Last week Ritshidze launched a detailed report into the state of the public healthcare system in the North West. The report was based on the results of data collected through Ritshidze’s community-led monitoring. It was presented to the provincial and district health departments, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and other duty bearers at a community accountability meeting in Mafikeng. You can read the summary presentation here and watch the full recording below.
The community meeting gave people living with HIV and other public healthcare users in the province the opportunity to talk directly to those in power. People living with HIV in the province were able to tell duty bearers what discourages them from going to the clinic. Together with people’s personal experiences, we also presented data from Ritshidze that highlights problems at our local clinics and offers solutions to fix the challenges found.
Stockouts and shortages of medicines was one critical issue raised. This
crisis has been raised with provincial duty bearers multiple times, yet the problem persists and needs an urgent turnaround strategy. A further extensive community-led monitoring effort had taken place in May at 56 facilities across the province led by the Treatment Action Campaign (TAC), Stop Stockouts Project (SSP) and Ritshidze.
This fact finding mission exposed 895 reports of different medicines, contraceptives and vaccines being out of stock in total across 56 facilities. Out of data for 220 reports, 121 were resolved in a month or less. Worryingly, however, 28 reports involved stockouts of 5 months or more. Shockingly, three cases of stockouts of essential medicines lasted over a year, with one lasting over two years. This community member explained her frustrations at stockouts of ARVs at her clinic. “They tell me that there is no stock and there is nothing they can do about it. You don’t know what your future holds because these pills make us survive”.
Another key challenge raised was around excessively long waiting times. Ritshidze data shows that patients wait on average more than 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 complained of waiting for many hours at the clinic while nurses sit and take long breaks together. She complained that this is worsened when her file is lost, adding to the time she must wait. “I wish that we can get help”, she pleaded.
Key populations — like transgender people, sex workers, men who have sex with men, and people who use drugs — are disproportionately affected by HIV and face many additional challenges in accessing services. Often they are ridiculed, discriminated against and treated poorly at the clinic. It is evident why some key populations do not access services or disengage from care 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 North West Department of Health and PEPFAR implementing partners in the province.