People who miss appointments or stop taking their treatment often report being treated badly by healthcare workers when they return to health facilities. This fear of being reprimanded discourages people from going back to the clinic to seek support and receive their treatment. 

Monitoring through Ritshidze between October to December 2020 shows that poor staff attitude remains a major barrier. Reports of staff reactions to patients who missed a facility visit for ARV collection were often unwelcoming, unempathetic, or at worst objective human rights violations. Across clinics, out of 7,162 patient responses, only half (54.6%) of patients thought that the staff were always friendly and professional. 

The graph below outlines the worst performing sites where investigations should take place into the allegations of poor staff attitude. 

One woman living with HIV told us that every visit to the clinic is a nightmare. The name calling is insulting, an irritation and “makes me so cross and makes me want to cry”. She says she’s routinely spoken to rudely by the admin staff in particular. She feels singled out when staff tell her to produce an appointment card even though she has never been issued one and she says she’s not familiar with the clinic’s system having only moved to the area recently. 

“They will tell me that because of that card they can’t help me and then they just let me sit. Sometimes I sit till late in the afternoon even though I come there early. “They don’t care that I am hungry and I don’t have a lunchbox or money to buy food. They just cheek you and say things like ‘don’t waste my time’ or ‘we have a half day today so don’t come with your problems’.”

Of the nearly 5,000 survey responses, only 13% (676) of PLHIV said that staff were welcoming when they came to collect ARVs if they had previously missed a visit. Many reported being punished, with 545 reporting being sent to the back of the queue. 

Another 518 PLHIV reported being reprimanded for missing a visit. This compares to only 410 of PLHIV who report that staff will provide counseling on adherence if you return to the clinic after missing a visit. 

The graph below shows the responses from PLHIV to what happens when you miss a clinic visit by province, listed from best performing to worst performing.

The graph below shows the clinics where the most PLHIV report being reprimanded and shouted at for missing a clinic visit.

The graph below shows the clinics where the most PLHIV report being sent to the back of the queue after missing a clinic visit.

So what can the Department of Health and PEPFAR do?

• All staff should be trained to provide a friendly and welcoming environment for all patients whether accessing HIV prevention, accessing ART, or, most especially, returning to care after a treatment interruption.

• No PLHIV should be sent to the back of the queue if they miss an appointment.

• “No “referral letter” should be required for people to transfer to a new facility

• The provincial Department of Health must carry out investigations into all allegations made with regard to health personnel failures — including bad attitudes — and that following this investigation disciplinary action be taken where appropriate and compensation be paid out to victims of neglect or ill-treatment. 

This data set was presented to the Operation Phuthuma meeting on 5th March 2021. You can view the full presentation here. 

Please note: data related to the Western Cape has been excluded from the presentation and blog. This is whilst ongoing discussions with the Western Cape provincial department of health continue in order to allow for Ritshidze to proceed with monitoring. Until this negotiation has concluded, Western Cape DOH has refused to allow us to engage in monitoring or publish any findings.