On 31 October 2025, Ritshidze launched a detailed report into the state of the public healthcare system in the Free State that reveals the challenges arising in our clinics following the PEPFAR disruptions earlier in the year. While the data reveal some positives in the Free State, the low quality of health services being provided is undeniable – extremely long waiting times, the least friendly provision of services, with the most reports of punishment of people living with HIV, and the most reports of denying people services including people without transfer letters, migrants, people with out IDs, and members of key populations.
Ritshidze is particularly concerned by the poor quality of services in Mangaung, where waiting times were among the worst recorded, filing systems were in complete disarray, and staffing shortages were acute. This is one of the country’s high HIV burden districts that has never received PEPFAR support – offering a clear picture of what the long-term absence of that support looks like. The situation in Mangaung is a warning. PEPFAR support clearly contributed to better outcomes in other districts, and without urgent action, gaps left behind will deepen inequalities. High burden districts like Mangaung must receive the staff, systems, and support they need. We call for special monitoring of the situation in Mangaung at both the national and provincial levels.
The full press release is here.
This is the fifth edition of the annual Free State, State of Health report. Since inception, Ritshidze data has been consistently collected across sites in the two PEPFAR priority districts in the Free State: Lejweleputswa and Thabo Mofutsanyana. While Ritshidze monitoring will continue in these districts, PEPFAR implementing partners have now had their contracts terminated in both districts – 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. From this reporting period, Ritshidze data will also be collected in Mangaung, a non-PEPFAR priority district. By moving beyond only monitoring PEPFAR priority districts, Ritshidze aims to understand the quality of service provision in the next layer of high demand/high burden districts.
Facility level data was collected between April 2025 and June 2025 at 57 public health facilities in three districts: Lejweleputswa (17 sites), Mangaung (20 sites), and Thabo Mofutsanyana (20 sites). Surveys were carried out with 57 Facility Managers, 3,021 public healthcare users and 1,503 people living with HIV in the Patient survey, and 2,522 public healthcare users in the Patient Exit survey.
Key Population service data was collected in the community between July 2024 and September 2024 in three districts in the Free State: Lejweleputswa, Mangaung, and Thabo Mofutsanyana. A total of 1,551 surveys were carried out in the province (including 1,377 people using public health facilities). This combined 420 gay, bisexual, and other men who have sex with men (GBMSM), 594 people who use drugs, 219 sex workers, and 144 trans people.
#FSHealth #KeyPopsHealth
