A woman in her forties who is living with HIV says she was denied services at a public healthcare facility because she didn’t have a transfer letter, resulting in her treatment being interrupted. She says she also developed mental health problems. (Spotlight knows the identity of the woman, but is withholding it since she does not wish her HIV status to be made public.)
Initially, she says she was taking her medication at Gateway Clinic in Mthatha but after developing mental health problems, her family took her to Gqeberha. She says that she was turned away at the Motherwell NU8 Clinic and the Motherwell Community Health Centre (CHC) for not having a transfer letter. As a result, she says her condition became unbearable. She says she also fell ill with tuberculosis.
It was only when she sought treatment at KwaZakhele CHC that she said she received the help she needed.
“My condition was becoming worse as I was not eating and started to develop TB symptoms. My brother recommended Kwazakhele CHC, which I had to spend R40 on taxi fare to and from KwaZakhele.” There she says they provided her with ARVs and she was put on TB treatment. “What I was subjected to in Motherwell is equal to negligence and how the department handling the issue of transferred letters is disappointing,” she says.
She is not alone.
‘Nobody should be denied treatment’
Community-led clinic monitoring project Ritshidze in its latest report on the state of health in the Eastern Cape, states that there are still patients living with HIV in the Eastern Cape who, when they relocate, are being shouted at and refused lifesaving ARVs because they don’t have a transfer letter.
According to Shelly Mabandla, manager of HIV and AIDS and TB programmes in the Buffalo City District, it is always necessary to provide a transfer letter for the continuation of a patient’s treatment and for the distribution of the correct medication to the patient. She says it helps that transfer letters are now stored in an electronic system.
“However, if clients don’t have a transfer letter, we have to provide them with treatment as if they were new patients. Nobody should stop taking treatment or be denied treatment in our facilities. If a client is turned away, he or she needs to report this to the department or our stakeholders,” she says.
One of 10 key issues in Ritshidize report
Being denied health services is one of ten key issues highlighted in the third edition of Ritshidze’s report on healthcare services in the Eastern Cape. The report was launched in two districts – Braelyn in Buffalo City on 19 September and Ikwezi in the OR Tambo District on 21 September. Monitoring for the report was conducted at 46 facilities and a total of 2 514 public healthcare users were interviewed. Just over half of the people surveyed are living with HIV.
According to the report, 294 people had been denied services at various facilities because they did not have an identity document.
Other issues highlighted in the report include challenges people experienced in collecting ARVs at pick-up points either at the facility or in the community. The Central Chronic Medicines Dispensing and Distribution (CCMDD) programme is meant to reduce the burden on facilities and make it quicker and easier for people living with HIV to collect their medication.
Mkhululi Ndamase, spokesperson for Eastern Cape Health MEC Nomakhosazana Meth, tells Spotlight that the department employs different tactics to reduce waiting times at facilities. One of those is the CCMDD programme.
“Through the CCMDD programme, patients pick up their chronic medication through a fast lane at our facilities or at any of the 234 non-health facilities such as private pharmacies, general practitioners, or churches in the province. At the end of the previous financial year, there were 309 551 patients in the CCMDD programme. The department [wants] to increase the number of pick-up points this current financial year and add a further 48 000 patients onto the CCMDD programme,” Ndamase says.
I use Port St Johns CHC. There is no care there. I go to collect ARVs. You wake up early, you might even pass out due to hunger. I had two blood tests this year, but no results. When I asked for my results, they claim they lost my file #ORTamboHealth #EasternCapeHealth pic.twitter.com/1XnOBHYehv— Ritshidze (@RitshidzeSA) September 21, 2023
Plenty of room for improvement
Yet, despite the benefits for the health system and people living with HIV, more than half of people living with HIV (59%) said they had never been offered one of these options, and almost half (49%) wish they could collect their ARVs closer to home, according to the Ritshidze report. “Of those using facility pick-up points, 70% of people using facility pick-up points must still collect files, take vitals, and see a clinician before getting their parcel making clinic visits drag on for hours,” reads the report.
The report also shows that there was an increase in the number of people living with HIV who received three to six-month medicine refills.
Among the 1 386 people living with HIV surveyed, 94% report having received a viral load test in the last year and only 80% (of the total) reported that they knew their viral load. “This year, 87% reported they understood that having an undetectable viral load means treatment is working well, and 85% understood that having an undetectable viral load means a person cannot transmit HIV,” the report reads.
As with most Ritshidze reports, staff shortages were again flagged as a major concern. Only 13% of facilities reported there were enough staff – a slight worsening from 14% last year. While up from 21% last year, this year, of 2 507 public healthcare users, only 32% said there was always enough staff to meet the needs of public healthcare users. Despite the ongoing staffing challenges, waiting times in facilities have been reduced from 3:59 hours last year to an average of 3:14 hours this year, according to the report.
Many healthcare users interviewed, however, complain about long waiting times. Most of them – 63% blamed the long waiting times on staff shortages and 18% blamed disorganised filing systems.
Recommendations and frustrations
Among Ritshidze’s recommendations this year and in previous reports have been for the Department of Health to ensure that their staff treat people in a dignified and friendly manner, to investigate any reports of poor attitudes raised by Ritshidze, and to take disciplinary action where appropriate. They also recommend that staff are made aware that transfer letters are not required for ARV continuation or to restart treatment.
“Reports where treatment is delayed due to the requirement of a transfer letter should be urgently investigated, and disciplinary action should be taken where appropriate,” the report states.
Anele Yawa, Secretary-General of the Treatment Action Campaign (TAC – which is part of Ritshidze), says he is frustrated and disappointed by how the healthcare system is failing its citizens.
“Our country has eight million people living with HIV, of whom 5.8 million are on treatment, but many of those 5.8 million people choose to quit treatment for personal reasons. It seems no one cares about fixing the reasons why they quit treatment,” says Yawa.
‘Encouraged by measurable improvements’
Mabandla, however, says that the department acknowledged the recommendations and is encouraged by the measurable improvements in the Ritshidze report. “This shows our quality improvement initiatives are taking shape. There is nothing I can defend or deny, but as professionals, we need to provide a comprehensive enough service to our clients, regardless of what their explanations may be. In BCM (Buffalo City Metro), we have discussed these challenges and one of the actions we agreed upon was to educate the communities,” she says.
“Our team is investigating these complaints and we assess the facility when we investigate these allegations. These concerns are discussed during cluster meetings. Our staff must cease treating our clients unfairly because we are called to serve the nation. Despite infrastructure challenges, medication is always available in our facilities,” says Mabandla.
This article was written by Luvuyo Mehlwana and first published on Spotlight.
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