Polokwane, 26 August 2021 — Today Ritshidze is launching a detailed report into the state of the public healthcare system in Limpopo. The report — based on the results of data collected through Ritshidze’s community-led monitoring — will be presented to the Limpopo Department of Health and other duty bearers at a community accountability meeting in Polokwane.
“Today’s community meeting will give people living with HIV and other public healthcare users in the province the opportunity to talk directly to those in power. Our data and the experiences of people using the public health system in the province are a reality check for duty bearers — pointing to why so many people living with HIV either never start treatment, or are pushed to stop,” said Sibongile Tshabalala, 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 Limpopo, while 91% of people living with HIV know their status, only 73% of those people are on HIV treatment, out of which 87% are virally suppressed.
“Our data point to a number of reasons we are missing the 95-95-95 targets. For one, only 57.9% of patients thought that the staff were always friendly and professional. This lack of professionalism and bullying attitudes by some nurses has come to define the experiences of many patients reliant on Limpopo’s clinics. We need a clear strategy to change this as it inflames tensions between communities and their local healthcare workers. Most devastatingly, it has removed trust and confidence in the healthcare system and has resulted in dire impacts on patients’ care,” continued Tshabalala.
“Perhaps the most surprising finding is the very high proportion of people living with HIV in Limpopo receiving only one-month or less supply of ARVs refills (46%) — this is shocking considering that South Africa’s national policy standard is for two months,” said Ndivhuwo Rambau, a Ritshidze Project Officer.
“Extending ARV supply to 3 or 6 months and channelling more stable people living with HIV to external pick up points are two of the strategies proving to get the thumbs up. It has reduced congestion, waiting times and patient loads at clinics. And most significantly, it minimises patients’ unnecessary interactions with staff. It’s this experience patients often describe as the most traumatising and dehumanising part of trying to manage their illnesses or just to get some medical help,” continued Rambau.
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 17 facilities in the province as well as to offer possible solutions.
In preparation for today’s community meeting, Ritshidze teams spoke directly to many people living with HIV to better understand what makes them discouraged from going to the clinic.
“One man told me that people living with HIV find it difficult to access care at clinics due to the way that they are treated. He explained that in his village everyone knows his status because of home based care workers,” said Charles Maponya, a Ritshidze District Organiser from Positive Action Campaign. “If he gets involved with anyone they will literally tell the person to be careful of him because he is living with HIV. This really hurts him. People are even dying due to stopping treatment and being afraid to go back to the clinic. When you come back to the clinic, close to 10 nurses will huddle around you and lash out while other patients are listening. Even if a patient dies, the nurse publicly announces that a “defaulter” has died.”
“One community member told me that it seems nurses find any excuse to bully patients like her. Adding that they are always shouting at the patients and even if you get there by 7am and they know you are only going there to collect medicine they won’t help you. They let you sit there till 3pm or 4pm,” said Andronicah Mogano, a Ritshidze Community Monitor from Positive Action Campaign. “She says the few times she’s been unable to make her collection dates she’s literally blasted and screamed at like a misbehaving child. “They make me want to default – they don’t want to hear that I had a problem coming to the clinic on that day” she said. The attitude of the nurses at the clinic is traumatising and deeply hurtful for her. This August she was approved to collect medicines at an external pick up point which has come as a huge relief for her.”
“One woman told us that the clinic is staffed with nurses that are not interested in helping patients, are rude and “have attitude problems”. The relationship has become so bad that she says frustrated patients regularly get into arguments with nurses. Now that she only has to return to the clinic every three months for a check-up and can pick up her ARVs at a doctor’s practice at three-months intervals she says her anxiety levels and stress has dropped,” said Walter Maluleke, a Ritshidze Community Monitor from TAC.
“One man told us that just to go there to pick up your medicines means you can wait an hour or more at each queue. Adding that there have been occasions when he’s just been told to come back on another day once he’s got to the front of the queue. He says it is frustrating that the clinic staff don’t understand that when they can’t operate efficiently it affects patients’ entire days,” said Virginia Motau, a Ritshidze Community Monitor from TAC.
“One sex worker told me that they always oppose giving sex workers medication and she ended up not going to the clinic anymore. Adding that she has been treated badly at all times,” said Nkhensani Mavasa, a Ritshidze Key Populations Organiser from TAC. “A trans person told me that they do not feel comfortable at the facility. They are not accepted and it makes them feel threatened or unsafe by just being themself. There is no confidentiality whatsoever. They only shout at trans people, people who are gay, and sex workers.”
Today, Ritshidze is providing a platform for community members to raise these concerns directly to the Limpopo 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/591689280/2ad1822618
The full Limpopo State of Health report is available here.
A summary presentation 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 17 clinics and community healthcare centres in Limpopo across three districts — 5 in Capricorn, 5 in Mopani, and 7 in Vhembe. 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 Limpopo 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; 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.