Yesterday Ritshidze launched a detailed report into the state of the public healthcare system in the Free State that finds that while the province has marginally improved in certain indicators, it has worsened in many and too often Free State facilities are among the worst performing sites across all provinces monitored. The report was presented to the Free State Department of Health and other duty bearers at a community meeting in Batho location, Bloemfontein. You can find the presentation here and watch the full recording below.
While 79% of facilities again reported being understaffed and unable to meet the needs of public healthcare users this year, the number of vacancies in sites monitored has almost doubled from 26 to 50. Public healthcare users also reported a worse situation, with only 16% who thought there were enough staff, down from 36% last year.
Inadequate staffing often means longer waiting times, forcing people to arrive early and wait for many hours to be attended to. 82% of public healthcare users thought waiting times were long this year — many blaming too few staff, as well as clinic staff in place working too slowly.
Community members explained how they sit all day at the clinic only to be sent home without help.
Positively, there has been an increase in the number of people getting a 3 month refill of ARVs (up to 13%), however this is slow progress compared to 52% in Mpumalanga (the province that is performing the best) and 75% of people are getting 3 to 6 months supply in other PEPFAR supported countries. Extending ARV refills is an important strategy to support people living with HIV to remain on treatment as well as ease the burden on already overstretched facilities.
It remains a priority to urgently improve staff attitudes to ensure friendly and welcoming services for all people living with HIV and key populations, including those returning to care after a treatment interruption. Only 41% of people thought that the staff were always friendly and professional (down from 44% last year) and 56% of people said staff sent them to the back of the queue if they missed an appointment. The fear of poor treatment only discourages people from ever going back to the clinic.
Another key issue revealed is people living with HIV being denied ARVs because of not having a transfer letter. Transfer letters are not required in the national adherence guidelines, yet 573 people in the Free State reported being 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.
Treatment literacy levels have declined since last year. Ensuring people living with HIV understand the importance of starting on staying on treatment effectively is critical to improve linkage and long term retention, yet just 76% of people living with HIV understood that an undetectable viral load is good for their own health, and only 57% understood that an undetectable viral load means you cannot transmit HIV. This low level of understanding correlates with the fact that only 78% of people living with HIV reported that a healthcare provider actually explained their viral load test result, down from 82% last year.
This is just a snap shot of the issues discussed in the community meeting. It was a space for public health users to talk directly to those in power. Community members reported their challenges and sought rapid interventions by the Free State 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.