Yesterday Ritshidze launched a detailed report into the state of the public healthcare system in Mpumalanga. The report was based on the results of data collected through Ritshidze’s community-led monitoring. It was presented to the provincial and national health departments, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and other duty bearers at a community accountability meeting in Ermelo. You can read the summary presentation here and watch the full recording below.
The community meeting was a space for public healthcare users to talk directly to those in power — to tell them what it is really like to use public clinics in the province. Together with these first hand experiences, we also presented data collected through Ritshidze, outlining some of the problems we identified at our local clinics, and offered solutions to reverse the challenges found. Below we take a look at a few highlights.
One major challenge identified is excessively long waiting times. Ritshidze data shows that patients at 20 out of 43 clinics monitored wait over 5 hours to access services. This simply does not work well for most people — particularly working people and those in school. Having people living with HIV spend an extended time at a clinic, simply to collect ART refills, increases the risk of that person disengaging from care. This community member explained what the long waiting times and early morning starts mean for her.
Another key challenge raised was around frequent trips to the clinic just to collect ARVs. Efforts need to be made to support people living with HIV with suppressed viral loads to receive longer refills, meaning less trips to the province. Ritshidze data reveals that 37.6% of people living with HIV reported receiving 3 month ART refills. This is a positive step towards longer multi month dispensing. However, 60% of people living with HIV interviewed still received less than 3 months supply. This compares to only 21% in other PEPFAR supported countries.
Another issue we raised was the need to provide better treatment and viral load literacy information to support more people living with HIV to start and stay on treatment. By becoming as informed as possible, people living with HIV are empowered to take control of their own health and sex lives. 96.6% of people living with HIV we spoke to had gotten a viral load test in the last year, yet only 70.5% of those participants reported that they knew their viral load, and only 76.9% said that a healthcare provider had explained the results. As outlined in the slide below: 82% of people living with HIV agreed with the statement; “having an undetectable viral load means the treatment is working well” and only 60.6% agreed with the statement “having an undetectable viral load means a person is not infectious.”
Most people living with HIV are getting a viral load test, but many do not really know what that means. This community member’s experience confirmed this challenge. She was shouted at by nurses for not knowing when she her next viral load test is. She explained to us that her treatment regimen had never been explained to her. She said she felt like stopping ARVs altogether because of this. We need widespread treatment literacy led by people living with HIV and key populations to rectify this challenge.
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 instead people are sometimes treated badly, or they fear they will be, so may not come back — even if that means stopping treatment altogether. This community member told us about the poor treatment she faced when she missed her appointment because she was at the hospital. When she went back to the clinic, the staff shouted at her and would not give her any ARVs.
Data from Ritshidze suggests that this unwelcoming environment is a significant reason for people living with HIV to disengage from care. Clinics should be friendly to people living with HIV, treat them with respect instead of shouting at people or sending them to the back of the queue if they miss an appointment.
This is just a snap shot of the issues discussed in yesterday’s 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 Mpumalanga Department of Health and PEPFAR implementing partners in the province. The Mpumalanga Department of Health committed to responding in detail within two weeks on our recommendations. We await the response.