[MULTI MEDIA] Recap of our community accountability meeting on #GautengHealth

This week Ritshidze launched a detailed report into the state of the public healthcare system in Gauteng that finds clinics plagued by unfriendly services and disorganised filing systems. The report — based on the results of data collected through Ritshidze’s community-led monitoring of 118 clinics in Gauteng — was presented to the Gauteng Department of Health and other duty bearers at a community accountability meeting in Katlehong. You can find the presentation here and watch the full recording below.

This is the second edition of the Gauteng State of Health report; the first was published in December 2020. Like the earlier edition, the 2021 report identifies challenges that discourage people from going to the clinic, contributing to Gauteng’s failure to reach the UNAIDS 95-95-95 targets: in Gauteng while 90% of people living with HIV know their status, only 72% of those people are on HIV treatment, out of which 88% are virally suppressed. The failure to meet these targets is a result of the decay in the health system.

One challenge remains long waiting times. In Gauteng, public healthcare users reported that they spent an average of 4:24 hours waiting in the facility, of which an average of 4:05 hours is waiting after the facility opens. The average waiting time was 5 hours or more at 37 facilities, 6 or more hours at 14 facilities, with 6 of these facilities having average waiting times of more than 7 hours. This is a very long time to spend at a facility in which public healthcare users are usually only seen for a very short consultation. Early mornings, feeling unsafe outside the clinic, and long waiting times cause people to dread clinic days or even stop going.

29% of patients interviewed by Ritshidze put long waiting times down to the fact that it takes too long to find files, the filing system is messy, and/or files are lost. Ritshidze observations reported filing systems to be in a bad condition in 24% of sites monitored. Messy and disorganised filing systems increase the delays to healthcare users being attended to and increase the burden on already overstretched healthcare workers.

Community members at the meeting explained how lost files impact them at the clinic:

Ritshidze data reveals that compared to other provinces, overall Gauteng performs best in terms of extending ARV
refill length. 48% of PLHIV reported receiving 2 month ART refills in this reporting period and 36% of PLHIV reported 3 month ART refills compared to just 26% getting 3 month refills in the same reporting period last year. While improvement has been shown, only ensuring a third of PLHIV are receiving a 3 month supply is low in comparison to other PEPFAR supported countries who are implementing multi month dispensing much more rapidly. For example, while 59% of Ritshidze respondents in Gauteng still received refills of less than 3 months, only 25% of PEPFAR supported clients in other countries had refills of less than three months.

Functional adherence clubs play an important role in providing adequate treatment literacy information to ensure PLHIV stay on treatment and reducing the burden on people living with HIV and clinics. Yet adherence clubs at some sites have been suspended due to COVID-19, or reduced to a pick up point. Only 28 facilities reported having clubs in place currently, compared to 52 facilities in the same reporting period last year. Further, only 5% of the PLHIV we interviewed used a club compared to 9% in the same reporting period last year. Additionally only 48% of club users report that treatment literacy information is provided at clubs compared to 79% in October to December 2020 when we started collecting that data, highlighting the shift of clubs becoming pick up points. Awareness of clubs has also worsened compared to the same reporting period last year, which again points to fewer clubs functioning. The health department and district support partners should develop strategies for restarting suspended clubs, while maintaining the safety of club members during the pandemic.

People living with HIV lead complicated lives and may well miss appointments and even miss taking some pills. When they do, meeting them with support when they return to the clinic helps ensure long term adherence. But people living with HIV who return to the clinic and are treated badly, or who fear they will be, will often not come back — even if that means stopping treatment altogether. This poor treatment and unwelcoming environment is a significant reason for people living with HIV to disengage from care. Out of 3,196 patient responses, only 61% of patients thought that the staff were always friendly and professional. While this has improved compared to the same reporting period last year — with only 48% of patients who thought staff were always friendly and professional — there is still a way to go to ensure all public healthcare users are treated with dignity, respect, and compassion at all times.

Community members explained how the bad staff attitudes can discourage people living with HIV from going to the clinic to collect ARVs.

Treatment literacy improves helps ART continuity as people living with HIV understand the importance of starting and remaining on treatment effectively. By becoming as informed as possible, people living with HIV are empowered to take control of their own health and sex lives. 91% of PLHIV we spoke to had gotten a viral load test in the last year. Only 79% agreed with the statement; “having an undetectable viral load means the treatment is working well”, and just 72% agreed with the statement “having an undetectable viral load means a person is not infectious.” While this has improved compared to the same reporting period last year, it is not quick enough. The department of health and district support partners must ensure that 100% of people living with HIV understand the benefits of adhering to treatment.

While index testing has the ability to help identify individuals who may have been exposed to HIV earlier, if implemented in ways that cause harm to individuals, undermine their rights to consent, privacy, safety and confidentiality, it erodes communities’ trust of healthcare providers. This is extremely important in the context of South Africa where the country faces a well documented epidemic of gender-based violence. Worryingly, of the 1,436 people living with HIV who were asked to disclose their contacts, only 78% reported that the healthcare worker explained that they were allowed to “say no” or refuse to give the names of their partners.

Furthermore, only 88% of Facility Managers say that they always screen PLHIV for intimate partner violence (IPV) as part of their index testing protocol, and 36% of the Facility Managers report that when they do screen for IPV the practice is still to contact all the partners of PLHIV regardless of reported violence. This is a major concern and violation of people’s safety and privacy. Only 9% said that they don’t trace the contacts for which there was reported violence for HIV testing. There is no point to the IPV screen if contacts are just notified of their exposure anyway. Only 69% of PLHIV reported that they were asked about the risk of violence from their partners. Two community members explained how their lives were put in danger as a result of nurses calling their partners.

One major barrier to HIV prevention and treatment services for key populations (KPs) — including sex workers, trans people, men who have sex with men, and people who use drugs — is being discriminated against at the facility. Clinics are the entry point for most KPs to access HIV, TB and other health services. Ritshidze interviews with KPs highlight the pain, discrimination and even trauma they face when trying to access services — and it is very clear why some people give up altogether.

This is just a snap shot of the issues discussed in the community accountability 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 Gauteng Department of Health and PEPFAR implementing partners in the province. Follow Ritshidze on twitterfacebook and instagram for regular updates or go to www.ritshidze.org.za for more.

A masked community member holds the red Gauteng State of Health report. In the background we see the Ritshidze team who are presenting the report at the Gauteng community accountability meeting. Photo by Rian Horn
Shot from outside the marquee we see the community members seated and listening to the presentation at the community accountability meeting. Photo by Rian Horn


“Ritshidze” — meaning “Saving Our Lives” in TshiVenda — has been developed by people living with HIV and activists to hold the South African government and aid agencies accountable to improve overall HIV and TB service delivery.

Partner organisations include the Treatment Action Campaign (TAC), the National Association of People Living with HIV (NAPWA), Positive Action Campaign, Positive Women’s Network (PWN) and the South African Network of Religious Leaders Living with and affected by HIV/AIDS (SANERELA+)—in alliance with Health Global Access Project (Health GAP), the Foundation for AIDS Research (amfAR), and Georgetown University’s O’Neill Institute for National and Global Health Law.

CLICK HERE to read more and see where we work.