Mdantsane, 23 September 2021 — Today Ritshidze is launching a detailed report into the state of the public healthcare system in the Eastern Cape. The report is based on the results of data collected through Ritshidze’s community-led monitoring. It will be presented to the Eastern Cape Department of Health and other duty bearers at a community accountability meeting in Mdantsane.
“Through our community-led monitoring we hear many stories from people living with HIV, key populations and other people using public clinics about the challenges they face in accessing healthcare. It is these challenges that make it hard for someone to test for HIV, access HIV prevention options, or even to stay on their HIV treatment once they have started. Today’s meeting is giving community members the chance to tell these stories directly to those in power,” said Anele Yawa, from the Treatment Action Campaign (TAC).
“Severe overcrowding and clinics that are too small to service their growing number of patients are just the start of problems for the Eastern Cape — a province that remains one of the poorest in the country. Add to this are challenges of improving road access and general amenities to some of the most remote parts of South Africa. It makes the problem of attracting and retaining nurses and doctors to these far-flung regions a tall ask. We can see this in Ritshidze’s data where 133 unfilled vacancies have been reported across 28 of the facilities monitored,” said Ndiphiwe Bekwaphi, a Ritshidze District Organiser from TAC.
“Over and over Ritshidze is hearing complaints about poor staff attitudes and unprofessional conduct by nurses. Only 64% of patients we interviewed thought that clinic staff were always friendly and professional and people living with HIV at 25 facilities monitored complained of being shouted at if they missed an appointment,” said Bellinda Setshogelo, a Ritshidze Project Officer.
“While nurses may be burdened with their own challenges, and are in some cases overworked and overwhelmed by their patient load and shortage of support, their attitudes and work behaviour remain one of the easiest targets to shift if the Department of Health can commit to bringing their employees to order. These problems seem insurmountable but there are targets that the province can and must improve on,” continued Setshogelo.
Improving the quality of services provided in public clinics is vital to ensuring enough people are accessing HIV and TB prevention services, are getting tested, and are starting and staying on treatment. It is key to achieving the UNAIDS new scaled up 95-95-95 targets that now aim for 95% of people living with HIV knowing their HIV status; 95% of people who know their status on treatment; and 95% of people on treatment to have suppressed viral loads.
Yet in the Eastern Cape, while 91% of people living with HIV know their status, only 72% of those people are on HIV treatment, out of which 88% are virally suppressed. This translates to just 66% of all people living with HIV receiving ARVs in the province and only 58% of all people living with HIV being virally suppressed. The failure to make sufficient progress towards the 95-95-95 targets, most especially keeping enough people on treatment, can be directly linked back to the crisis in our clinics in the Eastern Cape.
“Two solutions include getting more people living with HIV out of the clinic and into external pick up points, that are quicker and friendlier ways to collect ARV refills, as well as by extending ARV refills to 3 or 6 month supply. Together this can reduce the burden on clinics, ease congestion, and reduce unnecessary interactions between patients and clinic staff. Yet currently only 15% of people living with HIV that we spoke to are getting 3 months supply and 3% are getting 6 month supply, compared to 22% of PLHIV received 6 month supply and 53% received 3-5 months supply in other countries,” said Simphiwe Xaba, a Ritshidze Project Officer from SANERELA+.
In preparation for today’s community meeting, Ritshidze teams spoke directly to many people living with HIV and communities of key populations to better understand what makes them discouraged from going to the clinic.
“One woman explained to me how after being retrenched at short notice, she didn’t have enough time to go to the clinic to ask for a transfer letter. But when she got back home and went to the Matatiele Clinic they said they wouldn’t help her because she couldn’t show them a transfer letter – even though they knew her from before she went to Joburg,” said Mandisa Ndinisa, a Ritshidze Community Monitor from Positive Women’s Network.
“It means she hasn’t returned to the clinic in months and as a result she has defaulted on treatment. It’s been nine months since she was last on her ARVs. She knows that returning for treatment after an extended break will just invite being shouted at and being given a dressing down – in front of everyone. She says it’s too much, she doesn’t want to go back,” continued Ndinisa.
“One man told me that he has not received his viral load test results, even though he took the test a year ago. They keep telling him that they will add the results to his file but they cannot find them. This does not sit well with him because he doesn’t know if the treatment is working or not He didn’t know the name of his treatment either, just that he should take one pill at night — showing that treatment literacy is not happening at the clinic,” said Olona Soyamba, a Ritshidze Community Monitor from the National Association of People Living with HIV (NAPWA).
“One woman who is a sex worker told me that she is much happier now that she collects her ARVs every three months. It’s worked smoothly so far and importantly it’s helped to reduce her interaction with the facility that she says is run by nurses who can have a bad attitude. She is also always asked why she needs to take so many condoms with each clinic visit. Then when she has presented with sexually transmitted infections on several occasions over the years she says she’s judged – including being asked why she didn’t use a condom,” said Akona Ntsaluba, a Ritshidze Key Populations Organiser.
“Another woman who is trans explained to me how the staff at the clinic judge her. One nurse referred to her as “another one of those who don’t know what they are” to her colleagues. Humiliated, she left the clinic without getting any medication or any further help. She said she felt that there was no point in complaining as they just make fun of you if you are LGBTQI – even the suggestion box is useless. She has vowed never to return to Thanduxolo Clinic because of her traumatising experience there,” added Ntsaluba.
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 49 facilities in the province as well as to offer possible solutions.
Today, Ritshidze is providing a platform for community members to raise these concerns directly to the Eastern Cape health department, district and national health departments, and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) partners working in the province. The State of Health report outlines a number of recommendations to address these challenges. To follow proceedings virtually please join at: https://vimeo.com/611539071/2d9b587dbe
The full Eastern Cape State of Health report is available here.
The full presentation is available here.
A summary report is available here.
A recording will be available after the event on the Ritshidze website, Facebook and YouTube channels.
Ngqabutho Mpofu | +27 72 225 9675 | firstname.lastname@example.org
Lotti Rutter | +27 82 065 5842 | email@example.com
Through Ritshidze we are monitoring the state of HIV and TB services delivered at 49 clinics and community healthcare centres in the Eastern Cape across six districts: 14 in OR Tambo, 11 in Buffalo City, 9 in Alfred Nzo, 6 in Amathole, 5 in Nelson Mandela Bay, and 4 in Chris Hani. 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/
The Eastern Cape State of Health report takes a detailed look at the challenges people living with HIV face in the province. The report focuses on the following critical themes: long waiting times and staff shortages; infrastructure; ART collection and continuity; treatment and viral load treatment literacy; the implementation of index testing to find people living with HIV; stockouts and shortages of medicines; accessibility of health services for key populations; TB infection control; and accountability.