Patients face a long line outside the Manzini Clinic in Ehlanzeni, one of 43 clinics monitored by Ritshidze in Mpumalanga, in November 2020 (Photo by Rian Horn)
Public health facilities across the province are making their patients feel worse than better. This is evident in a new report compiled by the very people who use them.
Not only are the facilities collapsing around them, but the environment is so harsh that many patients lose sleep the night before they leave and fear the staff.
They prefer to stay away. Even if it means running out of vital drugs.
the Report on the state of health of Mpumalanga May 2021 is filled with data from observations and interviews conducted by community monitors at 43 facilities across the province in April and May 2021.
These monitors are part of Project Ritshidze, a clinical monitoring system managed by the people who use them. The project was developed by organizations representing people living with HIV, such as the Treatment Action Campaign.
The report and oral testimony were presented to the Mpumalanga health department on May 25. The department has committed to responding in detail to the recommendations by June 8.
In the meantime, patients continue to struggle with a tough healthcare system.
The managers of the establishments and the patients of Mpumalanga agree: there is not enough staff. Less than a third of patients felt that there were enough staff. Only 7.3% of facility managers felt that they had enough clinical and non-clinical staff to meet the needs of their patients. The people most needed were the data captors, nurses and pharmacists.
Community health workers, key to making sure patients don’t run out of medicines, are present in almost all clinics, but nearly half do not have reliable transportation.
Not only does this increase the pressure on the few staff there, but it also increases wait times. On average, patients wait four hours and 41 minutes in a queue of at least 85 people. And this is only valid for short visits, such as collecting refills of antiretroviral therapy.
Knowing this, patients start lining up two hours before the doors open, hoping to be seen earlier so they can go to work or care for their children. Patients believe long lines are the result of staff shortages and long breaks.
“Overall – long wait times and the need to arrive at dawn in often dangerous conditions – it is no wonder that many patients are
unable to support HIV, TB and other care, ”say the report’s authors.
“Even with scripts for several months, one man told me that having a check-up every four months at the clinic is an experience he absolutely hates,” said Lucky Gwebe, an organizer from the Ritshidze district of the ‘National Association of People Living with HIV during the presentation to the provincial health ministry.
“He goes early, waking up at 4:45 am to make sure he gets into the queue early. It costs him R24 in a taxi for a round trip and when he arrives he has to wait outside, even if it is raining, windy, cold or even very hot – he there is no shelter.
“You also have to stand up, because there are no chairs for the patients. He went on to say that they separate people living with HIV from other patients without any discretion or respect for patient privacy, ”Gwebe said.
Owen Nhlanhla, an organizer from the Ritshidze district of the Treatment Action Campaign, said: “One woman explained that it is difficult to really understand why the lines at the clinic are long and why the staff seem to work slowly and inefficient way.
“At the moment, she only needs to go to the clinic every three to six months and collect her medication from her supermarket. She says it only takes 15 minutes to pick up and leave, which is a far cry from an all-day clinic visit. She says she doesn’t sleep the night before a date because she’s so stressed.
And this wait may have been in vain. Once inside the facility, patients faced chaotic filing systems, crumbling infrastructure, and the possibility that the drugs they spent hours queuing up for were not in stock.
Almost a quarter had dysfunctional filing systems. The files were accessible to all who walked by. They were often misplaced and lost – finding them prolonged wait times. The main challenge was that the facilities simply did not have the space for a proper filing system.
“We see and hear that filing systems are often messy, resulting in longer queues and even lost files. A woman explained that there are sometimes delays in getting files or she does not get a file or is told it is lost. She explained that it is not pleasant to go to the clinic. Telling me that during her date, she is so unhappy. When it’s your date, you are so miserable, ”said Innocentia Ndlovu, a Ritshidze community counselor from the Positive Women’s Network.
In addition, the buildings themselves were dilapidated and in dire need of routine maintenance and additional space for waiting areas, medical treatment rooms and space for filing, facility officials said. Clinics were generally clean, but 60% of the toilets were in poor condition, with no soap or toilet paper, patients said.
Almost 11% of patients leave facilities without the medication they need. This includes ARVs, anti-tuberculosis drugs and contraceptives. Of the 11%, half received alternative medicine while almost 40% received a shorter supply and almost 10% were returned empty-handed.
One of the main concerns was to promote and protect the long-term use of antiretroviral therapy.
The province is meeting one of the UNAIDS targets – about 90% of people know their status.
However, only 64% of people living with HIV in the province receive antiretroviral therapy and 58% of all people living with HIV are virally suppressed. This shows that there are major obstacles in the way of long-term treatment.
It is standard operating procedure to provide prolonged refills or repeat prescriptions to support long-term adherence to antiretroviral therapy. However, 61.9% of patients received refills for less than three months.
The indifferent and unwelcoming environment of the facilities was one of the main reasons people living with HIV avoided the facility and disengaged from care. More than half of the patients found the staff to be unfriendly and unprofessional. Some said they were yelled at, reprimanded and sent back to the back of the queue if they missed an appointment for any reason. It alienated them even more.
Almost three quarters of patients said there was no psychosocial support. This means that there is no one to discuss the reasons for stopping treatment and to help develop a strategy for resuming treatment. In addition, they were not aware of the membership clubs at the facility. It is a space for people living with HIV to share their experiences and information, as well as to receive their medications and a clinical assessment.
Despite these challenges, just under half of patients living with HIV had never missed an appointment. Of those who had done so, most were contacted by the establishment. Facility officials said the biggest challenges were incorrect contact details and lack of phones.
“A woman told me that it was difficult to speak out and protest the bad service,” said Lungile Biyela, a Ritshidze community counselor with the Treatment Action Campaign.
“She says the staff are yelling at the patients. It scares people to think that if they complain they won’t be taken seriously, or worse, they will be victimized. SM / MC
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This notice was published: 2021-06-09 09:32:16