Love in a time of prejudice
A new report shows that service delivery at many primary healthcare facilities in Gauteng is far from healthy.
Lebo’s mother is scared to go back to the clinic. She knows the staff will shout at her, race through the appointment and tell her that her daughter’s chronic medication is out of stock – again. But she also knows she will go back, like she has been for the past six months, every Monday and Friday, to check whether her child’s medicine is finally in stock.
Without the medication Lebo is a danger to herself, says her mother. The treatment keeps her daughter calm. The past six months have left her exasperated and prepared to spend the extra money and time to travel much further to a hospital – at least there her daughter will receive proper care.
And then maybe the school will allow Lebo back into the classroom next year. They’ve barred her. They insist they can’t handle her if she doesn’t take the medicine.
Lebo’s mother shared this at the launch of a new report on the state of health in Gauteng on World Aids Day in Soweto. The backbone of this report is a survey conducted by Ritshidze, a community-led programme that monitors the quality of HIV service delivery in eight of South Africa’s provinces.
The programme’s community monitors have spent the past six months examining the quality of care at 120 clinics in the province. They spoke to more than 4,000 primary healthcare users – Lebo’s mother was one of them. The monitors are community members from civil society organisations led by people living with HIV.
Now, they’ve collated their data and given the government the names of clinics that fail their patients. Moreover, they tell them exactly how to fix it.
And they’ll be following up.
The programme has been keeping a close eye on clinics for years. This vast grid covers 400 primary healthcare facilities across 27 districts in eight of the country’s provinces. These facilities cover nearly half of all people living with HIV on treatment in the country in 2020.
The project is being implemented by the Treatment Action Campaign (TAC), the National Association of People Living with HIV, the Positive Action Campaign, the Positive Women’s Network and the South African Network of Religious Leaders Living with or Personally Affected by HIV and Aids. They have the support of the likes of the Health Global Access Project and UNAids.
The new report shows that patients face the same chronic barriers to accessing care across Gauteng. The crux is severe understaffing and a lack of space. This results in waiting times of 4.5 hours, disorganised filing systems and a lack of confidentiality.
Opening times have not been extended, despite a government circular issued last year. Medicine stock-outs are endless. HIV medicine is in short supply. Patients have to return regularly for their medicine, impacting their ability to follow a treatment plan.
There were zero facilities that met the basics of TB infection control. The minority had support programmes for specific “key populations”, such as sex workers or people who use drugs. Clinic committees are few and far between.
Those who spoke at the public hearing told of how the verbal abuse spewed by staff made them avoid the clinic altogether. One man spoke of how as a young person he felt trapped by his HIV status. He said the nurses were not concerned with keeping it confidential and their constant reprimands made him avoid the clinic and therefore default on his treatment.
Because Ritshidze consists of thousands of community monitors who go out to the clinics and engage with patients directly, it is possible for their data to be highly specific.
Lebo’s family used to go to Stanza Bopape Clinic in Mamelodi, in Tshwane, before transferring to a hospital. The report indicates that most patients who use this clinic said it never had enough staff and 75% said it was not open for long enough.
People arrive as early as 4.30am to queue outside. Most said they felt “very unsafe” waiting for the clinic to open and that staff were unfriendly and unprofessional. Patients report that it has no TB infection control in place.
This level of detail was welcomed by the chief director of the National Department of Health’s HIV/Aids and sexually transmitted infections cluster, Dr Zukiswa Pinini, who was in attendance at the public hearing.
“You have the right to go to a facility and get treatment and if you don’t get treatment then you need to report it. Take the name of the facility and the individual, and report to authorities – first the facilities manager and if need be then escalate to the province. We do really want to care for everyone in the country,” she said.
However, community monitors have found they have been barred entry to clinics. TAC general secretary Anele Yawa took this up with Minister of Health Zweli Mkhize and the director-general of the National Department of Health, Sandile Buthelezi.
They gave the instruction that all Ritshidze community monitors must be allowed to do their work at any clinic in the country.
Yawa said: “Mkhize gave the instruction to Buthelezi that Ritshidze must operate in all provinces, districts and facilities. We will heed this instruction. And make a follow-up in two weeks’ time to give feedback to them.
“We are not here to ask favours. We are here to demand our constitutional rights. And the government is aware of this.”
People arrive as early as 4.30am to queue outside. Most said they felt ‘very unsafe’ waiting for the clinic to open and that staff were unfriendly and unprofessional