- People living with HIV not being decanted to pick-up points closer to home is one among a number of challenges outlined in a new Ritshidze State of Health report for Eastern Cape (5th edition). The report looks at the impact of the PEPFAR disruptions in our clinics, following the U.S funding cuts and slow response of the government earlier this year.
When clinic queues stretch beyond two to three hours and files take an hour or more to find, people give up and leave – interrupting treatment and risking harsh treatment and punishment on return. “When you are at the clinic you wait for the longest time. You end up wanting to leave without getting help,’’ explained one person living with HIV.
People living with HIV, like many people in South Africa, are under immense pressure just to survive. They’re hustling to earn money, care for children, and keep households running. Losing half a day at a clinic means losing income and having to neglect other responsibilities that families depend on. Long waits aren’t just frustrating – they drive people out of the system. Every extra hour in a line is another reason to miss a treatment collection, to skip a visit, or to stop coming back.
The Eastern Cape had the second longest waiting times out of the six provinces monitored by Ritshidze – with 48% of people complaining that the waiting times were long. One person told us: “sometimes I don’t even want to go to the clinic because of the long waiting hours.. we arrive early in the morning. Even when it’s still dark, just to queue. And we end up leaving very late. That’s one of the reasons people stop using the clinics”. These queues directly undermine the National Department of Health’s goal to get 1.1 million more people on, or back on, treatment.
One solution that makes it easier for people to collect their pills – while decongesting clinics and reducing waiting times for everyone else still there – is to let people collect ARVs at a place closer to home. However, over the last few years the Eastern Cape has consistently had the fewest people reporting to Ritshidze that they get to use these “external pick-up points”. After the PEPFAR disruptions earlier this year, progress has only deteriorated further.
One person living with HIV who has returned to the clinic described the ease at the pick-up point: “I used to collect my treatment at Clicks, and that system was very helpful. You would get there, press “collect” on the machine, sit down, and then they’d call you to collect your treatment. The process was very quick”. However, only 9% of people surveyed in the Eastern Cape said they were collecting their ARVs at an external pickup point – down from 20% in January 2025. A considerable 11% reduction. This compares to 32% in KwaZulu-Natal – which also saw a drop after PEPFAR partners withdrew support – but managed to remain the best performing province out of the six provinces monitored by Ritshidze.
Conversely, 57% of people surveyed in the Eastern Cape said they had to collect their ARVs at the facility after waiting in long queues to collect files, take vitals, consult with a health worker, get a rescript, and visit the pharmacy. One person explained this long process saying: “There is no sense of urgency.. when you go to collect your treatment, you will still leave at 4pm when they are about to close. Ideally, your treatment should already be packed so you can just collect it and leave”. The Eastern Cape had the most reports of people having to collect through standard facility medicine dispensing out of all six provinces monitored by Ritshidze.
OR Tambo performed worst out of all 16 districts monitored, with 25% fewer people using external pick-up points after the PEPFAR disruptions. This while 65% of people said they would like to collect ARVs closer to their home if it were possible.
Today, many pick-up points depend on private pharmacy networks (often urban) and, until recently, PEPFAR-funded implementing partner providers not relying on being paid a service fee. After the cuts, fewer people are now using external pick-up points and more were pushed back to facility queues, defeating the purpose of decanting.
One person living with HIV described the challenge after being sent back to the facility: “it changed to a nurse prescribing [our treatment], and you have to collect it from the pharmacy. When you get there, there’s a waiting area where everyone is looking at you. You feel ashamed and try to hide the medication. Sometimes the staff will ask loudly – “how many pills did you get last month?” – and everyone in the room can hear. I would answer quietly, “2 months’ worth” but other patients would still overhear, which made me very uncomfortable and discouraged me from returning to the clinic”.
The solution is simple: many community based organisations (CBOs) are ready to run pick-up points in their own communities. But the current funding model is designed for large private pharmacy networks serving thousands, not small CBOs in rural or peri-urban areas that may serve 50 people or so. The funding model must make these smaller, community-based pick-up points viable, not just the big chains. Administrative processes to register as an external pick-up point also need to be reduced and simplified – CBOs face complex requirements designed for government service providers.
The National Department of Health and National Treasury must create a dedicated CBO-friendly funding model – one that makes it easy to register, contract, and fund community-led pick-up points. It is time to leverage community partners – because they do not just hand out ARVs. They know the people they serve, can follow up when someone misses an appointment, provide support when people face challenges, and often deliver parcels directly to people’s homes at no extra cost.
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
Notes:
The Eastern Cape State of Health report is available here: https://ritshidze.org.za/wp-content/uploads/2025/10/Ritshidze-State-of-Health-Eastern-Cape-2025.pdf
A summary presentation is available here: https://ritshidze.org.za/wp-content/uploads/2025/10/Ritshidze-Eastern-Cape-State-of-Health-October-2025.pdf
What is Ritshidze?
Ritshidze is a community-led monitoring (CLM) system implemented by the Treatment Action Campaign (TAC). Through Ritshidze, community members systematically collect data at clinics and in the community that are analysed, and then used to generate solutions to problems that are put to duty bearers for action. Community-led monitoring is an indispensable strategy for improving the state of our public healthcare system, and getting more people on ARVs.
How does Ritshidze collect data?
Ritshidze collects both quantitative and qualitative data through observations, as well as through the implementation of standardised surveys and in depth interviews with healthcare users (public healthcare users, people living with HIV, members of key populations) and healthcare providers (Facility Managers, pharmacists/pharmacist assistants). All Ritshidze’s data collection tools, our data dashboard, and all raw data are available through our website.
What changes have been made in where Ritshidze collects data following the PEPFAR disruptions?
Prior to the end of January 2025, Ritshidze data was collected across sites in four PEPFAR priority districts in the Eastern Cape: Alfred Nzo, Buffalo City, Chris Hani, and OR Tambo. Following cuts in funding, Ritshidze monitoring has continued in Buffalo City and OR Tambo only. PEPFAR implementing partners are still active in both districts. Ritshidze data will be able to document any changes in the quality of service provision following the PEPFAR disruptions.
What changes were made to data collection to determine the impact of PEPFAR funding cuts on HIV services?
A new tool was developed in this reporting period to survey patients as they exit the clinic. This was to gather evidence to the state of service provision that day – to better understand the impact of the PEPFAR disruptions on clinics. All monitoring tools are available here: https://ritshidze.org.za/category/tools/
Data collection periods and locations
- Facility level data was collected between April 2025 and June 2025 at 40 public health facilities in two districts: Buffalo City (20 sites), and OR Tambo (20 sites). Surveys were carried out with 40 Facility Managers, 2,107 public healthcare users and 1,150 people living with HIV in the Patient survey, and 2,108 public healthcare users in the Patient Exit survey.
- Key Population service data was collected in the community between July 2024 and September 2024 in 4 districts in the Eastern Cape: Amathole, Buffalo City, Nelson Mandela Bay, and OR Tambo. A total of 3,149 surveys were carried out in the province (including 2,196 people using public health facilities). This combined 542 gay, bisexual, and other men who have sex with men (GBMSM), 834 people who use drugs, 605 sex workers, and 215 trans people.