New report shows shortcomings in Free State public health service despite some improvement 

Close up of someone reading Ritshidze report

Patients using public health facilities in the Free State face hostile services, staff shortages, and long waiting times. Some patients have even reported being turned away and denied care. 

These are just some of the findings of a report published by Ritshidze, a coalition of non-profit HIV advocacy organisations, this week. 

The report shines a spotlight on public health service delivery in the Free State. This is the third edition of the annual community-led monitoring report. 

Hostile environment

Data in the report were collected between April and May 2023. It includes interviews with 21 facility managers, as well as 1,095 people who use public healthcare in the  Lejweleputswa and Thabo Mofutsanyana district municipalities.  

Patients belonging to key populations reported the lack of friendly, safe and confidential services as the biggest factors stopping them from using public healthcare facilities. Key populations are people at higher risk of HIV infection including men who have sex with men, sexworkers, and transgender people. 

“It is always an unpleasant experience to go to the facilities. Unfortunately, there are no alternatives. It is the only clinic in the area. I got to understand why other key populations prefer to go to more remote facilities because of the poor attitude they get from this clinic,” says Steven Hendricks*.

Hendricks is a gay man who was interviewed by Ritshidze in July. His nearest health facility is  Phuthaditjhaba Clinic in the Thabo Mofutsana area.  

“This clinic is practically next to where I live. It’s sad that I am considering going to a facility very far away,” he says. 

Staff shortages

Paulina Mohale* uses Tseki Clinic, in Phuthaditjhaba. She pays someone R70 to queue for her on the days that she has to go to the clinic. Queuing can start as early as 5:30am.

“But even in that case, you may not get help that day. When you get to the front of the queue you can be told that there are no nurses on duty that day. Then you are turned away and told to return the next day, only for the same thing to happen again,” says Mohale in an interview with Ritshidze.

Waiting times and denied care

A consequence of the staff shortage is people waiting hours for health services. 

While patient waiting times at monitored public health facilities are shorter than last year, people are still waiting for nearly five and a half hours to be seen. Last year the normal waiting time was 6:03 hours. 

Ninety percent of the monitored public health facilities indicated that there was not enough clinical or non-clinical staff.

Another key is that patients are being denied access to healthcare services. More than 350 people reported being turned away because they didn’t have transfer letters. But transfer letters are not required for people to start or resume antiretroviral therapy. An additional 529 people reported being denied health services for not having an identity document.

Other gaps

According to the report, lubricants are also in short supply. Lubricants were only freely available in 45% of the 104 facilities monitored in the province. 

“While this is up from 23% last year, there is still a way to go to make this commitment a reality,” says the report.

“It is not all preventative services that you are able to access at the clinic. You only find external condoms. And I do not feel comfortable with the fact that you have to enquire about lube (lubricants),” says Mpho Monyane*, a gay man who spoke to Ritshidze in July 2023, at Phuthaditjhaba clinic.

“Why are they not made a priority or put in accessible places? It is very difficult to enquire about the lubricants in such a hostile environment,” he says.

The report also identified a major shortcoming in HIV care. Only 3% of people living with HIV were able to receive ARV refills for three months or more in the province. National guidelines recommend a three to six month refill. 


But there have been improvements in some areas. Most of the facilities being monitored offer pre-exposure prophylaxis (PrEP) to key populations. For example, 70% of the health facilities actively offer PrEP to men who have sex with men. This is  up from 25% last year.

The report found that: “64% of facilities offer PrEP to people who use drugs (up from 15% last year); 72% to sex workers (up from 30% last year); and 65% to transgender people (up from 25% last year)”. 

But more can be done to ensure that all facilities offer PrEP to each key population group. The report makes several recommendations that the Free State health department and its partners can follow to address some of these issues. – Health-e News.

*Not their real names 


  • Ndivhuwo Mukwevho

    Ndivhuwo Mukwevho is citizen journalist who is based in the Vhembe District of Limpopo province. He joined OurHealth in 2015 and his interests lie in investigative journalism and reporting the untold stories of disadvantaged rural communities. Ndivhuwo holds a Bachelor of Arts degree in Media Studies from the University of Venda and he is currently a registered student with UNISA.

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