‘They treat us badly, they judge us… Some of the people I work with have stopped going for their HIV medication because of the type of attitude that they get. They should treat us like human beings.”

These are the words of a member of one of the communities monitored by the Ritshidze project, an initiative striving for accountability and service delivery in the public health sector in South Africa.

Ritshidze launched its second report on the KwaZulu-Natal (KZN) health system in Umlazi last week, highlighting the issues that discouraged people from visiting clinics for HIV, TB and other services.

Umlazi residents attend the launch of the latest report on the state of KwaZulu-Natal’s health system by Ritshidze. (Photo: Ritshidze)

According to the report, LGBTQIA+ communities, people who use drugs and sex workers were, on the whole in KZN, provided with the least friendly and worst services across all provinces.

“The clinic staff should not discriminate against us just because we sometimes come dirty. Most guys die on the road while there is a clinic next to them because they know they will not get help,” said a member of the key population groups in the report.

The report focused on the following issues:

Staff shortages

• 81% of facilities (103 facilities) monitored remained understaffed and unable to meet the needs of public healthcare users this year.
• 18% of facility managers said their facilities had enough staff compared with 19% last year.
• 55% of public healthcare users said there was always enough staff, up from 45% last year.

Improvements in waiting times and shortest waiting time across provinces

• This has dropped from 3.2 hours to 2.39 hours in facilities that opened over the past year; 30 facilities had average waiting times of under two hours.
• 17% of public healthcare users felt very unsafe or unsafe waiting for clinics to open (24% last year).

ARV collection and adherence

• 49% of people living with HIV (PLHIV) received three or more months’ supply of ARVs, up from 31% last year.
• 41% of PLHIV would like to collect ARVs closer to their home, reflecting a decrease from 54% last year.
• 82% of people thought staff were always friendly and professional when collecting their ARVs (up from 75% last year).
• 39% of PLHIV across 61 clinics monitored said they were welcomed back if they missed an appointment.

Key populations who received the worst healthcare services

• 26% of gay, bisexual, and other men who have sex with men have stopped accessing healthcare due to past experiences at clinics.
• 61% of sex workers say privacy is not well respected at facilities.
• Only 41% of gay, bisexual and other men who have sex with men say they have been offered Pre-exposure prophylaxis (PrEP).

According to Ritshidze’s latest report on the state of KwaZulu-Natal’s health system, out of 7,946 people, 82% thought staff were always friendly and professional — up from 75% last year. (Graphic: Ritshidze)

The report found infrastructure issues remained problematic at facilities — not enough space and concerns about the lack of cleanliness.

“Let us not have any room to justify the violation of human rights… let us not have any room to justify people who are ill-treating patients,” said Anele Yawa, General Secretary of the Treatment Action Campaign, while addressing community members at the launch of the report.

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“Yes, our clinics are overcrowded, but they are also understaffed. More than 42 million people out of the 60 million in South Africa are public healthcare users.

“In both the private and public sectors, we have less than 400,000 healthcare workers… one of the reasons some nurses have this [negative] attitude towards us is because they are overworked.

“Instead of them venting their anger at their bosses, we become the victims as the patients,” said Yawa.

“We are tired of producing these reports and then nothing happens after that. We want to see something being done so that people can start going to clinics without having the frustrations that they go through.” DM/MC