“The service is so bad there every time I think about a clinic appointment date I get angry, I don’t feel okay.”
Johannesburg, 1 December 2020 — To mark World AIDS Day 2020, the Ritshidze project is launching a detailed report into the state of the public healthcare system in Gauteng. The report — based on the results of data collected through Ritshidze’s community-led monitoring — will be presented to the Gauteng Department of Health and other duty bearers at a community meeting in Soweto today.
“Today we will highlight the real situation people face when using public clinics in Gauteng. As well as presenting our data, we will hear the voices of people living with HIV and other patients, and offer solutions to reverse the collapse of the healthcare system on which mostly poor people depend and rely,” said Sibongile Tshabalala, from the Treatment Action Campaign (TAC).
Gauteng is one of the South African provinces lagging furthest behind in the HIV response. In 2019, the province had 89% of people living with HIV knowing their status, yet only 66% of people living with HIV receiving HIV treatment, and only 52% of people living with HIV being virally suppressed. PEPFAR’s data shows that whilst 131,070 people were initiated on treatment between October last year and June this year, the total number of people on treatment only increased by 1,070 in the province. All of this points to extensive linkage and retention challenges.
“We have the tools to turn South Africa’s HIV crisis around, but it continues when people living with HIV avoid starting ARVs or are pushed out of care because of conditions in the health system and the ways we are treated. Whether it’s long queues, being shouted at, or being sent home without medication, these problems can and must be urgently fixed,” 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 120 facilities in the province as well as to offer possible solutions.
In preparation for today’s community meeting, Ritshidze’s community monitors carried out community-led monitoring to speak directly to many people living with HIV to better understand what makes them frustrated or even avoid accessing HIV treatment or care at the clinic altogether.
“One person told us he worries for himself as the services deteriorate. He says he knows of people who have just not bothered to start treatment or to stay on treatment because clinic visits have turned into such tedious experiences and leaves such sour tastes in patients’ mouths,” said Thabang Mhlanga, a Ritshidze District Organiser from NAPWA .
“We know the burden of trips to the clinic just to collect HIV treatment refills. It is why we have been pushing for longer 3 or 6 month supplies. Yet one woman told us she has to be back at the clinic every 12 days to pick up her ARVs. She has not been given a full month’s supply of medicines, never mind multi-month supplies that are recommended to ensure fewer clinic visits,” said Sihle Sibisi, a Ritshidze Community Monitor, from Positive Women’s Network.
“We see and hear that filing systems are often disorganised and dysfunctional, leading to longer queues and even lost or misplaced files. One man explained that he asks clinic staff how they can know the history of his problems if they have to open a new file every time. He explained that they don’t even care when he asks this,” said Karabo Xaba, a Ritshidze Community Monitor from SANERELA+.
“One man told us that he thinks poor filing systems also prevent people living with HIV who stop going to the clinic from being traced,” said Lindiwe Mahlangu, a Ritshidze District Organiser from Positive Women’s Network. “He explained that they don’t phone those people to ask why they’re not taking treatment or coming back to the clinic. But he can believe that, he said, because they can’t find anyone’s files so he thinks they just don’t care for anyone.”
“During our door to door engagement, at times confidentiality is raised as a challenge,” said Fikile Mtsweni, a Ritshidze District Organiser from TAC. “One person explained that sometimes he wants to discuss something with the nurse but now he has to say it in front of everybody so he keeps quiet instead. He does not understand why they don’t work in the other rooms and then they can also see more patients at a time.”
“Another person told me that it is the security guard who takes their appointment cards and goes to find the files. He went on to say that the person is harsh, he screams at them and there’s no confidentiality and everyone knows they are there because they are HIV positive because he is shouting at them to stand in different queues.”
Today, Ritshidze is providing a platform for community members to raise concerns directly to the Gauteng health department and aid agencies working in the province. To follow proceedings virtually please sign up at https://bit.ly/RitshidzeGauteng.
The full State of Gauteng Health report is available here.
A summary presentation is available here.
A recording will be available after the event on the Ritshidze website.
Contact:
Ngqabutho Mpofu | +27 72 225 9675 | ngqabutho.mpofu@tac.org.za
Lotti Rutter | +27 82 065 5842 | lotti@healthgap.org
Follow Ritshidze on twitter, facebook and instagram for regular updates or go to www.ritshidze.org.za for more information.
Through Ritshidze we are monitoring the state of HIV and TB services delivered at 120 clinics and community healthcare centres in Gauteng across four districts — City of Johannesburg (49 facilities), City of Tshwane (24 facilities), Ekurhuleni (39 facilities), and Sedibeng (8 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/