“You go to the clinic very early; sometimes I wake up by 4am because I’m not sleeping anyway because I’m stressed about the clinic visit… Then you find yourself sitting there and it’s 10am, and then it’s 11am and you’re still waiting and then it’s 12 noon and you’re still there – there’s something not right with that.”
Ermelo, 25 May 2021 — Today the Ritshidze project is launching a detailed report into the state of the public healthcare system in Mpumalanga. The report — based on the results of data collected through Ritshidze’s community-led monitoring — will be presented to the Mpumalanga Department of Health and other duty bearers at a community accountability meeting in Ermelo today.
“Today’s community meeting is a space for public healthcare users to talk directly to those in power — to tell them what it is really like to use public clinics in the province. Together with these first hand experiences, we will present data collected through Ritshidze that identifies the problems at our local clinics, and offer solutions to reverse the challenges found,” said Sibongile Tshabalala, from the Treatment Action Campaign (TAC).
The good news is the province is on track to reach the first target set by UNAIDS — 90% of people living with HIV know their status. However, only 71% of those who know their status are actually on treatment. Too many people never start treatment, or they are then driven away because of conditions in the health system and the ways they are treated.
“To get more people on treatment, we must fix the problems that mean people avoid starting ARVs or stop taking them altogether. Some people living with HIV in Mpumalanga who are already on multi-month scripts told us how even as clinic visits have become less frequent, it still gives them stress and literal sleepless nights every time they know they have to set foot into the facilities that make them feel worse rather than better,” said Simphiwe Xaba, a Ritshidze Project Officer from SANERELA+.
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 43 facilities in the province as well as to offer possible solutions.
In preparation for today’s community meeting, Ritshidze’s community monitors spoke directly to many people living with HIV to better understand what makes them discouraged from going to the clinic.
“Even with multi month scripts, one man told me that the 4 monthly check up at the clinic is an experience he absolutely loathes,” said Lucky Gwebe, a Ritshidze District Organiser from NAPWA. “He goes there early, waking up at 4.45am to make sure he gets into the queue early. It costs him R24 in taxi fare for a return trip and when he gets there he has to wait outside even if it’s raining, windy, cold or even when it’s very hot – there is no shelter. You also have to stand, because there are no chairs for patients. He went on to say that they separate people living with HIV from other patients without any discretion or respect for patients’ privacy.”
“One woman explained that it’s difficult to truly understand why clinic queues are long and why staff seem to work slowly and inefficiently,” said Owen Nhlanhla, a Ritshidze District Organiser from TAC. “Right now she only needs to go to the clinic every three to six months and pick up her medicines at her supermarket. She says it can take her just 15 minutes to collect and go – which is a far cry from a clinic visit that takes all day. She says she doesn’t sleep the night before an appointment because she is so stressed.”
“We see and hear that filing systems are often messy, leading to longer queues and even lost files. One woman explained that sometimes there are delays getting files or they don’t get a file or are told it is lost. She explained that it is not nice going to the clinic. Telling me that on her date, she is so unhappy. When it’s your date you are so unhappy,” said Innocentia Ndlovu, a Ritshidze Community Monitor from Positive Women’s Network.
“One woman told me that it’s difficult to speak out and to protest against the bad service. She says staff shout at patients. It scares people into thinking that if they complain they will not be taken seriously, or worse, they will be victimised,” said Lungile Biyela, a Ritshidze Community Monitor from TAC.
Today, Ritshidze is providing a platform for community members to raise concerns directly to the Mpumalanga health department and aid agencies, including The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), working in the province. To follow proceedings virtually please join on vimeo, YouTube or facebook live.
The full State of Mpumalanga Health report is available here.
A summary presentation is available here.
A recording will be available after the event on the Ritshidze website.
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 43 clinics and community healthcare centres in Mpumalanga across three districts — Ehlanzeni (21 facilities), Gert Sibande (18 facilities), and Nkangala (4 facilities). 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 Mpumalanga 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: shortages of staff and long waiting times; infrastructural challenges; stockouts and shortages of medicines; challenges with long term ART adherence; tracing and re-engaging people living with HIV in care; challenges specific for key populations; ensuring the safety and confidentiality of index testing; poor TB infection control, and the dysfunction of clinic committees.