“When I go to collect my pills they tell me that there is no stock and there is nothing they can do about it. We must go buy them ourselves. I ask them how will I buy them because I am unemployed and I end up leaving without the treatment.”
Mahikeng, 25 June 2021 — Today the Ritshidze project is launching a detailed report into the state of the public healthcare system in North West. The report — based on the results of data collected through Ritshidze’s community-led monitoring — will be presented to the North West Department of Health and other duty bearers at a community accountability meeting in Mahikeng today.
“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. Together with people’s personal experiences, we will present data from Ritshidze that highlights problems at our local clinics and offer solutions to fix the challenges found,” said Anele Yawa, from the Treatment Action Campaign (TAC).
While the province is on track to reach the first target set by UNAIDS — 90% of people living with HIV know their status — only 60.5% of those who know their status are actually on treatment.
“The growing crisis in many clinics in the North West has reached a point where patient care is being compromised — and there is a deepening worry that people living with HIV are being pushed into stopping ARVs. Our data points to well rooted problems like staff shortages and unfriendly services. 100% of facility managers we spoke to said clinics were understaffed and only 60.3% of patients thought staff were always friendly. These were the major culprits for poor clinic care, together with a widespread and persistent stockouts crisis,” 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 14 facilities in the province as well as to offer possible solutions.
A further fact-finding mission took place in 56 clinics across the province led by TAC, the Stop Stockouts Project and Ritshidze to assess the availability of medicines — results of which revealed stockouts of 895 different types of medicines lasting anywhere between a month to two years.
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.
“One woman told us that there’s a day in the month that makes her especially anxious – it’s the day her 14-year-old daughter, Boipelo, has to go to the clinic to fetch her ARVs,” said Ludick Mabyane, a Ritshidze District Organiser from TAC. “She waits with her phone to hear what she says – because sometimes they will tell her they don’t have tablets left and she has to come home. She added though that she expects to wait till 2pm or 3pm before she hears from her daughter, because a visit to the clinic comes with a long wait.”
“One man explained that he believes that queues at the clinic are long because patient numbers aren’t properly managed,” said Tebogo Setshedi, a Ritshidze Community Monitor from Positive Action Campaign. “He told me that there are also problems with how patient files are kept. Patients have to wait for their file to be located or nurses simply open new files even though this comprises patient care because there is no medical history recorded in the new files. He says he gets to the front of the queue only to be told to come another day when his file can’t be found.”
“One trans woman told us that she has to fight being mis-gendered every time she goes to the clinic. Even though she dresses like a woman she will be addressed by “mister”. She says that for years the nurses would still ask her unacceptably prying questions about her sex life or they would start to preach to her about her life. She says that the nurses there want to know how she has sex with her partner or those that are very Christian are judgemental instead of giving her information or medical guidance,” said Gladness Seetseng, a Ritshidze Community Monitor from TAC.
“One man told us that he has lost count now at the number of times that he gets to the clinic to collect ARVs and they write him a letter to go fetch his medicines at the hospital in town. He says the best answer he gets is that they have medicine shortages, but there’s no actual communication or empathy for his situation. And often he admits that he doesn’t make it to the hospital, with the result that without his medicines he ends up defaulting on treatment,” said Priscilla Oliphant, a Ritshidze Community Monitor from Positive Action Campaign. “He went on to say that he does not default intentionally, but it costs him R24 to the clinic and R24 back for taxi, and it’s too far to walk.”
Today, Ritshidze is providing a platform for community members to raise concerns directly to the North West health department and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) partners working in the province. To follow proceedings virtually please sign up at https://bit.ly/RitshidzeNorthWest2021.
The full North West 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 14 clinics and community healthcare centres in North West across three districts — 3 in Ngaka Modiri Molema, 7 in Bojanala Platinum, and 4 in Dr Kenneth Kaunda. 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/
Further data specific to stockouts and shortages of medicines, vaccines, and contraceptives is outlined in this report. It was collected by a secondary team led by the Treatment Action Campaign (TAC), the Stop Stockouts Project (SSP) and Ritshidze at 56 facilities across North West in May 2021, based upon ongoing reports of major challenges in regard to the availability of medicines. The full data set is available here: https://bit.ly/NWstockouts2021
The North West 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.