Last week Ritshidze launched a detailed report into the state of the public healthcare system in KwaZulu-Natal. The report was based on the results of data collected through Ritshidze’s community-led monitoring. It was presented to the at a community accountability meeting in Umlazi, outside Durban. You can find the presentation here and watch the full recording below.
In KwaZulu-Natal, 94% of people living with HIV know their status, 85% of those people are on HIV treatment, out of which 89% are virally suppressed. Of all provinces, KwaZulu-Natal has made the most progress towards achieving the UNAIDS 95-95-95 targets, however there are serious threats that could erode the gains made in the province.
Ritshidze data reveal significant staff shortages that are undermining the quality of services provided at health facilities. Only 35% of public healthcare users think there are enough staff to meet their needs, and 81% of Facility Managers think there are not enough staff. Understaffed clinics mean healthcare workers are overburdened. This leads to longer waiting times, limited time to attend to patients, and at times, bad attitudes. These factors directly contribute to people living with HIV being able to start and stay on treatment.
One community member explained how “staff only start working around 12pm and in the mornings the clinic is crowded”.
KwaZulu-Natal a high number of vacancies that are not being filled, with vacancies reported across 92 facilities monitored in the province (68% of sites). The numerous open positions that are not being filled create gaps in capacity to deliver quality services. According to Facility Managers, the most commonly understaffed cadres were professional nurses (reported at 60 facilities), enrolled nurses (reported at 32 facilities), enrolled nurse assistants (reported at 20 facilities), data capturers (reported at 16 facilities) and cleaners (reported at 15 facilities). This challenge is worsened as staff retire and are not replaced.
The challenge of long waiting times is compounded by poor filing systems. 16% of Ritshidze respondents think that the queues are long because “it takes too long to find files, the filing system is messy or files get lost”. Ritshidze observations reported filing systems to be in a bad condition in 19% 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.
Positively 84% of clinics monitored in KwaZulu-Natal were in a good condition and the majority were clean. On overall clinic cleanliness, KwaZulu-Natal is performing the best when compared to other provinces. 80% of patients reported that clinics were “very clean” or “clean”. Only 2% of patients reported that facilities were “very dirty” or “dirty”.
Unnecessary trips to the clinic just to collect an ARV refill adds both a burden on PLHIV and to the already overwhelmed clinic and healthcare worker staff. This inefficiency can also contribute to PLHIV disengaging from care directly impacting the province’s attainment of 95% of PLHIV on treatment. Extending treatment refills, also known as providing “multi-month dispensing” or MMD, is one strategy to reduce unnecessary burdens and support both PLHIV and the health system to be more efficient.
One man explained how he went to the clinic twice as he was feeling weak and told them he was taking TB and HIV treatment. They never attended to him as he had no transfer letter. He spent two months suffering like that until he borrowed money to go back and fetch the letter. he is not working and has still not been able to pay back the money he owes.
Treatment literacy improves linkage and retention rates as people 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. Compared to other provinces, more people living with HIV interviewed in KwaZulu-Natal understood why an undetectable viral load is important. This is very positive however efforts should be continued to ensure that all people living with HIV understand what an undetectable viral load test means.
So much funding — largely wasted — is spent on gender sensitivity training of PEPFAR implementers while front line clinic staff discriminate, mock, and abuse sex workers, trans people, people who use drugs, gay men.
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 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.