Durban, 11 November 2021 — Today Ritshidze is launching a detailed report into the state of the public healthcare system in KwaZulu-Natal. The report is based on the results of data collected through Ritshidze as well as stories from community members about the challenges they face using public clinics. It will be presented to the KwaZulu-Natal Department of Health and other duty bearers at a community accountability meeting in Umlazi.
“Ritshidze provides community evidence about the persistent and unaddressed crisis in our clinics that cause barriers to long term HIV treatment adherence. We pinpoint challenges at public healthcare facilities that cause people living with HIV to interrupt treatment or even disengage from care altogether, as well as challenges other public healthcare users including key populations struggle with in accessing HIV prevention or other health services,” said Sibongile Tshabalala, from the Treatment Action Campaign (TAC).
“There’s growing concern that poor staff attitude is doing deep damage to primary healthcare. Not only is it affecting delivery of healthcare services to people but it’s indirectly putting people’s lives at risk too. 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 Simphiwe Xaba, a Ritshidze Project Officer from SANERELA+.
“More and more people living with HIV are reporting that they have or are contemplating stopping treatment and some already stopped taking their medicines because they are fed up and can no longer stomach the abuse and dismissive attitude of nurses, security guards and cleaning staff working at the province’s facilities,” said Silindile Lukozi, a Ritshidze District Organiser from TAC.
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.
In KwaZulu-Natal, 94% of people living with HIV know their status, 85% of those people are on HIV treatment, out of which 89% are virally suppressed. Of all provinces, KwaZulu-Natal has made the most progress towards achieving these targets. However there is still a way to go to reach epidemic control in the province and failure to make sufficient progress towards these targets can be directly linked back to challenges found in our public healthcare facilities.
“We have solutions. For example, we can reduce the burden on clinics and people living with HIV by making use of more external pick up points, that are quicker and friendlier ways to collect ARV refills, and by extending ARV refills to 3 or 6 month supply. Yet currently only 29% of people living with HIV that we spoke to are getting 3 months supply and only 2% 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 Ndivhuwo Rambau, a Ritshidze Project Officer.
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.
“Dudu told me that picking up her ARV medicines at the Lindelani Clinic in Ntuzuma takes her on average six hours of queuing each time. She has for years heard complaints from other people living with HIV that they can’t afford to skip a day of work just to stand in queue and they would rather get paid at work and default on their treatment. She told me that people don’t want to stand there — there are too many people at Lindelani and the nurses are very bad — always shouting, shouting every time,” said Nelisa Khoza, a Ritshidze Community Monitor from Positive Women’s Network.
“Noncebo is currently on a three-monthly script for her ARVs, which has been a small relief but she says each clinic visit is still like a bad dream. She is still shunted from one queue to the next. It also happens often enough that she gets sent home because she’s told her file can’t be located. She will come back the next day and have to start waiting from the beginning again. She says it’s very exhausting dealing with the clinic and sometimes she feels like it’s not worth it to go to all this trouble just to stay on my ARV medication,” said Lungile Nsomi, a Ritshidze Community Monitor from the National Association of People Living with HIV (NAPWA).
“One transgender woman who is also a sex worker told me that nurses would shout out to each other “Is this one a boy or a girl?” every time she had to be in the facility to pick up her ARVs. Their relentless mocking made clinic visits tense and traumatising for her. But then the tensions turned to abuse and violence one day. She told me how she had defaulted on her treatment at that time but had returned to the clinic hoping to get some assistance to restart treatment. It was around 2.30pm and the nurses called the security and the guards came and dragged her out, and then they beat her outside,” said Monica Nyawo, a Ritshidze Key Populations Organiser.
“Another man who uses drugs told me that the staff at the clinic do not treat people who use drugs as human beings. They are very judgemental, calling them offensive names. He has been chased away from the clinic before because of being dirty, where the nurse told him that they will not assist “amaphara” which is a label for a thug. In some days they will assist everyone who came to the facility after his arrival and when he asked them they said “shut up, who are you to tell us what to do and who to see first”. He has stopped using this facility,” added Nyawo.
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 are more systematically documenting the failures in quality HIV, TB and other health service delivery at 135 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 KwaZulu-Natal 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/643525535/0f8b6fae40
The full KwaZulu-Natal 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.
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Through Ritshidze we are monitoring the state of HIV and TB services delivered at 135 clinics and community healthcare centres in KwaZulu-Natal across seven districts: 68 in eThekwini, 15 in uThukela, 15 in uMgungundlovu, 12 in King Cetshwayo, 11 in Ugu, 9 in Zululand, and 5 in Harry Gwala. 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 KwaZulu-Natal 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.