On 24 October 2025, Ritshidze launched a detailed data set looking into the state of the public healthcare system in Ehlanzeni, Mpumalanga, that reveals the challenges arising in our clinics following the PEPFAR withdrawal earlier in the year. Overall critical staffing shortages were reported with many facilities blaming the withdrawal of PEPFAR support. Friendliness, compassion and support have worsened, for all public healthcare users including people living with HIV returning to care and members of key populations. HIV prevention services have also been impacted including condom and lubricant availability, and PrEP services. Healthcare workers explaining people’s viral load tests, and overall treatment literacy understanding has also declined considerably.
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This is the 5th edition of the Ehlanzeni State of Health report, developed using Ritshidze data. Ehlanzeni data was also captured in the previous four editions of the Mpumalanga State of Health report. Following cuts in funding, Ritshidze monitoring has continued in Ehlanzeni only, with aims to expand back into Gert Sibande. PEPFAR implementing partners have now had their contracts terminated in all districts in the province – Ehlanzeni, Gert Sibande, and Nkangala – the province is no longer receiving PEPFAR support. Ritshidze data will be able to document any changes in the quality of service provision following the PEPFAR withdrawal.
Facility level data was collected between April 2025 and June 2025 at 20 public health facilities in Ehlanzeni. Surveys were carried out with 20 Facility Managers, 1,023 public healthcare users and 518 people living with HIV in the Patient survey, and 1,026 public healthcare users in the Patient Exit survey.
Key Population service data was collected in the community between July 2024 and September 2024 in 4 Ehlanzeni. A total of 659 surveys were carried out in the district (including 312 people using public health facilities). This combined 96 gay, bisexual, and other men who have sex with men (GBMSM), 105 people who use drugs, 44 sex workers, and 67 trans people.
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