Critical stockouts and shortages of essential medications are among the leading issues faced by the North West Department of Health. Long waiting times, staff shortages and hostile services for key populations are other key challenges. 

Ritshidze, a community monitoring organisation, revealed the findings of its third NW State of Health report in Mahikeng yesterday. 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.

Worst performing province on stockouts

“This year 21% of reported stockouts had lasted between 1 and 3 months, while 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,” says Mary Nyathi, a project officer at Ritshidze 

Nyathi says that public healthcare users continue to be sent home empty handed from facilities due to stockouts.

“The North West performed worst out of all provinces monitored on stockouts again this year. 49% of sites which were monitored and found to be out of medicines blames unreliable transportation for stock not arriving on time.  To be able to dispense medicines, almost 81% of facilities said they borrow from other facilities, which only creates an ongoing cycle of shortages,” says Nyathi.

The report found the province also performed the worst compared to other provinces on staff friendliness. Only 49% of respondents thought that clinic staff were always friendly and professional.

People living with HIV

Nyathi says that there has been little improvement in increasing the duration of ARV refills. 74% of people living with HIV who were interviewed said they receive a 2 months supply of ARVs, while only 21% of people received a 3 or 6 months supply. Comparatively, in Mpumalanga, 64% reported receiving a 3-6 month supply. 

A longer supply of medication can reduce waiting times and ease congestion. It can also help with treatment adherence. 

“29% of people living with HIV who return to the clinic after missing an appointment said that they are sent to the back of the queue, which is against the national adherence guidelines,” says Nyathi.

Nyathi says that there has been little improvement in increasing the duration of ART refills, as data shows that 74% of people living with HIV who were interviewed by Ritshidze revealed that they are still receiving two months supply, while only 21% of people received a 3 or 6 months supply

Mistreatment of key populations

The majority of key populations interviewed don’t feel safe or comfortable at health facilities, while many reported major privacy violations.

UNAIDS classifies gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs and prisoners and other incarcerated people as the five main key population groups that are particularly vulnerable to HIV and frequently lack adequate access to services.

A patient interviewed by Ritshidze says, “Everything is wrong at that clinic. I have been at the clinic when all they want 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 and I couldn’t believe it.”

Another patient, a transgender woman who went to a facility to seek medical attention after she was raped says, “They said to me that they don’t believe me, because 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 would I go to?”

According to the report, people who are living with HIV and key populations who are treated badly, humiliated, or refused access to services will inevitably stop going to the facility altogether, including for HIV, TB and STI testing and treatment.

Staff shortages

Staff shortages within North West public health facilities have also worsened from last year as only 6% of facilities reported there were enough clinical and non-clinical staff.

“Worsening from 15% last year, 43% of facilities blamed too few open positions on the shortages, while 43% blamed unfilled vacancies. Up from 11% last year, this year of 1,072 public healthcare users only 15% said there was always enough staff to meet the needs of public healthcare users,” reads the report.

Waiting times are a little better.

Nyathi says that one of the positives they found in the North West was that waiting times have reduced over the last year, but the average waiting time was over 4 hours at 29% of facilities monitored.

“92% of public healthcare users interviewed in the province still think that the waiting times at the facility are long,” explains Nyathi.-Health-e News.