A new Ritshidze report has revealed the worsening state of health care in the Free State, with some patients even having to halt their HIV treatment.

The reasons behind the demise are endless. Inadequate staffing, filth, long waiting periods, messy filing systems and patients being turned away due to a lack of transfer letters are just some of the challenges people face when seeking medical services within the public healthcare system in the province.

“Ritshidze” — meaning “Saving Our Lives” in TshiVenda — has been developed by people living with HIV and activists to hold the South African government and aid agencies accountable to improve overall HIV and TB service delivery.

This report is the second edition which was launched at a Bloemfontein community meeting yesterday.

Unable to meet the needs

It indicated that 79% of facilities again reported being understaffed and unable to meet the needs of public healthcare users this year. 

82% of public healthcare users interviewed in the province think waiting times are long. This has dramatically worsened since data collected between October and December 2021, where only 57% of public healthcare users thought the waiting times were long #FreeStateHealth pic.twitter.com/efnDpFYH8v

— Ritshidze (@RitshidzeSA) September 29, 2022

“The number of vacancies in sites monitored has almost doubled from 26 to 50. And public healthcare users also reported a worse situation with only 16% who thought there were enough staff, down from 36% last year,” said Ndivhuwo Rambau, Ritshidze Project Officer.

Focusing on critical areas

Ritshidze monitoring takes place every quarter at more than 400 clinics and community healthcare centres across  SA.

The Free State report, which covers 29 facilities, focuses on the following:

• Staffing
• Waiting times
• Infrastructure and clinic conditions
• ART collection
• Accessibility of health services for key populations
• Stockouts and shortages of medicines.

“Inadequate staffing often means longer waiting times which forces people to arrive early and wait for many hours.  A total of 80% of public healthcare users thought waiting times were longer this year. They blamed too few staff and staff members working too slowly,” said Rambau.  

Koketso*, a patient who shared her ordeal with Ritshidze, said she often waits for the whole day without success.

“I arrive in the morning and wait the entire day. Eventually, at 4pm, they’ll tell us to return the following day. This is why we skip appointments. It’s not acceptable, sitting there the whole day,” she said. 

The report stated that following a large increase in the number of unfilled vacancies reported in April and May, there had been a marginal decline in the number of open positions. 

Staff shortages and transfer letters

“Key positions remain open, creating gaps in capacity to deliver quality services. Currently, 50 vacancies remain open across 10 facilities. The most common vacancies are professional nurses, security guards, pharmacist assistants and cleaners,” said Rambau.

Another key issue revealed is that people living with HIV are denied antiretroviral treatment (ARVs) because they don’t have transfer letters. 

“Transfer letters are not required in the national adherence guidelines, yet 573 people in the Free State reported being denied access to services for not having since we started collecting this data last October,” stated the report.

The report also indicated: “This represents 16% 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 645 reports of people being denied access to services for not having an identity document.”

According to the report, treatment literacy levels have also declined since last year. Just 76% of people living with HIV understood that an undetectable viral load is good for their health, and only 57% understood that an undetectable viral load means you cannot transmit HIV. This low level of understanding correlates with the fact that only 78% of people living with HIV reported that a healthcare provider explained their viral load test result, down from 82% last year.

Poor infrastructure and filth

According to observations by Ritshidze, only 42% of facilities monitored are in good condition. This is a dramatic decline from 68% last year, and the Free State is the worst performer based on this indicator.

“The most commonly provided reasons for what is in bad condition are:

• No lights or lights not working in some areas of the facility (79% of sites)
• Broken or cracked roof, walls or floor (57% of sites)
• Old buildings needing renovation (36% of sites) and;
• Broken furniture (29% of sites)

On clinic cleanliness, the Free State also performed poorly as only 36% of people said that clinics were clean, and more than a quarter disagreed.

“Sites monitored in the Free State are some of the dirtiest compared to other provinces. Furthermore, toilets are often found in a bad condition. 69% of Ritshidze observations still found that toilets were in bad condition, with wide variation among districts,” the report indicated. 

Index testing concerns

Another worrying factor is the implementation of index testing in the Free State.

“Index testing is a case-finding strategy where people living with HIV are asked to disclose their sexual partners so that they can be targeted for HIV testing services. This is always voluntary, yet worryingly 35% of respondents said they refused to give the contacts. Worse, only 42% of respondents were not asked if their partners had any risk of violence, despite national guidelines mandating this process,” said the report.

It further highlighted that one area that needs improvement is the state of filing systems. Messy filing systems and files were observed in 50% of sites monitored, up from just 35% last year, and 60% of public healthcare users blamed lost files for the long waiting times.  – Health-e News