Ritshidze’s annual report on access to public healthcare at Free State clinics reveals continuing critical systemic issues, including exceptionally long waiting times, unprofessional staff and poor facility conditions.
One patient, diagnosed with diabetes and HIV three years ago, said that in his monthly visits to the Nthabiseng Clinic in Masaleng Village near Witsieshoek, he spends hours in frustrating queues, facing unprofessional behaviour from staff.
His frustration is compounded by the deplorable state of the clinic’s sanitation facilities and a lack of accountability among staff, who prioritise personal connections over patient care.
“One nurse always pushed her friends, or people that she knows, to the front of the queue, and then we must wait for even longer,” he said.
The appalling state of the clinic’s bathrooms also upset him: “You can’t use the toilets because they are dirty and sometimes there’s no water. It’s very bad to see the old people going outside to the yard to go to the toilet, but the toilets don’t get fixed. It’s not just the toilets… sometimes you can’t even wash your hands.”
Daily Maverick reports that his story is a common one in the Free State and his experience at Nthabiseng Clinic just one example of the struggles faced by many in the public healthcare system, as highlighted in Ritshidze’s annual report.
The latest report reveals that only 17% of people with HIV receive a three-month supply of antiretroviral medication. Long queues, a culture of unfriendliness and punishment from staff, denial of services, poor treatment, literacy, lack of availability of lubricants and dirty facilities are all issues highlighted in the report.
Ritshidze is a community-led monitoring system developed by organisations representing people with HIV, including the Treatment Action Campaign and the National Association of People Living with HIV.
The report was presented in a district community meeting in Thabo Mofutsanyana on 27 August.
Data were collected between April 2024 and May 2024 and interviews took place with 2 659 public healthcare users.
Long waits, staffing issues
Long waiting times continue to frustrate patients who waste hours in queues waiting for check-ups or even just to collect medication, with 81% saying the waiting times are excessive.
The average wait was more than three hours at 46 facilities monitored, more than four hours at 34 of those, more than five hours at 15 of those, and more than six hours at five others.
“This is a very long time to spend at a facility in which people are usually only seen for a brief consultation.
“For people with HIV either collecting refills through standard dispensing or at facility pick-up points, or returning to the facility for a rescript, spending an extended time there increases the risk of that person interrupting treatment and/or disengaging from care,” read the report.
Staff shortages remain a problem and the knock-on effect leads to long queues. Of 2 657 public healthcare users interviewed, only 24% said there was always enough staff to meet their needs.
A transgender patients from Lejweleputswa said: “Staff shortages are the biggest problem. If I arrive at the clinic between 8am and 9.30am, I normally leave without being attended to at 4pm when they are closing.”
There are 143 vacancies across 23 facilities, with only 20% of the managers saying their clinics have enough staff, and delays are exacerbated by chaotic paper filing systems, where staff struggle to find people’s files or lose them altogether.
“Filing systems were in good condition in only 57% of sites monitored, mostly due to filing rooms being too small to maintain and/or filing systems being messy,” read the report.
Of 2 648 respondents, 22% said after registering it took 60-120 minutes to get their file, and 18% said it took more than 120 minutes.
Culture of unfriendliness
Ritshidze’s data reveal that only 50% of respondents thought the staff were always friendly and 49% thought they were only sometimes or never friendly. Additionally, only 47% felt comfortable/very comfortable in using the facility.
An HIV patient at Phomolong Clinic said: “I hear how they talk to other patients. I dread going … When you ask questions they are rude. They say we are abusing them, but they are …abusing us with their attitude and rudeness. Going there is very stressful. Ask anyone from the community. They will tell you that you don’t get a wink of sleep the night before.”
Out of the 560 people with HIV who had missed appointments, only 25% said staff were welcoming when they went to collect ARVs if they had previously missed a visit, which is a lower figure than the 54% from the 2023 report. Alarmingly, some people even report health workers denying them ARVs after a late or missed appointment.
“Twenty-six percent said staff shouted at them instead. Only 1% of people said staff ask how they can make ARV collection easier; only 1% were offered a longer supply of ARVs to make collection easier, and 0% said staff told them about external pick-up points closer to home which would make collection easier,” reads the report.
This is despite the 2023 National ART Guidelines which recommend providing HIV patients with longer refills and the option to enrol in pick-up points or clubs to simplify treatment collection.
The report also notes that staff continue to mock, judge, or refuse to acknowledge people who use drugs, sex workers, and members of the LGBTQIA+ community – let alone be sensitive to or knowledgeable of the health services they need.
ARV refill issues
The 2023 ART Guidelines recognise that time constraints hinder HIV patients in collecting their treatment. They advocate for longer ARV refills (multi-month dispensing) and enrolment in pick-up points or adherence clubs, including for children and adolescents.
These strategies facilitate easier treatment access, improve adherence, and alleviate congestion and waiting times. But across the province, only 17% of people reported getting a three-six month supply of ARVs in the reporting period.
The Free State has made the least progress towards giving people longer ARV refills out of all provinces monitored by Ritshidze.
Only 11% reported receiving a three-month supply in Thabo Mofutsanyana and 25% in Lejweleputswa, compared with 98% of people reporting a three to six month supply in Mopani (Limpopo), and 97% in Bojanala (North West).
The report continues to call for urgent action to improve health services in the Free State, noting that the failures are core reasons why people struggle to stay on ARVs or access HIV prevention.
The report included a list of recommendations, which were submitted to the Free State government. Ritshidze asked for a response by 30 September.
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See more from MedicalBrief archives:
Abuse, humiliation rife in state health facilities – Ritshidze report
Free State worst performer in ARV dispensing, survey finds
Report shows deteriorating conditions at Free State clinics