Ritshidze data reveal key improvements in Eastern Cape clinics but poor staff attitudes remain

  • 2nd edition of State of Health report compares data over the last year of community-led monitoring in the Eastern Cape.
  • The data, together with stories from people living with HIV, key populations and other public healthcare users, will be presented at a community meeting today.
  • The meeting will be live streamed on vimeo, facebook and YouTube.

Mdantsane, 13 October 2022 — Not having to set foot in Maluti Clinic ever again has been liberation for Vuyo*. Her experience at the hands of nurses there over three years was distressing enough for her to “quit the clinic” and to stop taking her ARV treatment rather than to put up with what she says were hurtful, abusive nurses. 

Ritshidze data reveal that of 2,473 people interviewed, only 55% thought that clinic staff were always friendly and professional in the Eastern Cape, down from 63% last year. This poor treatment is off putting enough for people to miss appointments or even stop going to the clinic altogether. Some report being “terrified” at what awaits them.

“Sometimes I feel that I don’t want to go to the clinic,” another community member told us. “I would love them to change, especially in the way they speak to us. Sometimes I cry when I come from the clinic.”

Poor staff attitudes are among eleven key issues outlined in the second edition of a new Ritshidze State of Health report. The report will be launched at a community meeting in Mdantsane, East London today. Positively, the report reveals several improvements in the quality of services over the last year, however several challenges remain, and progress towards getting 95% of people on treatment remains way off track in the province. 

While waiting times have improved in the province, down from 4:37 hours to 3:47 hours waiting after the facility opens — long waits and unnecessary inefficiencies remain. Of 2,471 public healthcare users interviewed, 60% still thought that waiting times are long. As one community member put it: “All you want to do is sign for your pills and go – but it just isn’t like that, you have to sit and wait.” 

“We arrive at the clinic very early and don’t receive help. I have stopped taking treatment three times now,” another woman explained as to how long waiting times forced her to stop taking her ARVs in order to avoid losing her job.

Just thinking about the state of services made another man we interviewed “so angry”. For him a typical clinic visit starts at 6am in the morning and then drags on till after lunch time. “You wait two hours outside even before the clinic opens. Even if it’s raining you have to stand there and there is not a proper place for you to wait; people are getting sick having to be outside from that early in the morning.”

The long waiting times force people to begin queuing early in the morning, in an attempt to get seen more quickly, yet 45% of people reported feeling “very unsafe” or “unsafe” while waiting for the facility to be open. Opening clinic grounds early or spacing out appointment times throughout the day could help to improve these challenges. 

Extending the length of ARV refills is another key intervention called for in the report that can ease the burden on overstretched facilities and support people living with HIV to stay on treatment. 

“Positively, this year many more people living with HIV reported 3 to 6 month refills, up from 20% to 40%. However this compares to 59% in Mpumalanga, the best performing province, and remains very low in comparison to other PEPFAR supported countries where 80% of people living with HIV received 3 to 6 month ART refills in 2021,” said Ndiphiwe Bekwaphi, Ritshidze District Organiser from TAC.

Treatment literacy is key intervention to make sure people living with HIV understand the importance of adhering to ARVs. Positively the Eastern Cape is performing best on many treatment literacy indicators collected by Ritshidze. 91% of people living with HIV reported that a healthcare worker explained the results of their viral load test result, up from just 79% last year. People’s understanding has drastically improved too. 89% of people living with HIV know an undetectable viral load is good for their health (up from 72% last year) and 85% know it means they cannot transmit HIV (up from 67% last year). The report calls for this progress to continue so no-one is left behind.

For people who use drugs, sex workers, and LGBTQIA+ communities, public clinics often have little to offer in terms of specific services, and people face hostility and abuse when attempting to access services. 

“If you go to the clinic, they will judge you for the type of work that you do. Everyone will look at you and stare at you… some even laugh and gossip about you. Some have asked how much I sell my body for. If you go to a nurse and they find out you are a sex worker, they will assault you and call you names.” 

One trans* person told us that “it is really tough at the facility… the judgement from how the staff look at me before I even speak or explain my problem. The attitude is very bad, sometimes you end up thinking twice before going there.” 

Alarmingly, many of the key populations we spoke to had given up on healthcare altogether including 47% of gay, bisexual, and other men who have sex with men, 41% of people who use drugs, 39% of sex workers, 47% trans* people. Despite commitments by the health department and PEPFAR to sensitise clinic staff, disrespect and dehumanisation of communities of key populations remain a widespread challenge. The report calls for this to be urgently fixed, with consequences for clinic staff who treat people poorly.

“We commend where the Eastern Cape health department and health facilities in the province have listened to Ritshidze’s data reports and tried to improve the services being given at our clinics. But while there has been some progress, we also continue to see and hear about challenges that make it hard for someone to access HIV and TB prevention and treatment. The province must continue to be open to hearing the problems and taking rapid action to fix our clinics, so that everyone can access the HIV, TB and other health services they need,” says Anele Yawa, from the Treatment Action Campaign (TAC).

* Identity withheld to protect the public healthcare user.

For more information or to arrange interviews contact:

Ngqabutho Mpofu | +27 72 225 9675 | ngqabutho.mpofu@tac.org.za 

Lotti Rutter | +27 82 065 5842 | lotti@healthgap.org

Note to editors:

This is the second edition of the Eastern Cape State of Health report; the first was published in September 2021. Like the earlier edition, the second edition of the Eastern Cape State of Health report outlines key challenges people living with HIV, key populations and other public healthcare users face in the province. The report focuses on the following critical themes: staffing; waiting times; infrastructure and clinic conditions; ART collection; ART continuity; treatment and viral load literacy; accessibility of health services for key populations; specific services for men; the implementation of index testing to find people living with HIV; TB infection control, and stockouts and shortages of medicines and other health products.

Today, Ritshidze is providing a platform for community members to raise their concerns directly to the Eastern Cape health department, district and national health departments, and PEPFAR partners working in the province, MatCH and TB HIV Care. To follow proceedings virtually please join at: https://vimeo.com/759798360/caf6047a47

The full Eastern Cape State of Health report is available here

The full presentation is available here

A summary report is available here

A summary of recommendations is available here

The media alert is available here

A recording will be available after the event on the Ritshidze website, Facebook, and YouTube channels.

About Ritshidze: 

With the establishment of Ritshidze — a community-led monitoring system developed by organisations representing people living with HIV including 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+) — we have begun to more systematically document the failures in quality HIV, TB and other health service delivery at 50 facilities across the Eastern Cape: 9 in Alfred Nzo, 6 in Amathole, 12 in Buffalo City, 7 in Chris Hani, 1 in Nelson Mandela Bay, and 15 in OR Tambo.

Ritshidze collects data through observations, as well as through interviews with healthcare users and healthcare providers. All monitoring tools are available here: https://ritshidze.org.za/category/tools/ 

Data in this report were collected between July 2022 and August 2022 (Q4 2022).

  • Interviews took place with 50 Facility Managers
  • Observations took place at 49 facilities 
  • Interviews took place with 2,479 public healthcare users
  • 51% (1,272) identified as people living with HIV
  • 72% (1,797) identified as women
  • 26% (634) identified as young people under 25 years of age

Additional quantitative data related to key populations was collected between August and October 2021. Data collection took place across two districts: Amathole and OR Tambo. A total of 674 surveys were taken, combining 189 gay men, bisexual men, and other men who have sex with men (GBMSM), 403 people who use drugs, 63 sex workers, and 19 trans* people.

Follow Ritshidze on twitter, facebook and instagram for regular updates or go to www.ritshidze.org.za for more information.


“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.