On 14 October 2025, Ritshidze launched a detailed report into the state of the public healthcare system in KwaZulu-Natal that reveals the challenges arising in our clinics following the PEPFAR disruptions earlier in the year. The key highlights include: 31% fewer people getting a 3 month supply of ARVs, while there was a 40% increase in people getting a 1 month supply of ARVs. 27% of people saying staff shortages worse after PEPFAR disruptions in King Cetshwayo (where PEPFAR support was withdrawn) and 89% of sites with filing systems in bad condition in King Cetshwayo. 17% fewer people thought staff were always friendly, with members of key populations being treated particularly poorly. 12% fewer people reporting having viral load tests explained to them and treatment literacy understanding went down.
The full press release is here – with a deep dive on ARV refill length here.
This is the fifth edition of the annual KwaZulu-Natal State of Health report. Prior to the end of January 2025, Ritshidze data was collected across sites in six PEPFAR priority districts in KwaZulu-Natal: eThekwini, King Cetshwayo, Ugu, uMgungundlovu, uThukela, and Zululand. Following cuts in funding, Ritshidze monitoring has continued in eThekwini, King Cetshwayo, and uMgungundlovu only. PEPFAR implementing partners are still active in eThekwini, Harry Gwala, uMgungundlovu, uThukela, and Zululand – while contracts have been terminated in King Cetshwayo and Ugu. Ritshidze data will be able to document any changes in the quality of service provision following the PEPFAR disruptions in the districts we are monitoring.
Facility level data was collected between April 2025 and June 2025 at 60 public health facilities in three districts: eThekwini (20 sites), King Cetshwayo (20 sites), uMgungundlovu (20 sites). Surveys were carried out with 60 Facility Managers, 3,204 public healthcare users and 1,593 people living with HIV in the Patient survey, and 3,425 public healthcare users in the Patient Exit survey.
Key Population service data was collected in the community between July 2024 and September 2024 in 6 districts in KwaZulu-Natal. A total of 4,252 surveys were carried out (including 2,456 people using public health facilities). This combined 497 gay, bisexual, and other men who have sex with men (GBMSM), 1,257 people who use drugs, 471 sex workers, and 231 trans people.
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