- 3rd edition of State of Health report compares data over the last three years 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 in Mahikeng
- The meeting will be live streamed on vimeo, facebook and YouTube.
Mahikeng, 20 July 2023 — “I get there as early as 7am and leave around 3pm. We get into a long queue, only to be told that they don’t have tablets. I ask for the day off from work to come then have to ask for another day off to do the same thing… They should notify us upon arrival about the unavailability of our tablets, to avoid us wasting time and risking our jobs.”
Public healthcare users continue to be frustrated as they are sent home empty handed from facilities in the North West. Data collected by the Stop Stockouts Project, the Treatment Action Campaign (TAC), and Ritshidze from across 72 sites revealed 404 reports of different medicines, contraceptives, and vaccines being out of stock in the preceding three months. The North West performed worst out of all provinces monitored on stockouts again this year.
“Our clinic is a disaster. When you get there they tell you that they don’t have your medication,” one man told us, who is forced to borrow money from his neighbours to buy tablets. Another felt exasperated: “after being consulted, you realise they have a shortage of medication. They tell me that my treatment is incomplete because some of it hasn’t arrived. I don’t know how that is possible.”
21% of reported stockouts had lasted between 1 and 3 months, 11% had lasted between 3 to 6 months, and 7% had already lasted more than 6 months. Worryingly, 60% of these stockouts had not been resolved at the time of the survey. 49% of sites blamed unreliable transportation for stock not arriving on time — and in efforts to be able to dispense medicines, 81% of facilities said they borrow from other facilities, only creating an ongoing cycle of shortages.
Stockouts and shortages of medicines are among ten key issues outlined in the third edition of the Ritshidze State of Health report about the North West health system. The report will be launched at a community meeting today in Mahikeng.
Alongside stockouts, the North West also performed worst on staff friendliness. Only 49% of public healthcare users thought that clinic staff were always friendly and professional. Further, 29% of people living with HIV who return to the clinic after missing an appointment said they are sent to the back of the queue — something that is against national adherence guidelines.
“You ask yourself why because the clinic is a place where we should get help,” one person living with HIV explained. “You can’t miss your appointment by one day because they will scold you… They give you another appointment date… (but by) that time you only have a few tablets left, like now for example.”
Another frustrated community member told us: “The treatment is not good, especially if you miss your appointment date. They tell you a lot of things and even threaten to remove you from their clinic and (say) you will not get help anywhere else. They take you to all the consultation rooms, telling everyone in the facility that you had disengaged from care.”
Treatment of key populations is even worse. Only 34% of gay, bisexual, and other men who have sex with men said staff are always friendly, only 22% of people who use drugs, only 45% of sex workers, and only 30% of trans* people — and the majority of key populations interviewed did not feel safe or comfortable at the facility, and many reported major privacy violations.
“Everything is wrong at that clinic,” one woman said. “I have been at the clinic when all they want is to do is make a spectacle of you if you are gay or lesbian. They will even ask ‘how do you do it’ — about my sex life — I couldn’t believe it.”
A trans woman recounted how the facility ignored her after she faced sexual violence. “I was raped and went to the clinic, they said to me that they don’t believe me, that we “gays” like to sleep around. I was showing them all the bruises, cuts, and I was bleeding. I asked them if this is how I should look if it was consensual sex… if the people at the clinic did not believe me, who then do I go to?”
In other findings, while positively waiting times reduced over the last year, on average people still spend 4:14 hours waiting in the facility — and the average waiting time was over 4 hours at 29% of facilities monitored. Too many people still spend many hours at each visit which is a major source of dissatisfaction — “I will be there for the whole day on an empty stomach. You will leave at 4pm when they knock off”, one community member described.
Another said: “Patients arrive at the clinic at 4am and leave at 3pm while waiting to consult… The receptionists all go on a tea break at the same time, all four of them, without informing patients. The security guards prepare patient files… while the clerks are on their phones catching up on the previous week’s gossip. This needs to stop.”
92% of people reported long waiting times — with 71% blaming staff shortages, 41% blaming staff not working/working slowly, and 74% blaming disorganised filing systems.
One strategy to reduce waiting times and ease congestion is for people who are just collecting medicines to get a longer supply of medication. This simply means less trips back to the clinic. Unfortunately only 21% of people living with HIV we spoke to had gotten a 3-6 month ART refill — compared to 64% in Mpumalanga, the best performing province, and 80% in other PEPFAR supported countries.
A community member explained to us the distress of not being able to even get a 2 month refill. “I once requested that they give me a longer supply because… I got temporary work that will be for two months. The nurse gave me a one month refill and said I will have to make a plan wherever I’m going. They scolded me when I got back.”
Another strategy is to go straight to a pick-up point to collect ARVs. Yet 59% of people using facility pick-up points told us that they must still collect files, take vitals, and see a clinician before getting their parcel — adding unnecessary delays. While it should take less than 30 minutes to collect your parcel and go, 34% of people interviewed said it takes up to an hour, 18% said it takes up to 2 hours, and 33% said it takes more than 2 hours. Of those still using the facility, 50% said they had never even been offered the option to collect from a pick-up point — and 61% wish they could collect their ARVs closer to home.
“I used to collect from the Post Office… It was never explained to me why I had to go back to the clinic,” one individual explained at no longer being able to use an external pick-up point. “I would be happy to collect it at the Post Office again because there’s no stress. You just produce your appointment card, get your medication and leave.”
“Through our community-led monitoring, we see and hear many challenges that make it hard for people to access health services. Much more needs to be done to ensure that everyone can access the HIV, TB and other health services they need,” says Sibongile Tshabalala, from the Treatment Action Campaign (TAC).
In the words of one community member: “These things must go to a higher level because these nurses can’t be allowed to carry on this way. Even now when I am sick I can’t go to that clinic — I would rather suffer in my house than to go there — this is not right at all.”
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 third edition of the North West State of Health report; the first was published in June 2021, and the second in July 2022.
This week, Ritshidze is providing a platform for community members to raise their concerns directly to the district and provincial health departments and PEPFAR partners working in the province, Aurum and TB HIV Care. To follow proceedings virtually please join at: Vimeo / YouTube
The full North West State of Health report is available here
The presentation is available here
A summary report is available here
A summary of recommendations is available here
A recording will be available after the event on the Ritshidze website, Facebook, and YouTube channels.
About the report:
The report has been developed using data from 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+).
Ritshidze monitoring takes place on a quarterly basis at more than 400 clinics and community healthcare centres across 29 districts in 8 provinces in South Africa — including 28 facilities across North West: 10 in Bojanala Platinum, 8 in Dr Kenneth Kaunda, and 10 in Ngaka Modiri Molema. Additional quantitative and qualitative data is collected within the community specific to the quality and friendliness of health services provided for people who use drugs, sex workers, and the LGBTQIA+ community.
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/
Data in this report were collected between April and May 2023 (Q3 2023).
- Interviews took place with 18 Facility Managers
- Observations took place at 18 facilities
- Interviews took place with 1,072 public healthcare users
- 49% (527) identified as people living with HIV
- 14% (153) identified as young people under 25 years of age
In keeping with previous reports, additional quantitative data related to stockouts and shortages of medicines and other health products were collected between May and June 2023. Data collection took place at 72 sites across four districts: 17 sites in Bojanala Platinum, 18 sites in Dr Kenneth Kaunda, 16 sites in Dr Ruth Segomotsi Mompati, and 21 sites in Ngaka Modiri Molema. Data were collected by talking to Facility Managers and pharmacists or pharmacist assistants, where available. All data are available at https://bit.ly/NWStockoutsData2023.
Additional quantitative data related to key populations were collected between August and October 2022. Data collection took place across three districts: Bojanala Platinum, Dr Kenneth Kaunda, Ngaka Modiri Molema. A total of 1,826 surveys were taken, combining 558 gay, bisexual, and other men who have sex with men (GBMSM), 537 people who use drugs, 488 sex workers, and 243 trans* people.
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