Yesterday Ritshidze launched a detailed report into the state of the public healthcare system in KwaZulu-Natal that reveals improvements in several areas including reduced waiting times, better staff attitudes, and longer ARV refills. However, for LGBTQIA+ communities, people who use drugs, and sex workers, on the whole KwaZulu-Natal provided the least friendly and worst services across all provinces monitored. The report was presented to the KwaZulu-Natal Department of Health and other duty bearers at a community meeting in Umlazi, Durban. You can find the presentation here and watch the full recording below.
Positively waiting times have reduced by 41 minutes in the last year in KwaZulu-Natal, down from an average of 3:20 hours waiting after the facility opens to 2:39 hours. 30 facilities had average waiting times under 2 hours. The province continues to have the shortest waiting times reported out of all provinces monitored by Ritshidze.
Yet, public healthcare users at some sites still face delays and 48% of people still think waiting times are long.
Staff shortages were the most frequent reason given for this. Limited progress has been made in filling vacancies and hiring more staff across the year with 81% of facilities still reporting shortages and 449 vacancies still open. There is still a huge way to go to fill the human resource gap across sites in the province.
For people living with HIV, spending an extended time at a facility increases the risk of that person interrupting treatment. Longer ARV refills can reduce this risk and reduce the overall frequency of clinic visits. Positively, this year many more people living with HIV reported 3-6 month refills, up from 31% to 49%. However this compares to 59% in Mpumalanga (the best performing province) 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.
Providing friendly and welcoming services is another way to support long-term retention as outlined in the national adherence guidelines. Positively 82% of people thought that the staff were always friendly and professional, up from 75% last year — and 95% of PLHIV feel that facilities keep their HIV status private and confidential. KwaZulu-Natal is performing best out of all provinces monitored by Ritshidze on these indicators.
However, there is still further to go to ensure everyone is treated with dignity, respect, and compassion at all times. People living with HIV who have already disengaged from care and can no longer stomach the abuse and dismissive attitude of clinic staff were not at the facility to be part of these interviews — and for for people who use drugs, sex workers, and LGBTQIA+ community members the situation is much more dire.
On the whole KwaZulu-Natal provided the worst services for key populations across all provinces monitored. Only 28% of respondents reported that facility staff are always friendly and professional towards gay, bisexual, and other men who have sex with men (GBMSM), 19% towards people who use drugs; 16% towards sex workers; and 34% towards trans* people. Many key populations interviewed did not feel comfortable at facilities or safe and protected from abuse and harassment — and huge numbers complained of privacy violations.
Shockingly, many people reported being refused access to services because of being a key population — including 8% of GBMSM, 25% of people who use drugs, 13% of sex workers, and 13% of trans* people in the province. This is absolutely unacceptable and goes against section 27 of the Constitution. Clinic staff — from clinicians to security guards — must be sensitised and held accountable to provide safe, friendly, and confidential services to all key population communities.
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 KwaZulu-Natal 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.