Batho, 9 September 2021 — Today Ritshidze is launching a detailed report into the state of the public healthcare system in the Free State. The report — based on the results of data collected through Ritshidze’s community-led monitoring — will be presented to the Free State Department of Health and other duty bearers at a community accountability meeting in Batho location.
“Today’s community meeting is providing a space for people living with HIV and other public healthcare users in the province to raise their concerns directly to those in power. Ritshidze data together with the experiences of people using the public health system in the province highlight why so many people living with HIV either never start treatment, or are pushed to stop. Our data points to the reasons why we are missing the 95-95-95 targets,” said Anele Yawa, from the Treatment Action Campaign (TAC).
UNAIDS’s scaled up targets now aim for 95% of people living with HIV to know 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 Free State, while 91% of people living with HIV know their status, only 81% of those people are on HIV treatment, out of which 89% are virally suppressed.
“Patients who shared their experiences with Ritshidze during this reporting period tell of how they feel judged by nurses, are dealt with rudely and most tragically often don’t get the medical care they need. Only 44% of patients we interviewed thought that clinic staff were always friendly and professional and people living with HIV at 15 of the 22 sites monitored complained of being shouted at if they missed an appointment. Some understanding, some humanity and some basic professionalism are what Free State clinic users are crying out for in the province,” said Mary Nyathi, a Ritshidze Project Officer.
“Frustrated patients are increasingly pushing back against nursing staff’s bad attitudes. But even as this may signal a welcome increasing awareness of patients’ rights, the growing hostility at our clinics is a terrible warning sign that broken relationships need to be mended if the clinic healthcare system is to be fixed,” continued Nyathi.
“We see that clinic staff are overburdened and overworked. Our data show that 79% of facility managers say their facilities don’t have enough staff and 64% of patients agree that there is not always enough staff at facilities. Vacancies have been reported at 20 out of the 22 sites we monitored. We know this leads to long waiting times, and the Free State has the longest waiting times across all 8 provinces monitored,” said Ndivhuwo Rambau, a Ritshidze Project Officer.
“But we are not here to just point out the problems. Two key 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,” continued Rambau.
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 returning to her ARV treatment after stopping for four years wasn’t as easy a journey as she had hoped it would be. She wakes up very early, catches two taxis and tries to be there by 6am. The nurses maybe start arriving by 7.30am. But then she doesn’t know what they are doing because sometimes she can wait till 4pm,” said Lerato Mzozwane, a Ritshidze District Organiser from Positive Action Campaign. “Worst of all, sometimes she goes home empty handed. It’s not because of stockouts but because they sometimes can’t locate her patient file. They will tell her she must come back tomorrow but she has to study and can’t stand in the queue for two days. She hopes after some time that she will be able to pick up her medicines at a Clicks or a Shoprite, because these long waiting times are just so frustrating for her.”
“One woman told me that she wakes up to be in the clinic queue before dawn when she has to visit the pharmacy for a medicine collection. But sometimes she leaves empty handed. By 2.30 or 3pm they can come and tell her that she has to go home and come back the next day and then she starts all over again. She loses out on pay for the extra days she’s forced to take off work just because the clinics can’t manage stock and patient levels. In addition to this frustration, she says she encounters very rude nurses at the reception all the time,” said Nondhlela Mphambaniso, a Ritshidze Community Monitor from Positive Action Campaign. “She added that by the middle of the day the toilets start to get dirty and are not cleaned regularly enough and toilet paper runs out and is not replaced.”
“2020 was a tough year for one community member I spoke to as she developed symptoms of being depressed. But when she told nurses at the Thabang Clinic in Welkom about her sleepless nights, nervous anxiety and not feeling like she was coping with life, the nurses sent her home with just painkillers,” said Tsholofelo Moses Mosemeng, a Ritshidze Community Monitor from TAC. “She was also concerned because the nurses don’t give her her blood test results or communicate to her about her condition. She says nurses don’t wear their name badges and she believes it’s so they can get away with being rude to patients because they know there are no easy ways to identify them and so people can’t lay complaints against them. She says it is much better because she now picks up her ARVs on a set date at her local Clicks store.”
“One person told me about the poor service he gets because he is using drugs. After telling them that he uses drugs, they stopped taking him seriously. Suddenly they don’t treat him like a human being, but like an animal,” said Hannah Mabika, a Ritshidze Key Populations Organiser. “A trans person told me that their hormone therapy was stopped because of COVID-19. Now she would have to go to Bloemfontein, which is expensive and she would have to sleep over, but she doesn’t know anyone in Bloemfontein who can accommodate her. She is frustrated because she had to stop.”
“One sex worker told me that they don’t have any respect for her and there is no privacy. People now know that she is a sex worker because the clinic staff spread these rumours. Even her clients are complaining that maybe she should stop going to this clinic, because they are also scared of being known. She told me that all the gossip comes from the clinic. People know those who are sex workers and if they are HIV positive the whole community will know that as well,” added Mabika.
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 22 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 Free State 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/600263725/acb0a9165b
The full Free State — State of Health report is available here.
A summary presentation is available here.
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Through Ritshidze we are monitoring the state of HIV and TB services delivered at 22 clinics and community healthcare centres in the Free State across three districts — 12 facilities in
Lejweleputswa, 8 facilities in Thabo Mofutsanyana, and 2 facilities in Mangaung. 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 Free State — 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; infrastructural issues and clinic cleanliness; stockouts and shortages of medicines; short supplies of ARVs and too few people using external pick up points; unfriendly services and PLHIV not being welcomed back after missing an appointment; poor understanding of viral load; discrimination of key populations at the clinic; ensuring the safety and confidentiality of index testing; poor TB infection control, and the dysfunction of clinic committees.