KwaZulu-Natal clinics are outperforming facilities monitored in other provinces on various indicators and its health services have improved year-on-year, but some marginalised groups still battle to access services, and staff shortages still plague the region, shows the latest provincial report from community-led monitoring project Ritshidze.
The second edition of Ritshidze’s KwaZulu-Natal State of Health report outlines key challenges experienced by people living with HIV, key populations, and other public healthcare users in KZN (key populations being transgender, gay, bisexual, and men who have sex with men, sex workers, and people who use drugs).
Writing in Spotlight, Nthusang Lefafa reports that Ritshidze monitored 131 facilities across the province, mostly in eThekwini, interviewing facility managers and 7 973 public healthcare users – 52% (4 173) were people living with HIV, 68% (5 491) identified as women, and 22% (1 713) were under 25.
Some progress
This past year, the province has reduced average waiting times from three hours and 20 minutes to two hours and 39 minutes. Additionally, 30 facilities had average waiting times of under two hours, making KZN the province with the shortest waiting times at primary healthcare facilities monitored by Ritshidze (which monitors facilities in all provinces except for the Western and Northern Cape).
More people are also receiving multi-month supplies of ARVs, meaning fewer visits to health facilities.
KZN also showed encouraging progress in healthcare users receiving “friendly and welcoming services”. “Positively, 82% of people thought staff were always friendly and professional, up from 75% last year, and 95% of people living with HIV feel facilities keep their HIV status private and confidential,” the report states.
Provincial health department spokesperson Ntokozo Maphisa says the department has an ongoing training programme focusing on customer care, professional ethics, Batho Pele Principles, and patient rights.
The department also acts against employees where necessary. “Complaints are analysed and monitored at different levels, and action plans developed to inhibit future occurrences.”
Some shortcomings
But Ritshidze also flagged some shortcomings, including “limited progress” in filling staff vacancies – a key driver of long waiting times. The report said “81% of facilities [are] still reporting shortages and 449 vacancies [are] still open”. Staff shortages were a common finding in Ritshidze’s reports from other provinces.
Filing systems at some facilities were also still an issue, with missing files contributing to long waiting times.
“This year only 76% of facilities had a properly functioning filing room, down from 81% last year. Only 12 facilities improved in the year, while 19 worsened,” the report states.
Regarding missing files, Maphisa says filing systems have been standardised throughout using the Health Patient Registration System (HPRS), and that no patient “shall be sent home without medication or service”.
“All stable patients are registered on the CCMDD programme (central chronic medication dispensing and distribution) where they can get their medication outside the health facility to avoid long waits and congestion. They are also referred to the PeleBox programme, ensuring they receive two months’ ART supply.”
Poor services for key populations
One area where KZN falls short is in providing health services to key populations. “On the whole,” the report states, “KZN provided the worst services for key populations across all provinces monitored.”
“Only 28% of respondents said staff are always friendly and professional towards gay, bisexual, and other men who have sex with men; 19% towards people who use drugs; 16% towards sex workers; and 34% towards trans people.” Many did not feel comfortable, safe or protected from abuse and harassment at primary healthcare facilities.
Also, key populations often do not receive services specific to their needs. Among these were lubricants that were only available in 26% of sites monitored. Further, “only 41% of gay, bisexual, and men who have sex with men, 14% of people who use drugs, 31% of sex workers, and 59% of trans* people reported being offered PrEP at the facility”.
Maphisa says, “The department has established an LGBTQI+ and youth clinic in eThekwini, which is already operational. For uMgungundlovu, the clinic has been established at City Central Clinic and East Boom CHC. The department is also procuring HIV prevention sundries used by these communities.”
Difficulty accessing services
However, some organisations representing key populations told Spotlight the people they represent and support often are humiliated at some clinics.
“When you are a sex worker and want to collect condoms from clinics, nurses ask what you are going to do with so many condoms,” says Nokwande Gambushe, KZN Provincial Coordinator of the Sisonke National Sex Worker’s Movement. The Sisonke movement is a non-profit organisation advocating for, among others, the decriminalisation of adult consensual sex work.
Gambushe says sex workers often don’t access health services where they live because of discrimination. “They are scared because they are discriminated against by healthcare workers and the community.”
Sazi Jali, executive director of TransHope, a non-profit organisation for the rights of transgender and gender-diverse people in KZN, agrees that discrimination at clinics is a problem.
“Additionally, In most clinics, you rarely find lubricants readily available as you find condoms in dispensers,” she says.
Ritshidze reported that lubricant is available only in 26% of the sites monitored: just 19% of people using drugs, 13% of sex workers and 36% of transgender people using public healthcare facilities said they could access lubricant.
TransHope has been assisting some clinics in Umlazi South with condoms and lubes, says Jali. She says it is important to ensure that lubricants are also provided in dispensers such as those for condoms.
She added that private clinics such as the Aurum Institute’s POP INN clinic in Durban provide adequate services, and would like to see this replicated at public clinics. These POP INN clinics offer free sexual health services to men who have sex with men and transgender women.
Gaps in access to HRT
The Ritshidze report also flags limited access to gender-affirming care. “Apart from the psychological impact of gender dysphoria, in a country rife with transphobia and attacks on trans individuals, access to hormone therapy could mean life or death,” the report states. “Gender-affirming care is mostly only available in big cities, so out of reach for those without transport money or places to stay.”
Ritshidze reports that 54% of trans people interviewed said they wanted access to hormones at their facilities, “34% wanted outreach services for trans people, 21% wanted trans friendly STI prevention, testing and treatment, and 57% wanted access to psychosocial support services”.
Meanwhile, Jali tells Spotlight, “In KZN we do not have a mainstream system for accessing gender-affirming healthcare. There are only a few doctors trained to treat transgender people and do referrals to government institutions. Our organisation has been assisting people to transition medically by paying privately for people to see doctors and help them get HRT (hormone replacement therapy). One consultation can cost up to R1 000 and then patients must pay privately for HRT.”
See more from MedicalBrief archives:
Staff shortages and long waiting times plague KZN Health
PSC report on KZN Health warns on staff attitudes
Contraception shortages are failing South African women – Stop Stockout Report
Durban’s health clinics are ‘falling apart’ — SAMWU
Contraceptive roulette at SA’s state clinics