- 2nd edition of State of Health report compares data over the last year of community-led monitoring in the North West
- 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
Mafikeng, 21 July 2022 — When Tebogo* goes to the facility, he is told that there is no medication. Instead he is given a prescription to go to a private pharmacy and use his own money to buy the medicines. “When you don’t have money it is a problem. You end up not wanting to go to the clinic.”
Public healthcare users like Tebogo continue to be frustrated as they are sent home empty handed from some facilities in the North West province. Ritshidze data collected between April and May 2022 reveals that 26% of people interviewed had left, or knew someone who had left a facility without the medication that they needed in the last three months. The North West performed worst of all provinces monitored by Ritshidze on this indicator.
Stockouts cause frustration and confusion to public healthcare users and people living with HIV. Another community member explained that “the nurses shout at us when we default and talk to us the way they want to, while they are the ones that are not giving us medication”.
An extensive monitoring effort led by the Treatment Action Campaign (TAC), the Stop Stockouts Project (SSP), and Ritshidze at an additional 57 sites across all four districts in the province further revealed 398 reports of different medicines, contraceptives and vaccines being out of stock. While major improvements have been made, down from 895 reports across 56 facilities last year, the stockouts crisis still persists.
Stockouts 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 Mafikeng today.
The report finds improvement in certain indicators, and deterioration in others over the last year, impacting the overall quality of HIV, TB, and other health services.
One area of improvement is that of the 390 people living with HIV interviewed, all but one said that a healthcare provider had explained their viral load test results to them. This compared to 93% in the same reporting period last year. The province is performing best on this indicator for the second year in a row.
Healthcare providers must also ensure that they better explain the benefits of adhering to treatment. Overall just 73% of people living with HIV we spoke to actually agreed with the statement: “having an undetectable viral load means the treatment is working well”, and only 75% agreed with the statement “having an undetectable viral load means a person is not infectious”.
However this challenge can be pinpointed to Dr Kenneth Kaunda district. While the majority of sites in Bojanala and Ngaka Modiri Molema had 100% agreement with these statements, most people living with HIV in Dr Kenneth Kaunda were unable to correctly answer these questions, pointing to possible challenges with how viral load test results are being explained in the district.
“I don’t know anything about my medicine,” one community member from Rustenburg who had been switched to a one month script told us. “They also don’t write it in my file, so every time they will ask me from the beginning and I don’t know anything,” He says every time it feels like he’s just left in the dark a little more about exactly what’s happening in his body. He says it’s a waste of his time and money to drive to the clinic every month, but worse than that he can’t get anyone to explain to him why they made the decision to change his medicines.
On ARV refill length, facilities monitored in the North West are performing worst across Ritshidze’s 400 sites being monitored in the country, with just 17% of people living with HIV interviewed getting a 3-6 month ARV refill. This compares to 49% in Mpumalanga, the province that is performing best, and 75% of people are getting 3 to 6 months supply in other PEPFAR supported countries.
For key populations, the experience at public health facilities in the North West can be humiliating and even openly hostile. Out of 754 members of key populations we spoke to in the province between August and October 2021, 23% of gay, bisexual and other men who have sex with men, 38% of people who use drugs, 9% of sex workers, 20% trans* people had stopped accessing health services altogether.
One community member from Klerksdorp described his visits to collect ARVs as stressful and frustrating. “There is no privacy at the clinic, they have had shortages of medicines before and the nurses are very unfriendly and unhelpful,” he says. As an openly gay man he said that nurses are judgemental and rude and deliberately make fun of him. “They will give you looks and they gossip about you and make some wise cracks to your face,” he said, “you can’t discuss anything serious with them even when you have a problem.”
The report calls for all staff, from security guards to clinicians, to provide respectful, safe, friendly, and confidential services.
Another key issue revealed in the data is on people living with HIV being denied ARVs because of not having a transfer letter. “Last year I went to Potchefstroom to ask for my treatment. I am taking ARVs. They treated me badly and were shouting at me. They said I should go back to where I came from and come back with a transfer letter to get my medication”, a community member explained.
Transfer letters are not required in the national adherence guidelines, yet 123 people in North West interviewed by Ritshidze had been denied access to services for not having one since we started collecting this data last October. This represents 7% of all public healthcare users interviewed, but given that most people interviewed are unlikely to have attempted to transfer services, it continues to point to a much larger problem regarding the communication and policies regarding transfer letters. There were also numerous reports of people being denied access to services for not having an identity document.
“Through our community-led monitoring, we see and hear many challenges that make it hard for people to access HIV and TB prevention and treatment. The North West Department of Health has made certain improvements in the last year, however 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).
* Identity withheld to protect the public healthcare user.
For more information or to arrange interviews contact:
Ngqabutho Mpofu | +27 72 225 9675 | firstname.lastname@example.org
Lotti Rutter | +27 82 065 5842 | email@example.com
Note to editors:
This is the second edition of the North West State of Health report; the first was published in June 2021. Like the earlier edition, the 2022 report identifies challenges that discourage people from going to the facility for HIV, TB and other health services. The report focuses on the following critical themes: stockouts and shortages of medicines and other health products; staffing; waiting times; infrastructure and clinic conditions; ART collection; ART continuity; treatment and viral load literacy; accessibility of health services for key populations; specific services for men; and the implementation of index testing to find people living with HIV.
Today, Ritshidze is providing a platform for community members to raise their concerns directly to the North West 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/731281189
The full North West 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
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 13 facilities across the North West — including 6 in Bojanala Platinum, 4 in Dr Kenneth Kaunda, and 3 in Ngaka Modiri Molema.
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/
Additional quantitative data related to stockouts and shortages of medicines and other health products was collected between May and June 2022 by a secondary team led by the Treatment Action Campaign (TAC), the Stop Stockouts Project (SSP) and Ritshidze in an additional 57 facilities across all four districts in the North West. Data collection took place at 57 sites: 12 sites in Bojanala Platinum, 15 sites in Dr Kenneth Kaunda, 10 sites in Dr Ruth Segomotsi Mompati, and 20 sites in Ngaka Modiri Molema. Data were collected by talking to Facility Managers and pharmacists or pharmacist assistants, where available. Where unavailable, the team engaged with anyone tasked with oversight of the pharmacy. All data are available at bit.ly/NWstockouts2022
Additional quantitative data related to key populations was collected between August and October 2021. Data collection took place across three districts: Bojanala Platinum, Dr Kenneth Kaunda, Ngaka Modiri Molema. A total of 754 surveys were taken, combining 271 gay men, bisexual men, and other men who have sex with men (GBMSM), 340 people who use drugs, 74 sex workers, and 69 trans* people.