leave to go to a different facility in Schoemansdal.”
“I tested HIV positive there and I was so scared that I would have to go back to Buffelspruit Clinic to pick up my medicines that I now have to pay extra transport money to go to Schoemansdal instead,” she said.
A man who also told his story at the meeting said he used the Khumbula Clinic close to his home because of an STI he had. Though he was in the queue at around 7am, he only got to the front of the queue three hours later at 10am.
“When I got to the consulting room the nurse just left the room; she walked past me and only came back 30 minutes later. I waited inside the consulting room and when she got back she started shouting and asking me ‘why are you in here’.
“When I told her I had an STI she started shouting at me again for not using a condom,” he said.
The nurse also asked about his employment status. He was working at that time, which led the nurse to say they didn’t have the medicines needed to treat his STI and because he had a job he should buy the medicines himself. He also asked for a sick note for his employer but the nurse wouldn’t help him. It led to an argument and the man said he left the clinic without being helped because of the unprofessional attitude he had to suffer.
In chairing this second Mpumalanga community meeting, Treatment Action Campaign (TAC) General Secretary Anele Yawa said that leadership in the province, district and at facilities need to take decisive action and “consequence management” against staff who have become stumbling blocks to ensuring quality healthcare.
“Anyone who is denying the right to healthcare is violating the constitutional rights of every citizen, and everyone who lives in South Africa.”
“We know that when we have nurses who are just disclosing people’s HIV status or violating public healthcare users’ rights, especially those in the LGBTQIA+ community, that they are adding to the high number of people disengaging from treatment,” he said.
Yawa added that at the release of the second Mpumalanga State of Health report had to signal greater urgency by leadership to make good on promises and empty speeches. Also that it’s high time leadership stop ignoring the plight of the poor and vulnerable who can’t access quality healthcare as a basic human right.
“We are tired of marching, of picketing and fighting that does not yield positive results in improving the quality of services. As black people we have been colonised, the majority of us are unable to have medical aid in order to buy quality health services.
“Our political leaders can stop using their medical aid and start queuing with us, so they can feel what we go through on a daily basis,” he said.