Safe water, sanitation and hygiene are the cornerstones of public health – this was evident during the COVID-19 pandemic when hand washing was a big part of efforts to curb the spread of the disease. No one should go to a healthcare facility to get sick. Yet, hundreds of people face an increased risk of infection by seeking care in health facilities that lack basic necessities, including water, sanitation, and hygiene services. 

Health-e News took a snapshot of the state of sanitation in public clinics in three provinces. Our community journalists in the Free State, KwaZulu Natal, and Limpopo visited 31 clinics, speaking to more than 300 patients, and their observations paint a worrying picture.  

Most of the people we spoke to said the toilets are often out of order. There was no soap in 72% of the bathrooms. Of 30 facilities, 20 had poor hand washing facilities, some having no water. More than 90% of facilities don’t have toilet paper, 78% of bathrooms aren’t clean, with 40% of facilities having faecal matter and urine on the toilet seat, walls and floor.

Molefi Sompane in the Free State, Sandile Mbili in KwaZulu-Natal, and Montsho Matlala in Limpopo share their observations. 

Free State 

Patients at clinics in the Mangaung Metropolitan Municipality wish they could go to a clinic where they don’t need to bring their own water, toilet paper and soap in order to use the toilet during the frequent water cuts. 

This lack of basic hygiene facilities is making patients question the overall quality of care they’ll receive. Ntswaki Nthako uses Potlako Motlohi clinic. During a recent visit to the clinic she left without receiving the medical care she came for; the clinic had not water and she needed the restroom. 

“I was really pressed when I found a notice of toilets not working due to water unavailability. I left to go home and I couldn’t return to the facility after I used my home toilet. It’s normal in Botshabelo for a clinic to turn us away or order us to bring our own water to use the toilets,” she says.

Emily Roman, 37, uses Jazzman Mokhothu clinic.  She says the lack of toilet paper contributes to the overall uncleanliness of the toilets. “This sounds crazy but it is for these reason people decide to use wrong objects that also blocks the pipes and create problems for the facility,” Roman says.

Staff at these clinics say they have no choice but to close shop on days of water outages.  

Thabo Matsemela* works at Motlohi clinic. He says the toilets are dirty when there’s no water, and they force them to close the clinic to avoid a bad odour.

“You can imagine the stink of toilets when the water is cut. As a cleaner, I have to clean such dirt, and it also puts me in danger. I can get some diseases. That’s why we close the clinic until the next day,” he says.

Matshepo Mokhele*,  a cleaner at Jazzman Clinic, says “if we were not having constant water cuts we would allow patients to use the toilets. The municipality stopped water tankers during Covid-19, ever since when we have water cuts we do not get water tankers and it causes us to cease operations,” she says.

Currently, Potlako Motlohi, Jazzman Mokhothu and Harry Gwala clinics’ Jojo tanks are empty.

Mondli Mvambi, Department of Health spokesperson in the Free State, says they recently had a meeting with Mangaung municipality on the issue of water. 

“Whenever there are water cuts in any area where our health facility is to be affected metro is delivering water with tanks. Where such is not happening, we request the public and our health workers to notify us,” he says.

He adds that no facility is supposed to stop working due to no water for toilets.

“We understand that water plays a huge role at our facilities but our people can’t be prevented from getting help because there’s no water at the clinics”, Mvambi says.

He insists that the department provides supplies to the facilities. “Toilet paper, soap and sanitisers are delivered to clinics for hygiene purposes. Patients who do not get them should report the facility to the department.”

KwaZulu-Natal 

The conditions in the more than ten clinics in eThekwini were not much better. Many restrooms were unusable and far from suitable for patients. Broken toilets are left unfixed for weeks or even months, with “out-of-order” signs posted for extended periods. As a result, patients often had to wait longer, as fewer toilets were available.

Even after waiting, there was usually no toilet paper. Patients would have to go back to the clinic’s reception, cleaners, or security just to ask for it. Most toilets had broken locks or missing bases and lids, and around half lacked basic hand washing facilities like soap or sanitiser. Inside locks were often missing, making patients uncomfortable as they worried about someone accidentally walking in on them.

Another issue was that some broken or overflowing toilets lacked proper signage. Patients often didn’t realise a toilet didn’t flush until after using it. 

Several restrooms were visibly dirty, littered with cigarette butts, and stained, indicating a lack of daily cleaning despite a daily checklist supposedly used by cleaners.

Lamula Lamula, 48, from Clermont describes the conditions in the male toilets located outside Pinetown Clinic. 

“I was so surprised to see leaves inside the toilet hole which shows that someone who was there before me used those leaves to wipe him since there was no toilet paper. I tried flushing but the leaves would not go. There were newspapers on the floor which shows that they were the alternatives for tissue,” says Lamula.

Another problem is the inadequate number of toilets available to patients. Zanele Mazibuko* who is a professional nurse at Kloof Municipal Clinic says the facility does not have enough toilets since it has only three toilets. She says when both male and female toilets are occupied, patients usually use the disabled toilets as an alternative. This, in turn, poses a problem for patients with disabilities. 

One patient with disabilities who frequents KwaMashu Community Health Centre tells Health-e News that many male patients use the disabled toilets and don’t clean up afterwards. 

“They do not pull up toilet lids, therefore, we are always forced to wipe the urine on the seats before using the toilet. I raised my concern to the security at the facility, and she said I should write a complaint and place it in the complaint box.”

eThekwini municipality and the provincial health department did not respond to our questions. 

Limpopo

In Limopo we visited clinics in the Capricorn District Municipality and the Waterberg District Municipality. In all the nine clinics and one health centre that Health-e News visited, users complained about the lack of toilet paper and general poor hygiene including poor cleanliness.

They say if they find clinics with cleaner toilets, they won’t return. Until then they have no choice but to keep using the current facilities, ‘risking diseases’ while having inadequate privacy behind broken doors.

Our survey found that 90% of the women and 81% of the men in Limpopo don’t feel safe using toilets at primary healthcare facilities.

Chego Sema 34* says she is unlikely to return to Seshego Zone 3 clinic because of the shabby toilets.

“There is no toilet paper and no water for hand washing. I am disgusted by these two metal sheet toilets. They don’t even have signs to show which room is for men and another for women. And there is no full privacy inside because the doors do not close properly so some naughty people can peep through.”

Jacqueline Maha 47* a cleaner at Rethabile Health Centre in Polokwane says cleaning detergents are available but do get out of stock.

“The problem is the replacement when soap, sanitisers and toilet paper get finished.  It takes long for management to replace them.

“Even the cleaning staff is the problem, because when one of us no longer works due to retirement, resignation or death she is hardly replaced and this creates shortages.”

Lesiba Monyaki, provincial chairperson of the Democratic Nursing Organisation of South Africa (DENOSA) says there is a gross shortage of general workers.

“The replacement of these general workers, including cleaners, is not at the rate at which they exit. To my knowledge, soap and toilet paper are provided but they may not be replaced on time.” 

Limpopo Department of Health responds

Neil Shikwambana, spokesperson for Limpopo Department of Health concedes there are challenges regarding toilets in health facilities. 

“Toilet paper and other utilities are supplied regularly to all our facilities, so we don’t have a crisis.

“But with regards to some broken items or non-functioning, our infrastructure unit is aware of these maintenance challenges together with many others in various institutions.

“These problems are being attended to in line with the maintenance plan of the department. This also depends on the urgency of the matter.”

Capricorn District Municipality spokesperson Moffat Senyatsi says clinics and hospitals are primarily the responsibilities of the Department of Health.

A key takeaway from this experience: when visiting clinics in Limpopo, one must bring their own essentials, like toilet paper and sanitiser. – Health-e News 

*Not their real names

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