• 2nd edition of State of Health report compares data over the last year of community-led monitoring in Mpumalanga
• The data, together with stories from people living with HIV, key populations and other public healthcare users, will be presented at a community meeting today
• The meeting will be live streamed on vimeo, facebook and YouTube

Kabokweni, 23 June 2022 — Sometimes Zandi* feels stuck in a cycle of starting treatment, stopping, then restarting treatment all over again. Currently she has managed to stay on treatment for nearly a year, but she says that poor staff attitudes and bad services at the clinic are still major challenges for her.

“You have to go to the clinic from early on and you end up fighting with the nurses when you get there and you wait long to be helped and only get home past 4pm,” she says of her typical clinic visit. 

People living with HIV and other public healthcare users continue to be frustrated about long days spent at the clinic. 65% of people interviewed by Ritshidze between April and May 2022 complained of long waiting times — blaming messy filing systems and lost files (37%), staff shortages (31%), and staff working slowly or not working properly (31%) as the main causes of slow service. 

While there has been an improvement in the last year, with waiting times after the facility opens declining from 4:33 hours to 4:05 hours according to public healthcare users, this remains an extremely long time for people to have to wait at the facility to only be seen for a limited time.

One community member explained his frustration: “It hurts to feel less important in the community or clinic, because we spend the whole day moving from one bench to another, only to be told that they cannot help you. You don’t even have money to buy an orange. You are hungry and spend the whole day there. The nurses and doctors move up and down but it’s not clear what they are doing. Whenever you hear their footsteps, you look up in the hope that they’ll call out your name, but they don’t. They sometimes tell us to go and buy the treatment. I ask them how I should do that because the reason I come to the clinic is that I don’t have money.”

Long waiting times are among ten key issues outlined in the second edition of a new Ritshidze State of Health report. The report will be launched at a community meeting in Kabokweni today. 

Positively, since last year’s report, there have been several improvements in the quality of healthcare delivered in the province. For instance, while only 7% of Facility Managers reported that there were enough staff to meet demand last year, this has increased to 41% of Facility Managers this year. Further many vacancies have been filled in the sites monitored in the province. However, staff shortages persist in the majority of sites and 97 vacancies across 17 facilities remain to be filled. 

“There is a shortage of nurses, but you will also see that the nurses will take long tea or lunch breaks and they all go on tea and lunch together. It means that I can wait over five hours just to pick up my pills,” another community member explained.

Another positive is the increase in people living with HIV receiving 3 to 6 months supply of ARVs — up from 41% last year to 49% now. Facilities monitored in Mpumalanga are performing best across Ritshidze’s 400 sites being monitored in the country. However overall progress on multi-month dispensing is slow compared to other PEPFAR-supported countries where 75% of people are getting 3 to 6 months supply already. Worryingly also is the 17% of people living with HIV who reported getting one month or less supply, with 10% reporting just two weeks supply. Amsterdam CHC, Mkhondo Town Clinic, Piet Retief Clinic, Ethandakukhanya Clinic alone accounted for 107 reports of people living with HIV receiving 2 weeks supply of ARVs in this reporting period.

External pick-up points make ART collection quicker and easier according to 98% of respondents using them — and people are on the whole satisfied with them, although improvement can be made. As such more people should be given the choice to use these options, especially given that 53% of respondents still said they would prefer to collect ARVs closer to home.

One community member wanting to use an external pick-up point revealed how the paperwork to get her into the pick-up point to collect her ARVs has also been messed up repeatedly and she says she’s not the only person affected by poor administration. The clinic has in some cases been doing double dispensing, at the clinic and at the external pick-up points, she says, pointing out that it’s common that people return to the clinic with their extra medication, confused. There are currently only two external pick-up points for ARVs in the Amsterdam area and she told us there needs to be more. For instance, the 24-hour facility could have an after-hours pick-up point even if it doesn’t offer full clinic services after 4pm.

For key populations, the experience at public health facilities is often untenable. Too often staff are insensitive and unprofessional and some say the ill-treatment has been off-putting enough for them to prefer to go without ARV treatment or other health services.

“The nurses are bad; they say things behind my back about my gender or shout things about me as a trans* person in front of all the other patients. Everyone can hear, it makes you want to stay at home rather than to get your treatment.”

For those who continue to suffer the daily indignities associated with using the public health system, specific services remain unavailable for the most part: with only 11% of people who use drugs reporting access to methadone at drop-in centres; only 2% of gay, bisexual and other men who have sex with men saying lubricant is available at the facility; and 0% of trans* people reporting access to hormones.

The report calls for all staff, from security guards to clinicians, to provide respectful, safe, friendly, and confidential services — and for KP specific services to be made available at at least two designated public facilities per district.

“Through our community-led monitoring, we see and hear many challenges that make it hard for someone to test for HIV, access HIV prevention options, or even to stay on their HIV treatment once they have started. While the Mpumalanga Department of Health has made some significant improvement in the last year, more needs to be done to ensure that everyone can access the HIV, TB and other health services they need,” says Anele Yawa, from the Treatment Action Campaign (TAC).

“Ritshidze will continue to push for public healthcare users to understand their rights, be supported to raise their voices, and to be at the centre of determining the interventions that will get our clinics on the path of quality service delivery.” 

For more information or to arrange interviews contact:

Ngqabutho Mpofu | +27 72 225 9675 | ngqabutho.mpofu@tac.org.za 

Lotti Rutter | +27 82 065 5842 | lotti@healthgap.org

Note to editors:

This is the second edition of the Mpumalanga State of Health report; the first was published in May 2021. Like the earlier edition, the second edition of the Mpumalanga State of Health report outlines key challenges people living with HIV, key populations and other public healthcare users 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; accessibility of health services for key populations, specific services for men; the implementation of index testing to find people living with HIV; and stockouts and shortages of medicines.

Today, Ritshidze is providing a platform for community members to raise their concerns directly to the Mpumalanga health department, district and national health departments, and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) partners working in the province. To follow proceedings virtually please join at: https://vimeo.com/722578233 

The full Mpumalanga State of Health report is available here

The full presentation is available here

A summary report is available here

The media alert is available here

A recording will be available after the event on the Ritshidze website, Facebook, and YouTube channels.

About Ritshidze: 

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 42 facilities across Mpumalanga — including 21 in Ehlanzeni, 17 in Gert Sibande, and 4 in Nkangala.

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/ 

Follow Ritshidze on twitter, facebook and instagram for regular updates or go to www.ritshidze.org.za for more information.