Monitoring done by Ritshidze (a community monitoring project) from October to December 2020 shows that poor staff attitudes remain a major barrier to seeking and staying in healthcare. Staff reactions to patients who missed a facility visit for ARV collection were often reported to be unwelcoming, unempathetic or, at worst, human rights violations. 

Across clinics, out of 7,162 patient responses, only half (54.6%) of patients thought the staff members were always friendly and professional.

The graphs below outline the worst-performing sites, where we think investigations should take place into allegations of poor staff attitude. 

(Graphic: Ritshidze / Spotlight)

One woman living with HIV tells us every visit to the clinic is a nightmare. The name-calling is insulting, an irritation and “makes me so cross and makes me want to cry”. She says she’s routinely spoken to rudely, by administrative staff members in particular. She feels singled out when staff members tell her to produce an appointment card even though she has never been issued one and she says she’s not familiar with the clinic’s system, having only moved to the area recently.

“They will tell me that because of that card they can’t help me and then they just let me sit,” the woman says. “Sometimes I sit till late in the afternoon, even though I come there early. They don’t care that I am hungry and I don’t have a lunchbox or money to buy food. They just cheek you and say things like ‘don’t waste my time’ or ‘we have a half-day today so don’t come with your problems’.”

(Graphic: Ritshidze/Spotlight)

Of the nearly 5,000 survey responses, only 13% (676) of people living with HIV said staff members were welcoming when they came to collect ARVs if they had previously missed a visit. Many reported being punished, with 545 reporting being sent to the back of the queue.

Another 518 people living with HIV reported being reprimanded for missing a visit. This is compared with only 410 people living with HIV who report that staff will provide counselling on adherence if you return to the clinic after missing a visit.

The graph below shows the responses from people living with HIV to what happens when they miss a clinic visit by province, listed from best performing to worst performing.

(Graphic: Ritshidze / Spotlight)

You can find an accessible version of the above table here.

The graph below shows the clinics where the most people living with HIV report being reprimanded and shouted at for missing a clinic visit.

(Graphic: Ritshidze / Spotlight)

The link to an accessible data table is here.

The graph below shows the clinics where the most people living with HIV report being sent to the back of the queue after missing a clinic visit.

(Graphic: Ritshidze / Spotlight)

The link to an accessible data table is here.

So, what should be done?

• All staff should be trained to provide a friendly and welcoming environment for all patients, whether accessing HIV prevention, accessing ART or, most importantly, returning to care after a treatment interruption.
• No people living with HIV should be sent to the back of the queue if they miss an appointment.
• “No “referral letter” should be required for people to transfer to a new facility.
• Provincial departments of health must carry out investigations into all allegations made regarding health personnel failures — including bad attitudes — and disciplinary action must be taken where appropriate and compensation paid to victims of neglect or ill-treatment. DM/MC

Setshogelo is a project officer with Ritshidze and Tshabalala is the National Chairperson of the Treatment Action Campaign (TAC).

Disclosure: The Treatment Action campaign participates in the Ritshidze project. Spotlight is published by SECTION27 and the Treatment Action Campaign, but is editorially independent, an independence that the editors guard jealously. The views expressed in this article are not the views of Spotlight.

This data set was presented to an Operation Phuthuma meeting on 5 March 2020. You can view the full presentation here. For more updates from Ritshidze, you can follow them on Twitter, Facebook and Instagram. 

Data related to the Western Cape has been excluded from the above. This is while ongoing discussions with the Western Cape provincial department of health continue in order to allow for Ritshidze to proceed with monitoring. Until this negotiation has concluded, the Western Cape DOH has refused to allow Ritshidze to engage in monitoring or publish any findings.