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

Yesterday Ritshidze launched a detailed report into the state of the public healthcare system in Mpumalanga that finds clinics faced with persistent long waiting times and poor staff attitudes. The report — based on the results of data collected through Ritshidze’s community-led monitoring of 42 health facilities in Mpumalanga — was presented to the Mpumalanga Department of Health and other duty bearers at a community meeting in Kabokweni. You can find the presentation here and watch the full recording below.

This is the second edition of the Mpumalanga State of Health report; the first was published in May 2021. Like the earlier edition, the second edition of the Mpumalanga State of Health report outlines key challenges people living with HIV, key populations and other public healthcare users face in the province. Through our comparative data, it has meant this edition offers deeper analyses, stronger insights, and also, is accompanied by growing hope for solutions. 

Positively, since last year’s report, there has been a number of improvements in the quality of HIV, TB and other health service delivery in the province.

Staffing levels have improved from only 7% of Facility Managers last year reporting enough staff to meet demand, to 41% of Facility Managers this year. Further many vacancies have been filled. However, while clear progress has been made, staff shortages persist in the majority of sites. 97 vacancies across 17 facilities remain to be filled. We are clear that much more needs to be done in order to ensure adequate staffing levels. While we are cognisant of the major reductions in health budgets throughout the country as a result of austerity budgeting, we recommend a radical solution that would see eighty percent of the vacancies filled by December 2022.

While waiting times after the facility opens have reduced, from 4:33 hours last year, to just over 4 hours this year, this remains an extremely long time for public healthcare users to wait at the facility to only be seen for a limited time. This simply does not work well for most people — particularly working people and those in school. Further, having people living with HIV spend an extended time at a facility, simply to collect ART refills, also increases the risk of that person disengaging from care.

Inadequate space continues to be a challenge, with only marginal improvement over the year. Lack of space for HIV counselling (43% of sites) can mean PLHIV are consulted, tested, or counselled in the same room as someone else. Small waiting areas (23 sites) can have a profound effect on the TB and COVID-19 infection control and 70% of Facility Managers raised the need for additional space for public healthcare users to wait.

49% of PLHIV reporting 3-6 month ART refills compared to just 41% in the same reporting period last year. On this, facilities monitored in Mpumalanga are performing best across the country. However progress on multi-month dispensing is slow compared to other PEPFAR-supported countries. Further, worryingly, 17% of PLHIV reported getting one month or less supply, with 10% reporting just two weeks supply. Amsterdam CHC, Mkhondo Town Clinic, Piet Retief Clinic, Ethandakukhanya Clinic alone accounted for 107 reports of people living with HIV receiving 2 weeks supply of ARVs in quarter 3. This needs urgent resolution.

Repeat prescription collection strategies in the province do make ART collection quicker and people living with HIV are on the whole very satisfied with them. More people should be decanted to these options, especially given that 53% of respondents still said they would prefer to collect ARVs closer to home.

Treatment literacy improves linkage and retention as people understand the importance of starting and remaining on treatment effectively. Last year, the Mpumalanga Department of Health committed to train healthcare workers on the new adherence guidelines and to remind healthcare workers to consistently counsel people living with HIV. The impact of this can be seen in certain improvements in the treatment literacy understanding among people living with HIV where 74% understood the “undetectable = untransmittable” message, up from just 62% last year.

According to Ritshidze data, Mpumalanga is now one of the better performing provinces in terms of ensuring results are explained. However, all people living with HIV should understand these messages. The department and implementing partners must ensure that this progress is maintained so that all people living with HIV understand the benefits of adhering to treatment.

For key populations (KPs) the experience at public health facilities is often untenable. Too often staff are insensitive and unprofessional and some say the ill-treatment has been off-putting enough for them to prefer to go without ARV treatment or other health services — for example, 85% of trans* people not accessing healthcare give unfriendly services as the reason they don’t.

For those KPs who continue to suffer the daily indignities associated with using the public health system, specific services remain unavailable for the most part. Basic HIV prevention tools like condoms and lubricants are often unavailable at the clinic. Lubricants were only available in 38% of sites monitored, and only 2% of gay, bisexual and other men who have sex with men (GBMSM) reported lube to be available. Only 11% of people who use drugs (PWUD) reported access to methadone at drop-in centres and 0% of trans* people in the province reported access to hormones.

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 Mpumalanga 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.


“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.