Yesterday Ritshidze launched a detailed report into the state of the public healthcare system in the Eastern Cape that reveals several improvements in the quality of services over the last year. However, progress towards getting 95% of people on treatment remains off track. The report was presented to the Eastern Cape Department of Health and other duty bearers at a community meeting in Mdantsane, East London. You can find the presentation here and watch the full recording below.
Positively waiting times have improved in the province, down from 4:37 hours to 3:47 hours waiting after the facility opens. Yet 60% of public healthcare users interviewed still think that waiting times are long, with 66% blaming staff shortages for the long hours waiting.
Community members explained how frustrating the long waiting times are.
Extending ARV refills can ease the burden on overstretched facilities and support people living with HIV to stay on treatment. Positively, this year many more people living with HIV reported 3-6 month refills, up from 20% to 40%. However this compares to 59% in Mpumalanga and remains very low in comparison to other PEPFAR supported countries where 80% of people living with HIV received 3-6 month ART refills in 2021.
The majority of PLHIV who were surveyed (53%) said that they would like to collect ARVs closer to their home if it were possible. This points towards the fact that facilities should be working towards enrolling many more PLHIV out of the facility standard dispensing or facility pick-up points, and into external pick-up points or community adherence clubs closer to home.
Ensuring friendly and welcoming services for all people living with HIV and key populations is another way to ensure more people start and stay on treatment. However, this year only 55% of people thought staff were always friendly and professional — down from 63% last year. Only 27% of people who had missed appointments said that staff were welcoming when they returned — while 25% said staff sent them to the back of the queue and 14% said that staff shouted at them. There is still a long way to go to ensure people living with HIV are treated with dignity, respect, and compassion at all times.
Community members spoke about the bad attitudes they face at the clinic.
Another issue is people living with HIV being denied ARVs because of not having a transfer letter. Transfer letters are not required in national adherence guidelines, yet 403 people in the Eastern Cape interviewed by Ritshidze had been denied access to services for not having one since we started collecting this data last October. This represents 16% of all public healthcare users interviewed, but given that most people interviewed are unlikely to have attempted to transfer services, it continues to point to a much larger problem regarding the communication and policies regarding transfer letters.
The Eastern Cape is performing best on many of the indicators around treatment literacy — interventions that are integral to improving long-term retention as people understand the importance of starting and remaining on treatment effectively. Positively 91% of people living with HIV reported that a healthcare provider explained the results of their viral load test result, up from just 79% last year. This correlates to 89% of people living with HIV understanding the benefits of an undetectable viral load on their health
(up from 72% last year) and 85% understanding that an undetectable viral load means they cannot transmit HIV (up from 67% last year).
For key populations, clinic visits can be traumatic and staff can be unfriendly and even openly hostile. Many people we spoke to had given up on healthcare altogether (47% of gay, bisexual, and other men who have sex with men, 41% of people who use drugs, 39% of sex workers, 47% trans* people).
Despite commitments by PEPFAR and the National Department of Health to rollout a robust KP sensitization toolkit as part of standard in-service training for all facility staff, disrespect, ill-treatment, and dehumanisation of KPs remain a widespread challenge that needs to be urgently fixed — with consequences for clinic staff who commit privacy violations.
Toilets are often found to be in a bad condition. 74% of Ritshidze observations found that toilets were in bad condition. The Eastern Cape performed worst on this indicator out of all provinces. No soap, no toilet paper, dirty toilets, no light, and no water were the most common concerns.
This is just a snap shot of the issues discussed in the community meeting. It was a space for public healthcare users to talk directly to those in power. Community members reported their challenges and sought rapid interventions by the Eastern Cape Department of Health and PEPFAR implementing partners in the province. Follow Ritshidze on twitter, facebook and instagram for regular updates or go to www.ritshidze.org.za for more.