EASTERN CAPE STATE OF HEALTH - SEPTEMBER 2021 - Ritshidze
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EASTERN CAPE STATE OF HEALTH SEPTEMBER 2021
ANALYSE
THE DATA
GATHER GENERATE
EVIDENCE SOLUTIONS
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THE REPORT
The Eastern Cape Province State of Health Report has been developed using data from
Ritshidze and outlines community priorities for improving HIV, TB and other health
services in the province. Ritshidze is a community-led monitoring system developed
by organisations representing people living with HIV including the Treatment
Action Campaign (TAC), the National Association of People Living with HIV (NAPWA),
Positive Action Campaign, Positive Women’s Network (PWN) and the South African
Network of Religious Leaders Living with and affected by HIV/AIDS (SANERELA+).
Community-led clinic monitoring is a systematic collection populations) and healthcare providers (facility managers,
of data at the site of service delivery by community adherence club facilitators, pharmacists). All Ritshidze’s
members that is compiled, analysed and then used data collection tools, our data dashboard, and all raw data
by community organisations to generate solutions to are available through our website: www.ritshidze.org.za
problems found during data collection. In Ritshidze,
people living with HIV are empowered to monitor services
provided at clinics, identify challenges, generate solutions ABOUT THE DATA IN THIS REPORT
that respond to the evidence collected, and make sure
the solutions are implemented by duty bearers. Data in this report was collected in two data
Giving communities the ability to monitor the quality-of- collection periods: April to June 2021 (quarter
service provision and highlight performance problems 3) and August and September 2021 (quarter 4).
is an indispensable strategy for improving HIV and TB
+ Interviews took place with 44 Facility Managers
service delivery across South Africa. Through Ritshidze
we have begun to more systematically document the + Observations took place at 45 facilities
failures in quality HIV service delivery as well as gaps in + Interviews took place with 1210 patients
terms of implementation of a May 2019 circular issued
+ 75% (902) identified as people living with HIV
by the National Department of Health (appendix 1).
+ 64% (786) identified as female
Ritshidze monitoring takes place on a quarterly basis
+ 19% (237) identified as under 25 years of age.
at 400 clinics and community healthcare centres across
27 districts in 8 provinces in South Africa — including All data are available at: data.ritshidze.org.za. We are
49 facilities across Eastern Cape: 14 in OR Tambo, 11 in currently analysing the data and generating solutions,
Buffalo City, 9 in Alfred Nzo, 6 in Amathole, 5 in Nelson after which we will be feeding back the results of data
Mandela Bay, and 4 in Chris Hani. We collect data collected and recommended solutions to duty bearers
through observations, as well as through interviews with at facility and district levels.
healthcare users (patients, adherence club members, key
2 RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021
PROVINCE
AND SITE NAME IMPLEMENTING PARTNER
DISTRICT
Amadiba Clinic Maternal, Adolscent and Child Health (MatCH)
Imizizi Clinic Maternal, Adolscent and Child Health (MatCH)
Alfred Nzo District
Isikelo Clinic Maternal, Adolscent and Child Health (MatCH)
Municipality
Maluti CHC Maternal, Adolscent and Child Health (MatCH)
Matatiele Community Clinic Maternal, Adolscent and Child Health (MatCH)
Mount Ayliff Gateway Clinic Maternal, Adolscent and Child Health (MatCH)
Mount Frere Gateway Clinic Maternal, Adolscent and Child Health (MatCH)
St Patrick’s Gateway Clinic Maternal, Adolscent and Child Health (MatCH)
Tabankulu CHC Maternal, Adolscent and Child Health (MatCH)
Butterworth Gateway Clinic TB/HIV Care
Amathole District
Idutywa Village CHC TB/HIV Care
Municipality
Nozuko Clinic TB/HIV Care
Nqamakwe CHC TB/HIV Care
Willowvale CHC TB/HIV Care
Xhora CHC TB/HIV Care
Central Clinic (East London) Kheth’Impilo
Duncan Village CHC Kheth’Impilo
Buffalo City Metropolitan
Empilweni Gompo CHC Kheth’Impilo
Fezeka NU 3 Clinic Kheth’Impilo
Municipality
Gompo C Jabavu Clinic Kheth’Impilo
Greenfields Clinic Kheth’Impilo
EASTERN CAPE PROVINCE
Grey Gateway Clinic Kheth’Impilo
Luyolo NU 9 Clinic Kheth’Impilo
Nontyatyambo CHC Kheth’Impilo
Philani NU 1 Clinic Kheth’Impilo
Zanempilo Clinic (East London) Kheth’Impilo
Ngcobo CHC TB/HIV Care
Municipality
Chris Hani
District
Nomzamo CHC TB/HIV Care
Philani Clinic (Queenstown) TB/HIV Care
Tembelihle Clinic TB/HIV Care
Gustaye L’Amour Clinic n/a
Nelson Mandela
Letitia Bam Clinic n/a
Metropolitan
Municipality
Motherwell CHC n/a
Nomangesi Jayiya Clinic n/a
Rosedale Clinic n/a
Soweto Clinic n/a
Civic Centre Clinic (Mthatha) TB/HIV Care
Flagstaff Clinic TB/HIV Care
Holy Cross Gateway Clinic TB/HIV Care
Oliver Tambo District Municipality
Lusikisiki Village Clinic (Qaukeni) TB/HIV Care
Mhlakulo CHC TB/HIV Care
Mqanduli CHC TB/HIV Care
Mthatha Gateway Clinic TB/HIV Care
Ngangelizwe CHC TB/HIV Care
Ntapane Clinic TB/HIV Care
Port St Johns CHC TB/HIV Care
Qumbu CHC TB/HIV Care
St Elizabeth’s Gateway Clinic TB/HIV Care
Stanford Terrace Clinic TB/HIV Care
Tsolo Clinic TB/HIV Care
RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021 3
NOMANGESI CLINIC
BUTTERWORTH CLINIC
4
GREENFIELDS CLINIC
ALFRED
JOE GQABI NZO
OR TAMBO
CHRIS HANI
AMATHOLE
SARAH BAARTMAN BUFFALO
CITY
NELSON
MANDELA BAY
INTRODUCTION
In Eastern Cape:
+ 91% PLHIV know their status
+ 72% PLHIV who know their status on treatment
+ 88% PLHIV on treatment are virally suppressed
Severe overcrowding and clinics that are too small to service their growing number of
patients are just the start of problems for the Eastern Cape — a province that remains
one of the poorest in the country. Add to this are challenges of improving road access and
general amenities to some of most remote parts of South Africa. It makes the problem
of attracting and retaining nurses and doctors to these far-flung regions a tall ask.
Over and over Ritshidze is hearing complaints about poor staff people on treatment to have suppressed viral loads.
attitudes and unprofessional conduct by nurses. While nurses
Yet in the Eastern Cape, while 91% of people living with
may be burdened with their own challenges, and are in some
HIV know their status, only 72% of those people are on HIV
cases overworked and overwhelmed by their patient load
treatment, out of which 88% are virally suppressed1. This
and shortage of support, their attitudes and work behaviour translates to just 66% of all people living with HIV receiving
remain one of the easiest targets to shift if the Department ARVs in the province and only 58% of all people living with
of Health can commit to bringing their employees to order. HIV being virally suppressed. The failure to make sufficient
These problems seem insurmountable but there are targets progress towards the 95-95-95 targets, most especially
that the province can and must improve on. Improving keeping enough people on treatment, can be directly
the quality of services provided in public clinics is vital linked back to the crisis in our clinics in the Eastern Cape.
to ensuring enough people are accessing HIV and TB Recognising this important gap, in 2019 the National
prevention services, are getting tested, and are starting Department of Health announced a circular proposing
and staying on treatment. It is key to achieving the UNAIDS a series of policy changes designed to remove barriers
new scaled up 95-95-95 targets that now aim for 95% of to care and support accountability of healthcare
people living with HIV knowing their HIV status; 95% of workers (see Appendix 1). Yet two years later, this
people who know their status on treatment; and 95% of directive has not been enacted by many facilities.
1. N
ational Department of Health. Presentation made at the National Comprehensive Care, Management, and Treatment (CCMT) Quarterly
Program Performance Reviews Technical Working Group Meeting: “HIV/AIDs and STI Catch Up PlansFY 21/22 (April 2021 – March 2022)”
RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021 5
NOMANGESI CLINIC
COVID-19 has worsened healthcare in the province. In 2020, as province. The report focuses on the following critical themes:
with other provinces, there was a decline in the overall number long waiting times and staff shortages; infrastructure;
of visits to health facilities in the Eastern Cape compared to ART collection and continuity; treatment and viral load
previous years, a result of the COVID-19 pandemic, and fewer treatment literacy; the implementation of index testing
HIV tests were carried out in the province2. Similar is true for to find people living with HIV; stockouts and shortages
TB, with a decline in the number of GeneXpert tests carried of medicines; accessibility of health services for key
out3. Fewer people getting tested for HIV and TB will lead populations; TB infection control; and accountability.
to an increase in the number of people with undiagnosed
HIV or TB, and add to those not yet initiated on treatment.
Facility Manager: Have you had any of the following issues at
Ritshidze observations and data collected from interviews with
your clinic beacuse of the COVID-19 crisis?
patients and staff highlighted challenges due to COVID-19
Total Responses: 44
in the preceding three months including: longer waiting
times, less staff working than usual, increased stockouts, lack
of personal protective equipment (PPE), and a lack of safety
precautions at some facilities including no physical distancing,
a lack of availability of water/soap or sanitizer at the clinic,
and at times screening protocols not being followed.
A reduction in the overall provincial health budget due to
costs associated with the COVID-19 pandemic — together
with budget cuts from PEPFAR and an end to additional
surge funding that aimed to maximise progress towards
the 95-95-95 targets — is only worsening this crisis.
The Eastern Cape State of Health report takes a detailed
look at the challenges people living with HIV face in the
Is the clinic faced with any of the following issues becasue of Have you had any of the following issues getting healthcare
the COVID-19 crisis? because of COVID-19 crisis?
Total Responses: 52 Total Responses: 1207
2. P
illay, Y., Pienaar, S., Barron, P., & Zondi, T. 2021 May 17. Impact of COVID-19 on routine primary healthcare services in South
Africa. South African Medical Journal. Available at: http://www.samj.org.za/index.php/samj/article/view/13303
3. Ibid
6 RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021
NOZUKO CLINIC
1. Staffing
89% of facility managers say their facilities don’t + By December 2022, the Eastern Cape
have enough staff Department of Health should employ an
additional 10% of nurses (including professional
Only 29% of patients say there are always
enough staff at facilities
nurses, enrolled nurses and enrolled nurse
assistants) in Buffalo City, OR Tambo, Amathole,
Chris Hani, and Alfred Nzo.
133 vacancies reported across
28 sites monitored + The Eastern Cape Department of Health should
produce annual reports on the numbers of
Recommendations: healthcare workers (divided into sub-groups
such as CHWs, professional nurses, and GPs)
+ Understaffed clinics mean healthcare workers are
employed in each district and the numbers
overburdened. This leads to longer waiting times,
of people and size of areas covered by these
limited time to attend to patients, and at times, bad
healthcare workers. These reports should also
attitudes. These factors directly contribute to PLHIV
include year-on-year comparisons (from at least
starting and staying on treatment and can be linked
2020) of the number of filled posts in all districts
to the province only attaining 72% of PLHIV who
and the cost of these posts to the government.
know their status on treatment.
+ By March 2022, the Eastern Cape Department of
Health should fill 80% of vacancies in the province, Data collected in Eastern Cape reveal significant
and fill the remaining 20% by September 2022.
staff shortages that are undermining the quality of
+ By March 2022, the Eastern Cape Department of services provided at clinics. Ensuring access to quality
Health should ensure that all CHWs have reliable healthcare services and ensuring everyone living
transportation as required to find PLHIV who have with HIV and TB gets access to medicines and care
missed appointments or interrupted treatment, depends mainly on having enough qualified and
or to find people with TB and their contacts, that
committed staff. These shortages, including a high
is currently only available at 5 out of 43 sites
number of vacancies, lead to longer waiting times
monitored with CHWs.
and increased pressure on the few staff in place.
+ By March 2022, District Support Partners (DSPs) Ensuring that 80% of vacancies at facilities are filled
should ensure all PEPFAR supported sites have by March 2022 must be a priority in this province.
at least one male nurse and one male counsellor
in place, leading to a greater uptake of services The majority (89%) of Facility Managers do not have
by men (39% of sites monitored reported no male enough clinical and non-clinical staff at the facility
nurses, counsellors or healthcare workers). to meet the needs of patients. Data from patients
+ By March 2022, DSPs should ensure all PEPFAR are closely aligned: just 29% of patients interviewed
supported sites have at least one male clinic day report that there are always enough staff at the facility.
per week or Men’s Corners (ensuring male staff are Considerable variation is observed across districts:
on duty) integrated into service delivery to provide with 16% of patients in Buffalo City reporting there
services specific to the needs of men. are always enough staff at the facility, followed by
+ By December 2022, the Eastern Cape Department Chris Hani (19%), Nelson Mandela Bay (19%), Alfred
of Health should employ an additional 10% of Nzo (32%), OR Tambo (34%), and Amathole (37%).
pharmacists and assistant pharmacists in Alfred Nzo. The facilities with the lowest ranking for staffing
according to patients are shown in the table.
RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021 7
Facility manager: Does the facility have enough staff? Are there enough staff at the facility?
Total Responses: 44 Total Responses: 1207
Worst performing sites by patient responses for “Are there enough staff at the facility?” (August to September 2021)
According to Facility Managers, the most commonly In terms of impact of COVID-19, staff at 18% of
understaffed cadres were professional nurses, enrolled facilities monitored complained of working with
nurses, cleaners, doctors, enrolled nurse assistants, and fewer staff operating because of the pandemic
assistant pharmacists. This varied across districts: and 11% of patients interviewed also stated
+ High professional nurse shortages were reported there were less staff working than usual.
in Buffalo City (64% of sites - n=7), OR Tambo (64% of
sites - n=9), Amathole (83% of sites - n=5), and Alfred
Nzo (89% of sites 0 n=89%). High doctor shortages Which cadres are understaffed?
were reported at Alfred Nzo (78% of sites - n=7). Total Responses: 43
+ High enrolled nurse shortages were reported in
Chris Hani (100% of sites - n=4), Amathole (50% of
sites - n=3), and Alfred Nzo (78% of sites - n=7).
+ High enrolled nurse assistant shortages
were reported in Chris Hani (50% of sites - n=2)
and Amathole (50% of sites - n=3).
+ High pharmacist and assistant pharmacist
shortages were reported in Alfred Nzo with 5 sites
(56%) reporting shortages of both cadres.
+ High cleaner shortages were reported in OR Tambo (64%
of sites - n=9), Chris Hani (100% of sites - n=4), Amathole
(50% of sites - n=6) and Alfred Nzo (56% of sites - n=5).
8 RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021
Which cadres are understaffed according to Facility Managers (August to September 2021)
Which Cadres are Understaffed?
Professional nurse
General assistant
Adherence club
Linkage officers
Lay counselors
Lab technician
Security guard
Enrolled nurse
Enrolled nurse
Data capturer
pharmacist
Pharmacist
facilitators
Assistant
assistant
Cleaner
Doctor
District Facility
Amadiba Clinic Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Imizizi Clinic Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Isikelo Clinic Yes Yes Yes Yes Yes
Maluti CHC Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Alfred Nzo
Matatiele Community Clinic Yes Yes Yes Yes
Mount Ayliff Gateway Clinic Yes Yes Yes Yes Yes Yes Yes Yes Yes
Mount Frere Gateway Clinic Yes Yes Yes Yes
St Patrick’s Gateway Clinic Yes Yes Yes Yes Yes Yes Yes
Tabankulu CHC Yes Yes Yes Yes
Butterworth Gateway Clinic Yes Yes Yes
Idutywa Village CHC Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Amathole
Nozuko Clinic Yes Yes Yes Yes Yes Yes Yes Yes Yes
Nqamakwe CHC Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Xhora CHC Yes Yes Yes Yes Yes Yes
Duncan Village CHC Yes Yes Yes Yes Yes Yes Yes Yes
Empilweni Gompo CHC Yes Yes Yes
Gompo C Jabavu Clinic Yes Yes Yes
Greenfields Clinic Yes Yes Yes
Buffalo City
Grey Gateway Clinic Yes Yes Yes Yes Yes Yes Yes
Luyolo NU 9 Clinic Yes Yes Yes
Nontyatyambo CHC Yes Yes Yes Yes
Philani NU Yes Clinic Yes Yes Yes Yes
Zanempilo Clinic (East London) Yes
Ngcobo CHC Yes Yes Yes Yes Yes Yes
Chris Hani Nomzamo CHC Yes Yes Yes
Philani Clinic (Queenstown) Yes Yes Yes Yes Yes Yes
Tembelihle Clinic Yes Yes Yes
Nelson Mandela Bay Motherwell CHC Yes Yes Yes Yes Yes Yes
Civic Centre Clinic (Mthatha) Yes Yes Yes
Flagstaff Clinic Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Holy Cross Gateway Clinic Yes Yes Yes
Lusikisiki Village Clinic (Qaukeni) Yes Yes Yes Yes
Mhlakulo CHC Yes
Mqanduli CHC Yes Yes Yes
OR Tambo
Mthatha Gateway Clinic Yes Yes
Ngangelizwe CHC Yes Yes Yes Yes Yes Yes Yes Yes
Ntapane Clinic Yes
Port St Johns CHC Yes Yes Yes Yes
Qumbu CHC Yes Yes Yes Yes
St Elizabeth’s Gateway Clinic Yes Yes Yes Yes Yes Yes
Tsolo Clinic Yes Yes Yes
RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021 9
MOUNT FRERE GATEWAY CLINIC DUNCAN VILLAGE CHC
Facilities in the Eastern Cape (as well as KwaZulu-Natal) Cadres with vacancies
are performing worst at filling open vacancies, with both Total Responses: 40
provinces reported the highest proportion of vacancies
across all provinces. The numerous open positions that
are not being filled create gaps in capacity to deliver
quality services. According to Facility Managers, the
most commonly understaffed cadres were professional
nurses (23 vacancies), cleaners (17 vacancies),
enrolled nurses (14 vacancies), assistant pharmacists
(13 vacancies), and doctors (12 vacancies). This challenge
is worsened as staff retire and are not replaced.
Vacancies reported by Facility Managers across districts (August to September 2021)
What is clear, is that both Facility Managers and patients large portion of CHW work is performed outside of the
agree — there is a major gap between the staffing facility, these findings reveal an important barrier to the
needed to ensure high quality services and the staff efficacy of the CHW programme in the province. Further
present each day in the clinics in much of the province, challenges include there not being enough CHWs (raised
compounded by COVID-19 and unfilled posts. by Facility Managers at 17 sites), not enough phones (raised
by Facility Managers at 12 sites), safety issues for CHWs
working in the community (raised by Facility Managers at
COMMUNITY HEALTHCARE WORKERS (CHWS) 10 sites), and the fact that patients give wrong numbers
CHWs are recognised as an integral health human and addresses (raised by Facility Managers at 40 sites).
resource, playing a role in the HIV/AIDS, TB, and most
recently, COVID-19 response. 96% of facilities visited by Roles CHWs perform
Ritshidze reported CHWs based at the clinic. However, Total Responses: 41
Mount Ayliff Gateway Clinic and Tabankulu CHC both in
Alfred Nzo reported no CHWs. Defaulter tracing (95% of
sites), TB contact tracing (80% of sites), HIV testing and
counselling (61% of sites) and Treatment Literacy (56% of
sites) are the most common roles played by the CHWs.
Despite the presence of CHWs, there are significant
challenges to get what is needed from CHWs to help
improve people’s health. The majority of Facility Managers
(77%) said that CHWs at their facility do not have access
to transport to work outside of facilities. Of the Facility
Managers reporting that transport was available, just
five said that the transport was reliable. Given that a
10 RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021MOUNT AYLIFF GATEWAY CLINIC NOMZAMO CHC
COMMUNITY HEALTHCARE WORKERS ROLE IN ACHIEVING 90-90-90 IN ESHOWE, KWA-ZULU NATAL
In Eshowe, MSF provided HIV testing and linkage to care through community-based support
(through patient supporters and community health workers), resulting in Eshowe being able
successfully to achieve the 90-90-90 targets (95-95-95) a year ahead of the UNAIDS deadline.
Critical to this was the ability to use mobile sites and community-based support on farms and in deep rural communities.
Although over time the HIV+ yield of the CHW testing programme decreased, early on it was very high. The CHWs also helped
to “normalise” HIV testing and treatment as they became a fixture of normal community health services. Finally, when a HIV+
case was detected, they were able to follow up to try to ensure that the individual had been linked to HIV treatment services.
Following the achievement of the 90-90-90 targets, MSF started handing over activities related to HIV to the Department of
Health, remaining focused only on TB. The aim being to show how lessons learned from its HIV bending-the-curves strategy
and innovative strategies can be put in place to ensure TB cascade strengthening.
The following objectives were set to support the achievement of the aim of: 1) enhancing TB Prevention; 2) finding the missing
cases; and 3) improving treatment outcomes.
The project has worked closely with CHWs from the area in facilitating the implementation of community based sites (called
Luyanda sites) which aim at bringing screening services closer to the people. These sites are minded by CHWs from SHINE and
provide services such as TB, HIV, STI, NCD screening and family planning. A referral system has been established to provide
linkage of care for patients that need to be seen at facilities. Support is also provided by the mobile clinic nurse who visits the
site for nonurgent cases and provides needed resources. The sites are also ear-marked to be used as CCMDD pick up points.
MALE HEALTHCARE WORKERS and child health and systematic under-funding of men’s
services compared to women. About 30% of HIV transmission
The proportion of men who know their HIV status and occurs amongst stable partners and the HIV positive partner
are accessing ART is much lower compared to women in amongst sero-discordant couples is more commonly
South Africa. While men only account for a third of new male than female. This together with growing evidence
infections, they account for more than half of the HIV related that ART reduces HIV mortality and morbidity more so if
deaths, pointing to a major challenge in men’s uptake of treatment is started early and potential benefits of viral load
HIV treatment services. This is not unique to South Africa. suppression in reducing transmission, make men a critical
Research in many African countries has shown that HIV- target population to reduce HIV incidence and mortality.
positive men are less likely to initiate ART, and those who
do are more likely to present to clinics later, more ill and Positively Ritshidze data shows that 61% of facilities
have poorer retention and worse clinical outcomes. reported having male nurses, counsellors, and/or
healthcare workers at the facility. PEPFAR should ensure
Explanations put forward for men’s low attendance and that there is at least one male nurse or counsellor at each
poor outcomes include notions of masculinity that are site to support male uptake of services. Only 27% of
at odds with illness and ‘good patient’ behaviour, public facilities said they had male outreach services and 9% of
health systems that are historically built around maternal facilities said they had no male specific services at all.
What services are available for men according to Facility Managers per district (April to June 2021)
RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021 11NOMANGESI CLINIC
2. Waiting Times
Long waiting times are a major challenge in the Eastern
4:41 hours was the average reported
waiting time by patients (including
time before the facility opened)
Cape, where public healthcare users often spend hours
at each visit to the clinic. This simply does not work well
for most people — particularly working people and
4:31 hours was the average reported waiting those in school. Having people living with HIV spend an
time by patients after the facility opened extended time at a clinic, simply to collect ART refills,
increases the risk of that person disengaging from care.
124 was the average number of patients waiting
to receive clinical services In the Eastern Cape public healthcare users reported
that they spent an average of 4.41 hours waiting in the
40% of patients felt unsafe or very unsafe
waiting for clinic to open
facility (including time before the facility opens) as well as
an average of 4.31 hours waiting after the facility opens.
58% of facilities had a filing system The average was seven hours or more at 3 facilities, six or
observed in bad condition more hours at 6 facilities, five hours or more at 16 facilities,
and four hours or more at 29 facilities. This is a very long
Recommendations: time to spend at a facility in which patients are usually
only seen for a very short consultation. There is some
+ Early mornings, feeling unsafe outside the clinic,
variation between clinics and districts (as outlined in
and long waiting times cause people to dread
the table) but waiting times are long across the board.
clinic days or even stop going. This directly impacts
our ability to reach 95% of PLHIV on treatment.
+ By end November 2021, ensure a functional IT IS POSSIBLE TO DO BETTER!
filing system in Ntapane Clinic, St Elizabeth’s
Gateway Clinic, Nozuko Clinic, Civic Centre At Tembelihle Clinic and Ntapane Clinic the waiting time
Clinic (Mthatha), Isikelo Clinic, Amadiba was under 3 hours.
Clinic, Imizizi Clinic, St Patrick’s Gateway
Clinic, Motherwell CHC, Maluti CHC.
+ By March 2022, extend facility opening hours
Average Time Patients
Patients Spend at the
Spend at the Facility
Number of Facilities
(as per the NDoH circular from 5am to 7pm
Facility (including
on Monday to Friday). People living with
before it opens)
(after it opens)
Average Time
HIV should be able to use these extended
opening times to pick up their medication.
Assessed
+ By March 2022, open the grounds of clinics
by 5am to ensure safety of patients waiting District
to access services in the early mornings.
Chris Hani 4 3:22 3:05
+ By March 2022, implement functional
appointment systems at 100% of sites and Alfred Nzo 9 3:41 3:39
ensure that patients are aware of them. Amathole 6 4:46 4:46
+ By March 2022, the Eastern Cape Department of Buffalo City 11 5:05 4:47
Health and District Support Partners (DSPs) should
work together to reduce the burden on facilities OR Tambo 14 5:14 5:03
by getting at least 60% PLHIV out of the clinic and Nelson Mandela Bay 1 7:25 6:19
into external pick up points or adherence clubs.
Eastern Cape 45 4:41 4:31
12 RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021KOKSTAD CLINIC MOUNT AYLIFF GATEWAY CLINIC
Facilities with waiting times over 4 hours (August to September 2021)
Ritshidze Community Monitors completed 45 facility the information was collected by the Ritshidze team
observations in quarter 4, finding that on average around 10am). At the 16 clinics shown in the table
128 patients were observed waiting for services below, more than 100 patients were observed waiting
(the number of patients ranged from 15-500 and to be seen at around 10am at each facility.
Facilities with 100 or more patients waiting to be seen (August to September 2021)
Patients begin queuing early in the morning in an attempt usually open at 7am, they generally only start seeing
to get seen more quickly — often so they can make it to patients at 8am, yet at some clinics patients start arriving
work or to take care of their children. While the clinics at 5am, even before sunrise, in hopes of being seen early.
RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021 13GREENFIELDS CLINIC
Facilities with the earliest patient arrival times (August to September 2021)
Meanwhile, while they were pushed to arrive early, reported filing systems to be in a bad condition in 58% of sites
patients felt unsafe. Of 471 people who arrived before monitored. Messy and disorganised filing systems increase
the facility opened, 40% reported feeling “very unsafe” the delays to healthcare users being attended to, and increase
or “unsafe” while waiting for the facility to be open. the burden on already overstretched healthcare workers.
How safe is the facility to wait before it opens? Are the queues at the facility long?
Total Responses: 471 Total Responses: 1204
Patients interviewed are clear on the problem. 65% of Other reasons given for long queues
patients interviewed in the province believe the queues at Total Responses: 779
the facility are long. This varied across districts: Chris Hani
(33%), Amathole (54%), Buffalo City (66%), OR Tambo (75%),
Alfred Nzo (77%), Nelson Mandela Bay (100%). The most
frequent reason provided by patients for the long queues is
that “there are too many patients to serve” (57%), “there is not
enough staff” (54%), and that “staff take long breaks” (34%).
The challenge of long waiting times is further compounded by
poor filing systems. 32% of Ritshidze respondents think that
the queues are long because “it takes too long to find files, the
filing system is messy or files get lost”. Ritshidze observations
14 RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021What is observed in bad condition in filing systems (August to September 2021)
What is in bad condition? Please select all that apply:
There are too
stored where
Files are lost,
access them
patients can
are stored is
few people
where files
missing or
misplaced
The space
The filing
too small
system is
Files are
looking
for files
messy
District Facility
Amadiba Clinic Yes Yes
Imizizi Clinic Yes Yes Yes
Alfred Nzo
Isikelo Clinic Yes Yes
Maluti CHC Yes Yes Yes Yes
St Patrick’s Gateway Clinic Yes Yes Yes
Butterworth Gateway Clinic Yes
Amathole Nozuko Clinic Yes Yes
Nqamakwe CHC Yes
Xhora CHC Yes
Central Clinic (East London) Yes
Duncan Village CHC Yes
Greenfields Clinic Yes
Buffalo City
Luyolo NU 9 Clinic Yes
Philani NU Yes Clinic Yes
Zanempilo Clinic (East London) Yes
Nelson Mandela Bay Motherwell CHC Yes Yes Yes
Civic Centre Clinic (Mthatha) Yes Yes
Holy Cross Gateway Clinic Yes
Mhlakulo CHC Yes
Mqanduli CHC Yes
Mthatha Gateway Clinic Yes
OR Tambo
Ntapane Clinic Yes Yes
Port St Johns CHC Yes
Stanford Terrace Clinic Yes
St Elizabeth’s Gateway Clinic Yes Yes
Tsolo Clinic Yes
Functional appointment systems, if used effectively, have appointment system at the facility, however the majority
the potential to reduce waiting times in facilities. Only (96%) of those people thought they were functional.
82% of healthcare users we spoke to were aware of an
Less than 90% of patients aware of an appointment system (August to September 2021)
RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021 15NOZUKO CLINIC
3. Infrastructure and clinic conditions
52% of clinics in to address these infrastructural issues including
bad condition building new facilities, building temporary structures,
as well as decanting more PLHIV out of the facility to
86% of clinics need some
additional space
external pick up points or community based adherence
clubs (plus longer ARV supplies).
57% of clinics do not have enough
room in the waiting area According to observations by Ritshidze, 56% of clinics
80% of clinic toilets in monitored in Eastern Cape are in bad condition:
bad condition 70% in Buffalo City, 56% in Alfred Nzo, 50% in Chris
Hani, and 43% in OR Tambo. The most commonly
Only 6% of patients reported that facilities
are dirty or very dirty
provided reasons for the bad condition are: old
buildings that need renovation (14), broken or cracked
25 clinics reported being
understaffed on cleaners
roof (6), and no running water at the facility (4).
17 clinics had
cleaner vacancies
Concerns with the condition of the toilets
Total Responses: 24
Recommendations:
+ By October 2021, all patients should be consulted in
private rooms. Facing privacy violations such as being
consulted, tested, or counselled in the same room as
someone else can lead to PLHIV disengaging from
care.
+ By March 2022, the Eastern Cape Department of
Health should fill all cleaner vacancies to ensure clean
facilities and toilets.
+ By December 2022, the Eastern Cape Department of
Health should employ an additional 15% of cleaners
in OR Tambo, Chris Hani, Amathole and Alfred Nzo.
+ By December 2022, where there are small waiting areas
that lead to overcrowding (putting patients and staff IT IS POSSIBLE TO DO BETTER!
at risk of TB infection at the clinic) the Eastern Cape All facilities in Amathole were found to be in
Department of Health must implement strategies a good condition!
16 RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021Facilities observed to be in a bad condition (August to September 2021)
Out of 44 facilities assessed, 86% of the Facility Managers 25 sites, has a profound effect on the TB infection control
we spoke to reported needing more space to meet at the site level (this report will develop in a detailed
patient needs, with 50% Chris Hani sites, 85% in OR manner in all aspects of this issue later in the document).
Tambo, 90% in Buffalo City and 100% in Amathole.
Waiting space for patients, HIV testing/counselling
space, rooms for medical care, space for filing, and What do you need more space for?
space for data capturers were the most common Total Responses: 38
things Facility Managers needed extra space for.
Inadequate space impacts patients in multiple ways. Lack
of space for HIV counselling and testing can mean PLHIV
are consulted, tested, or counselled in the same room
as someone else (as reported at Lusikisiki Village Clinic,
Amadiba Clinic, Port St Johns CHC, Ntapane Clinic, Imizizi
Clinic, Isikelo Clinic.). This lack of privacy and confidentiality
can lead to individuals disengaging from care.
Small waiting areas can also lead to overcrowding and
even before COVID-19, patients have been forced to
wait outside in long queues at certain clinics. The lack
of appropriate space for patients to wait, as reported at
Facility Manager responses on “what do you need more space for” by district (April to June 2021)
On overall clinic cleanliness, the Eastern Cape is clinics were “very clean” or “clean”. Only 6% of patients
performing well compared to other provinces, only reported that facilities were “very dirty” or “dirty”.
second to KwaZulu-Natal. 77% of patients reported that
RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021 17EMPILWENI CLINIC MOUNT AYLIFF GATEWAY CLINIC
How clean is the facility?
Total Responses: 1206 IT IS POSSIBLE TO DO BETTER!
These 23 clinics are reported as clean by patients, with
zero reports by any patients of being dirty: Tembelihle
Clinic, Willowvale CHC, Nontyatyambo CHC, Idutywa
Village CHC, Nqamakwe CHC, Motherwell CHC, Luyolo
NU 9 Clinic, Civic Centre Clinic (Mthatha), Xhora CHC,
Ntapane Clinic, Empilweni Gompo CHC, Duncan Village
CHC, Fezeka NU 3 Clinic, Central Clinic (East London),
Philani Clinic (Queenstown), Grey Gateway Clinic, Ngcobo
CHC, Ngangelizwe CHC, Lusikisiki Village Clinic (Qaukeni),
Flagstaff Clinic, Gompo C Jabavu Clinic, St Elizabeth’s
Gateway Clinic and Holy Cross Gateway Clinic.
Worst performing facilities on “How Clean is the Facility?” (August to September 2021)
However, toilets are often found in a bad condition. Concerns with the condition of the toilets
80% of Ritshidze observations found that toilets Total Responses: 40
were in bad condition, with variation amongst
districts: Chris Hani (50%), Amathole (50%), OR Tambo
(79%), Alfred Nzo (89%), Buffalo City (100%). No
soap, no toilet paper, dirty toilets, no light and
no water were the most significant concerns.
18 RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021CENTRAL CLINIC
4. ART Collection
4a. Multi-month dispensing should be made to support patients with suppressed
viral loads to receive extended refills and/or enrollment
in a repeat prescription strategy. Implementing this SOP
21% of PLHIV received one month is vital to supporting improved long term adherence.
supply of ARVs Ritshidze data reveals that 61% of PLHIV reported
61% of PLHIV received two months receiving 2 month ART refills. Just 15% of PLHIV reported
supply of ARVs 3 month ART refills, which is low as the country aims
to move towards longer multi month dispensing.
15% of PLHIV received three months
supply of ARVs However, 21% of PLHIV still reported refills of 1 month
— which is very problematic considering that South
Recommendations: Africa’s national policy standard is for two months. It
is also worrying during the period of COVID-19 when
+ Unnecessary trips to the clinic just to collect an ARV refills should be longer to ensure PLHIV can make
refill adds both a burden on PLHIV and to the already fewer trips to the clinic. The table below outlines
overwhelmed clinic and healthcare worker staff. This
the facilities with the highest reports of 1 month
inefficiency can also contribute to PLHIV disengaging
supply, many of which are in OR Tambo. This should
from care directly impacting the province’s attainment
be looked into to assess whether this is an issue
of 95% of PLHIV on treatment. Extending treatment
related to sufficient stock, or other clinical reasons.
refills, also known as providing “multi-month
dispensing” or MMD, is one strategy to reduce Further, while 97% of Ritshidze respondents in the Eastern
unnecessary burdens and support both PLHIV and the Cape still received refills of less than 3 months, only
health system to be more efficient. 25% of PEPFAR supported clients in other countries had
+ From September 2021, the Eastern Cape Department refills of less than three months. Between October and
of Health should retain the government gazetted December 2020 in 21 PEPFAR supported countries, 22%
12 month ART scripting & implement the March 2020 of PLHIV received 6 month ART refills and 53% received
revised Standard Operating Procedures (SOPs) on 3-5 months of ART. This is compared to only 15% of Eastern
repeat prescription collection strategies with fidelity. Cape PLHIV reporting a 3 month ART refill and 3% of the
+ By October 2021, the Eastern Cape Department PLHIV interviewed reported receiving 6 months supply.
of Health and DSPs should ensure that no PLHIV
ever receives less than 2 months supply of ARVs
(as reported by nearly half of respondents), as per Length of HIV medicine refill?
national policy standards. Total Responses: 901
+ By March 2022, the Eastern Cape Department of
Health and DSPs should extend and implement ARV
refills to at least 3 month supply for all eligible PLHIV.
+ By December 2022, the Eastern Cape Department of
Health and DSPs should extend and implement ARV
refills to 6 month supply for all eligible PLHIV.
The revised National Adherence Guidelines Standard
Operating Procedures (SOPs) note that time constraints
represent a challenge to many patients and that efforts
RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021 19PHILANI CLINIC
NOMANGESI CLINIC
Lastly, only 61% of Facility Managers said they were giving that will allow for longer refills. While we recognise that
12 month scripts for stable PLHIV, a practice outlined in a progress is being made, there is still a way to go to get
government gazette on 12 month ART scripting in 2020 to longer multi-month dispensing for all stable PLHIV.
Facilities with 5 or more reports of 1 month supply (August to September 2021)
20 RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 20214b. Repeat prescription A total of 100% of facilities reported having Internal
Pick up Points (PuPs) available and 91% had External
strategies PuPs available to decant stable PLHIV to.
In order to be effective, repeat prescription collection
87.4% of PLHIV think Internal PuPs strategies should make ARV collection quicker, easier and
make ARV collection quicker more satisfactory for PLHIV. Out of 199 PLHIV interviewed
using Internal PuPs, 87.4% thought they made ARV collection
100% of PLHIV think External PuPs
make ARV collection quicker
quicker. Out of 91 PLHIV interviewed using External Pick
PuPs, 100% thought they made ARV collection quicker. The
54% of PLHIV would like to collect majority of PLHIV were either satisfied or very satisfied with
ARVs closer to their home both Internal and External PuPs. Given the high satisfaction
rates, it is important to ensure that as many stable PLHIV
Recommendations: as possible are enrolled in a repeat prescription strategy.
+ Long waiting times and frequent trips to the clinic In terms of adherence clubs, there was low awareness of
place an unnecessary burden on PLHIV, health clubs. 63% of PLHIV not already in an adherence club we
facilities and healthcare workers. This directly spoke to were not aware of any clubs at the facility. However
impacts the province’s ability to reach 95% of PLHIV this varied across the districts — Chris Hani (79%), Amathole
on treatment and 95% of PLHIV virally suppressed. (57%), OR Tambo (43%), Alfred Nzo (13%), Buffalo City (5%).
+ By October 2021, the Eastern Cape Department
of Health and DSPs should discuss strategies
with Ritshidze and the PLHIV Sector on ways
to maintain adherence clubs safely during
On a scale of 1 to 5, how satisfied are you with the
COVID-19 (including options for making clubs internal pick up point you use? If 1 is VERY UNSATISFIED,
smaller in size, meeting outside etc.) and 5 is VERY SATISFIED
Total Responses: 199
+ By March 2022, the Eastern Cape Department
of Health and DSPs should ensure that 60%
of all PLHIV in the province are using a repeat
prescription collection strategy (at least
25% of those PLHIV should be accessing
treatment from an external pick up point and
at least 20% from an Adherence Club).
+ By March 2022, DSPs should ensure all
facilities are registered on the CCMDD
programme (789 facilities in July 2021).
+ By March 2022, DSPs and the Eastern Cape
Department of Health should establish at least
two external pick up points at each site in order
to provide greater access to refills closer to home
and at more convenient locations to PLHIV. On a scale of 1 to 5, how satisfied are you with
+ By March 2022, the Eastern Cape Department the external pick up point you use? If 1 is VERY
of Health and DSPs should scale up facility UNSATISFIED, and 5 is VERY SATISFIED
and community based adherence clubs Total Responses: 91
so that there are clubs available at all
facilities and that 20% of eligible PLHIV are
voluntarily decanted into this model.
Repeat prescription collection strategies should simplify and
adapt HIV services across the cascade, in ways that both serve
the needs of PLHIV better and reduce unnecessary burdens
on the health system. These should be much simpler and
quicker systems than waiting in long clinic queues. Most of
the PLHIV we interviewed used either an internal pick up
point (22%), external pick up point (10%) or collected at
the facility through standard medicine dispensing (63%).
However, currently at some sites (including Empilweni
Gompo CHC, Gompo C Jabavu Clinic, Greenfields Clinic,
Where do you collect ARVs? Nontyatyambo CHC, Philani NU 1 Clinic, Zanempilo Clinic
Total Responses: 900
(East London), Ngcobo CHC, Tembelihle Clinic, Civic Centre
Clinic (Mthatha), Mhlakulo CHC, Mqanduli CHC, Ntapane
Clinic, Tsolo Clinic) have been reportedly suspended due
to the COVID-19 pandemic. We maintain that functional
adherence clubs play an important role in providing adequate
treatment literacy information to ensure PLHIV stay on
treatment and should not be removed in light of COVID-19.
Rather the department and district support partner should
develop strategies for restarting suspended clubs, while
maintaining the safety of club members during the pandemic.
RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021 21PHILANI CLINIC
More than half of PLHIV who were surveyed (54%) Would patients like to collect ARVs closer to home?
said that they would like to collect ARVs closer to Total Responses: 902
their home if it were possible. This points towards
the fact that facilities should be working towards
enrolling many more PLHIV out of the facility standard
dispensing or Internal PuPs, and into External PuPs
or community adherence clubs closer to home.
COMMUNITY STORY
When Cecilia fell pregnant in 2016 with her third child she also
received the news that she had been diagnosed with HIV.
Her local clinic, Matatiele Clinic, started her on ARVs and for the first few months she adjusted to her medication and to life with
a newborn baby. Five months after the birth of her daughter Cecilia decided to take up a job offer in Johannesburg.
Intending to continue with her ARVs she checked in at a local clinic in the city. She had to be “started from scratch”, she says
through an isiXhosa translator. But she put up with the hassles and the retesting process and carried on with treatment.
It was about six months later however, that she was suddenly retrenched. Without an income she
decided to move back home to the Eastern Cape and did so within days of losing her job.
“It was short notice so I didn’t have enough time to go to the clinic to ask for a transfer letter. But when I
got back home and went to the Matatiele Clinic they said they wouldn’t help me because I couldn’t show
them a transfer letter – even though they knew me from before I went to Joburg,” she says.
Frustrated Cecilia stopped trying to get medication. Three months later she fell ill and had to be admitted to hospital. The doctors
picked up that she had defaulted and initiated the process to have her ARVs restarted at Matatiele Clinic. That resumed for a time.
In 2020 though she had to take her child to the clinic; she says she was deeply anxious and desperate. But she was also
wary because she had lost two children and didn’t believe the nurses gave those children the help they needed.
This time though, the nurses didn’t even attend to her child, telling Cecilia that she was in the wrong clinic
under demarcations set up under COVID-19 restrictions. She ended up going to the Maluti Clinic that
cost her additional taxi fare and more stress and anxiety being delayed to get her child help.
“Even today my child is not well. The doctors say she is underweight for her age
and they have given her supplements but she is weak,” she says.
Cecilia hasn’t returned to Matatiele Clinic in months following that episode. As a result she has
defaulted on treatment once again. It’s been nine months since she was last on her ARVs.
“The service there is drastically deteriorating. When I used to go there you would see the people doing
registration are just playing on their computers and phones; the nurses move up and down but nobody is
coordinating and the managers, they are there just to warm their seats – nobody cares,” she says.
Cecilia knows that returning for treatment after an extended break will just invite being
shouted at and being given a dressing down – in front of everyone.
“It’s too much, I don’t want to go back,” she says.
22 RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 20215. ART continuity
Only 64% of patients thought that disengaging from care) including by investigating
the staff were always all allegations and taking disciplinary action where
friendly and professional appropriate. As per the Patients’ Rights Charter,
“everyone has the right to complain about health care
PLHIV at 24 facilities say they are
sent to the back of
the queue if they miss an appointment
services and to have such complaints investigated and to
receive a full response on such investigation”.
+ From October 2021, the Eastern Cape Department
PLHIV at 25
they miss an appointment
facilities say they
are shouted at if
of Health should accelerate implementation of the
2020 Standard Operating Procedures on National
Adherence Guidelines including by issuing a circular
PLHIV at 36
they miss an appointment
facilities say they
are welcomed back if
that highlights that patients who return from a
treatment interruption but have not missed a
dose be screened for immediate access to a repeat
prescription collection strategy, and acknowledge it is
Recommendations: normal to miss appointments and/or have treatment
+ PLHIV lead complicated lives and may miss interruptions, and support and empower patients to
appointments and even miss taking some pills. When improve retention after re-engagement as per the 2020
they do, meeting them with support when they return Standard Operating Procedures.
to the clinic helps ensure long term adherence. But + By December 2021, the National Department of Health
PLHIV who return to the clinic and are treated badly, should withdraw the measure that PLHIV who miss
or who fear they will be, will often not come back. appointments should be sent to the back of the queue,
Often staff do not treat people properly due to stress, and work with Ritshidze, the PLHIV Sector and MSF to
exhaustion, and burn out as a result of the malfunction develop strategies to support implementation.
in the health system including, lack of time, tools,
equipment or medicines. This directly impacts our
ability to reach the 2nd and 3rd 95 targets. People living with HIV lead complicated lives and may well miss
+ By October 2021, the Eastern Cape Department of appointments and even miss taking some pills. When they do,
Health should implement with fidelity the 2020 Standard meeting them with support when they return to the clinic helps
Operating Procedures on National Adherence Guidelines ensure long term adherence. But people living with HIV who
including by issuing a circular that calls on all staff in the return to the clinic and are treated badly, or who fear they will
facility to be welcoming, and acknowledge it is normal to be, will often not come back — even if that means stopping
miss appointments and/or have treatment interruptions, treatment altogether. This poor treatment and unwelcoming
and support and empower patients to improve environment is a significant reason for people living with
retention after re-engagement as per the 2020 Standard HIV to disengage from care. This is particularly problematic
Operating Procedures. for key populations (discussed in section 9 of this report).
+ From October 2021, the Eastern Cape Department of
Staff attitude remains a major barrier. Across facilities, out
Health should address all issues of poor staff attitude
of 1207 patient responses, only 64% of patients thought
(that contribute to PLHIV stopping treatment or
that the staff were always friendly and professional.
Worst performing sites: “Are the staff friendly and professional?” (August to September 2021)
Many people we spoke to had never missed a visit to next time they came to the facility. Only 52 PLHIV
collect ARVs. Out of the 279 PLHIV who had missed reported that staff will provide counseling on adherence
appointments, 119 said that staff were welcoming if you return to the clinic. 80 PLHIV said that if you
when they came to collect ARVs if they had previously miss an appointment to collect ARVs you are sent
missed a visit. 44 said that staff shouted at them the to the back of the queue next time you come in.
RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021 23NOZUKO CLINIC
PHILANI CLINIC
When a patient misses a visit, what happens the next
IT IS POSSIBLE TO DO BETTER! time the patients comes to collect ARVs?
Total Responses: 566
11 facilities were reported as welcoming and had
no reports of PLHIV being reprimanded or sent to
the back of the queue: Central Clinic (East London),
Butterworth Gateway Clinic, Tabankulu CHC,
Tembelihle Clinic, Greenfields Clinic, Xhora CHC,
Nomzamo CHC, Ntapane Clinic, Fezeka NU 3 Clinic,
Mhlakulo CHC, Philani Clinic (Queenstown).
24 RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021When a patient misses a visit, what happens the
next time the patients comes to collect ARVs?
Staff Counsel
Staff Reprimand Staff Send you to Staff are you on
District Facility You Back of Queue Welcoming Back Adherence
Amadiba Clinic 1 12
Imizizi Clinic 3 3 7
Isikelo Clinic 2 6 1
Maluti CHC 2 6 4
Alfred Nzo
Matatiele Community Clinic 1 4 1
Mount Ayliff Gateway Clinic 1 1
Mount Frere Gateway Clinic 1 1 4
St Patrick’s Gateway Clinic 5 5 2 3
Tabankulu CHC 1
Butterworth Gateway Clinic 5
Idutywa Village CHC 1 2
Amathole Nozuko Clinic 1 1 2 1
Nqamakwe CHC 1 6 1
Willowvale CHC 2 2 2
Xhora CHC 2
Central Clinic (East London) 1 1
Duncan Village CHC 1 1 2
Empilweni Gompo CHC 3 1
Fezeka NU 3 Clinic 1 2
Gompo C Jabavu Clinic 4 3 2
Buffalo City
Greenfields Clinic 1 1
Grey Gateway Clinic 3 1
Luyolo NU 9 Clinic 2 1 2
Nontyatyambo CHC 1 2
Philani NU 1 Clinic 2 2
Zanempilo Clinic (East London) 2 2 2
Nomzamo CHC 2 1
Chris Hani Ngcobo CHC 1 2
Philani Clinic (Queenstown) 2 5
Tembelihle Clinic 2 2
Nelson Mandela Bay Motherwell CHC 1 7 1
Civic Centre Clinic (Mthatha) 2 2 3
Flagstaff Clinic 1 5
Holy Cross Gateway Clinic 1 5
Lusikisiki Village Clinic (Qaukeni) 4
Mhlakulo CHC 4 1
Mthatha Gateway Clinic 2 1 2 1
OR Tambo Mqanduli CHC 1 4 2
Ngangelizwe CHC 7 3 4
Ntapane Clinic 8 3
Port St Johns CHC 1 12
Qumbu CHC 1 1 11 6
Stanford Terrace Clinic 5 2 1
St Elizabeth’s Gateway Clinic 5 1
Tsolo Clinic 2 3
RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021 25PHILANI CLINIC
It is critical that PLHIV who interrupt treatment are times staff call out patients’ names at the gate for their
supported to re-engage in care. It is essential to support treatment. Further 12.6% of PLHIV feel that the facilities
this reengagement by reducing or removing health system do not keep their status private and confidential.
barriers to being retained in care. The revised National
Adherence Guidelines SOPs include a new SOP, “SOP 9
Do patients feel this facility keep people’s HIV status
Re-engagement in care”. The guiding principles of this SOP
confidential and private?
describe how staff should be friendly and welcoming and
Total Responses: 900
acknowledge the challenge for life-long adherence.
A lack of confidentiality and privacy are other factors that
can impact life-long adherence. The most commonly-
observed privacy violation was more than one person
being consulted or counselled in the same room, in
6 facilities. Less common were PLHIV being separated from
other chronic patients (in 3 facilities) and security guards
checking patients’ medicines when they leave (in 3 facilities).
Furthermore we receive complaints that in certain facilities
PLHIV receive treatment in separate dispensaries and at
Facilities with the most observed privacy violations (August to September 2021)
26 RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 20216. Treatment + Viral Load Literacy
Only 92% of PLHIV we spoke to had gotten a viral load test in
95% of PLHIV had a viral load test
in the last year
the last year, with only 81.4% of participants living with HIV
reporting that they knew their viral load. Only 70.6% agreed
79% of PLHIV said that a healthcare provider with the statement; “having an undetectable viral load means
had explained the results the treatment is working well”. Further just 67.2% agreed
with the statement “having an undetectable viral load means
78% agreed that having an undetectable viral
load means treatment is working well
a person is not infectious.” Only 80.8% of them said that a
healthcare provider had explained the results of the viral load
66% agreed that having an undetectable viral test results. The districts that performed worst were, Alfred Nzo
load means a person is not infectious where only 66% of PLHIV said a healthcare worker explained
the results, followed by OR Tambo (75%) and Amathole (77%).
Recommendations:
+ Treatment literacy improves linkage and retention Treatment literacy: do patients understand viral load
rates as people understand the importance of starting and their health?
and remaining on treatment effectively, directly Total Responses: 902
contributing to reaching the 95-95-95 targets.
+ From October 2021, the Eastern Cape Department
of Health and DSPs should ensure that all healthcare
workers (including CHWs) provide accurate and easily
understandable information on treatment adherence
and the importance of an undetectable viral load when
talking to PLHIV, through consultations, counselling,
outreach, and health talks at clinics.
+ From October 2021, the Eastern Cape Department
of Health and DSPs should ensure that viral load test
results are properly explained to all PLHIV in a timely
manner.
+ In COP22, PEPFAR should fund an expansion of PLHIV-
Treatment literacy: do patients understand viral load
led treatment literacy efforts across all provinces, and transmission?
including the Eastern Cape through training, education Total Responses: 900
and localised social mobilisation campaigns.
Treatment literacy improves linkage and retention rates
as people understand the importance of starting and
remaining on treatment effectively. By becoming as informed
as possible, people living with HIV are empowered to
take control of their own health and sex lives. However,
Ritshidze monitoring revealed major gaps in knowledge
about what an undetectable viral load test means.
Worst performing facilities on knowing that an undetectable viral load means
treatment is working well (August to September 2021)
RITSHIDZE EASTERN CAPE – STATE OF HEALTH – SEPTEMBER 2021 27You can also read
